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CommonWell Announces Sites For Interoperability Rollout

Nine months after announcing their plan to increase interoperability between health IT data sources, the CommonWell Health Alliance has disclosed the locations where it will first offer interoperability services.

CommonWell, whose members now include health IT vendors Allscripts, athenahealth, Cerner, CPSI, Greenway, McKesson, RelayHealth and Sunquest, launched to some skepticism — and a bit of behind-the-hand smirks because Epic Systems wasn’t included — but certainly had the industry’s attention.  And today, the vendors do seem to have critical mass, as the Alliance’s founding members represent 42 percent of the acute and 23 percent of the ambulatory EMR market, according to research firms SK&A and KLAS.

Now, the rubber meets the road, with the Alliance sharing a list of locations where it will first roll out services. It’s connecting providers in Chicago, Elkin and Henderson, North Carolina and Columbia, South Carolina. Interoperability services will be launched in these markets sometime at the beginning of 2014.

To make interoperability possible, Alliance members, RelayHealth and participating provider sites will be using a patient-centric identity and matching approach.

The initial participating providers include Lake Shore Obstetrics & Gynecology (Chicago, IL), Hugh Chatham Memorial Hospital (Elkin, NC), Maria Parham Medical Center (Henderson, NC), Midlands Orthopaedics (Columbia, SC), and Palmetto Health (Columbia, SC).

The participating providers will do the administrative footwork to make sure the data exchange can happen. They will enroll patients into the service and manage patient consents needed to share data. They’ll also identify whether other providers have data for a patient enrolled in the network and transmit data to another provider that has consent to view that patient’s data.

Meanwhile, the Alliance members will be providing key technical services that allow providers to do the collaboration electronically, said Bob Robke, vice president of Cerner Network and a member of the Alliance’s board of directors.  CommonWell offers providers not only identity services, but a patient’s identity is established, the ability to share CCDs with other providers by querying them. (In case anyone wonders about how the service will maintain privacy, Robke notes that all clinical information sharing is peer to peer  – and that the CommonWell services don’t keep any kind of clinical data repository.)

The key to all of this is that providers will be able to share this information without having to be on a common HIE, much less be using the same EMR — though in Columbia, SC, the Alliance will be “enhancing” the capabilities of the existing local HIE by bringing acute care facility Palmetto Health, Midlands Orthopaedics and Capital City OB/GYN ambulatory practices into the mix.

It will certainly be interesting to see how well the CommonWell approach works, particularly when it’s an overlay to HIEs. Let’s see if the Alliance actually adds something different and helpful to the mix.

December 13, 2013 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 @annezieger on Twitter.

Hospitals Still Struggling With HIE Data Sharing

Hospitals are trying hard to make HIEs work, but establishing robust data exchange remains a major challenge, particularly given the difficulty involved in processing paper records, a new study by HIMSS Analytics suggests.

The report, sponsored by ASG Software Solutions, draws on a survey of 157 senior hospital IT executives.

More than 70 percent of respondents to the survey reported that they participated in an HIE with other hospitals and health systems.

The thing is, the facilities reported that they’re having difficulty exchanging patient information in meaningful, powerful ways. Also, survey respondents noted that sharing information outside of HIEs is held back by budget concerns and staffing problems.

Juggling electronic and paper-based data is still a major issue, the study suggests:

* 64 percent of health information organizations reported that they shared data with nonparticipating hospitals via fax
* 63 percent of the same organizations converted faxed information into digital form via scanning
* 84 percent of respondents integrated their output/print environment directly into their EMR/HIS system
* 42 percent of survey respondents said their output/print environment was “high effort”

Unfortunately for HIE fans, coordination and management of paper records is far from the only issue standing in the way of making them work acceptably in a hospital environment.

According to a study by Chilmark Research, the focus of most HIEs is still on secure clinical messaging, which doesn’t do the job for cross-enterprise care coordination. The Chilmark research estimates that queries of databases for patient information needed at the point of care account for just 2 percent to 10 percent of HIE transactions overall.

As Chilmark CEO John Moore recently told Information Week, the problem is particularly acute in ambulatory care. Most ambulatory EMRs haven’t been able to generate CCDs that other EMRs can consume or execute queries using a record locator service. This is a pretty serious weakness in the HIE space, given that 80 percent of care takes place in ambulatory setting.

Given their importance, it’s troubling to see how many obstacles remain to robust HIE use by hospitals and physicians. Let’s hope the next 12 months see some breakthroughs.

September 30, 2013 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 @annezieger on Twitter.

Interoperability vs. Coordinated Care

Andy Oram asked me the following question, “Is the exchange of continuity of care documents really interoperability or coordinated care?

As it stands now, it seems like CCDs (continuity of care documents) are going to be the backbone of what healthcare information we exchange. We’ll see if something like Common Well changes this, but for now much of the interoperability of healthcare data is in CCDs (lab and radiology data are separate). The question I think Andy is asking is what can we really accomplish with CCDs?

Transferring a CCD from one doctor to the next is definitely a form of healthcare interoperability. Regardless of the form of the CCD, it would be a huge step in the right direction for all of the healthcare endpoints to by on a system that can share documents. Whether they share CCDs or start sharing other data doesn’t really matter. That will certainly evolve over time. Just having everyone so they can share will be of tremendous value.

It’s kind of like the fax machine or email. Just getting people on the system and able to communicate was the first step. What people actually send through those channels will continue to improve over time. However, until everyone was on email, it had limited value. This is the first key step to interoperable patient records.

The second step is what information is shared. In the forseeable future I don’t seeing us ever reaching a full standard for all healthcare data. Sure, we can do a pretty good job putting together a standard for Lab results, Radiology, RXs, Allergies, Past Medical History, Diagnosis, etc. I’m not sure we’ll ever get a standard for the narrative sections of the chart. However, that doesn’t mean we can’t make that information interoperable. We can, are, and will share that data between systems. It just won’t be in real granular way that many would love to see happen.

The idea of coordinated care is a much harder one. I honestly haven’t seen any systems out there that have really nailed what a coordinated care system would look like. I’ve seen very specific coordinated care elements. Maybe if we dug into Kaiser’s system we’d find some coordinated care. However, the goal of most software systems haven’t been to coordinate care and so we don’t see much on the market today that achieves this goal.

The first step in coordinating care is opening the lines of communication between care providers. Technology can really make an impact in this area. Secure text message company like docBeat (which I advise), are making good head way in opening up these lines of communications. It’s amazing the impact that a simple secure text message can have on the care a patient receives. Secure messaging will likely be the basis of all sorts of coordinated care.

The challenge is that secure messaging is just the start of care coordination. Healthcare is so far behind that secure messaging can make a big impact, but I’m certain we can create more sophisticated care coordination systems that will revolutionize healthcare. The biggest thing holding us back is that we’re missing the foundation to build out these more sophisticated models.

Let me use a simple example. My wife has been seeing a specialist recently. She’s got an appointment with her primary care doctor next week. I’ll be interested to see how much information my wife’s primary care doctor has gotten from the specialist. Have they communicated at all? Will my wife’s visit to her primary care doctor be basically my wife informing her primary care doctor about what the specialist found?

I think the answers to these questions are going to be disappointing. What’s even more disappointing is that what I described is incredibly basic care coordination. However, until the basic care coordination starts to happen we’ll never reach a more advanced level of care coordination.

Going back to Andy’s question about CCDs and care coordination. No doubt a CCD from my wife’s specialist to her primary care doctor would meet the basic care coordination I described. Although, does it provide an advanced level of care coordination? It does not. However, it does lay the foundation for advanced care coordination. What if some really powerful workflow was applied to the incoming CCD that made processing incoming CCDs easier for doctors? What if the CCD also was passed to any other doctors that might be seeing that patient based upon the results that were shared in the CCD? You can start to see how the granular data of a CCD can facilitate care coordination.

I feel like we’re on the precipice where everyone knows that we have to start sharing data. CCD is the start of that sharing, but is far from the end of how sophisticated will get at truly coordinated care.

August 19, 2013 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

HIEs Unable To Keep Up With User Demands

While HIEs are expanding their offerings to include analytic and care coordination functions useful for population health management, they aren’t doing it quickly enough to meet market demand, according to a piece in Information Week.

The IW story, which outlines the conclusions of a new report from Chilmark Research, notes that the focus of most HIEs is still on secure clinical messaging, which is not adequate for cross-enterprise care coordination. The Chilmark report estimates that queries of databases for patient info needed at the point of care account for just 2 percent to 10 percent of HIE transactions overall.

Information Week also drew attention to a study appearing in Health Affairs noting that the most common functions of the 119 operational public HIEs were transmitting lab results, clinical summaries and discharge summaries. While there’s been a large increase in the number of HIEs that can exchange Continuity of Care Documents, few EMRs can integrate the data components of CCDs in to structured fields, the Health Affairs piece noted.

The problem is particularly acute in ambulatory care. As Chilmark CEO John Moore told Information Week, most ambulatory EMRs haven’t been able to generate CCDs that other EMRs can consume or do queries using a record locator service. “The value that HIEs provide to the ambulatory sector, where 80 percent of care takes place, is pretty limited,” Moore told IW.

Still, despite their weaknesses, public HIEs continue to hold onto life. For example, as various industry stats have shown, hospital CIOs increasingly see participation in an HIE as a key initiative, if nothing else because Meaningful Use will eventually demand interoperability.

But as the Chilmark study emphasizes, HIEs have a long way to go before they’re making a major contribution to patient care. And getting enough momentum to address these problems seems elusive. All told, while HIEs are clearly an important movement, getting them to the point of true usefulness could take years more.

August 7, 2013 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 @annezieger on Twitter.

CMS Shares Benefits Of Meaningful Use

CMS has released new data which lays out some of the benefits of Meaningful Use since the inception of the program in 2011.  The data outlines various ways in which Meaningful Use requirements have played out statistically.

According to the statement, the following landmarks have been reached over the last few years:

• More than 190 million electronic prescriptions have been sent by doctors, physician’s assistants and other health care providers using EMRs.

• Health care professionals sent 4.6 million patients an electronic copy of their health information from their EMRs.

• More than 13 million reminders about appointments, required tests, or check-ups were sent to patients using EMRs.

• Providers have checked drug and medication interactions to ensure patient safety more than 40 million times through the use of EMRs.

• Providers shared more than 4.3 million care summaries with other providers when patients moved between care settings.

It’s clear from these stats that e-prescribing is on a serious roll — though it’s interesting to me that over the last few years I’ve only had my scripts e-prescribed a couple of times.  Clearly there’s a lot more work to do there despite the large number.

On the other hand, these factoids aren’t staggering given that they’re cumulative over a few years. For example, while it’s encouraging that providers have shared more than 4 million care summaries (Continuity of Care Documents, I assume), that’s still a tiny fraction of the volume that we’ll need to see to say we have anything like real interoperability.

I was actually surprised to see that the reminders issued about appointments, tests and check-ups stood at a relatively modest 13 million. Primary care practices, in particular, are under such pressure to make sure patients hit their marks that you’d think setting up such reminders would be a no-brainer. But apparently it’s not.

All told, the numbers cited by CMS definitely suggest progress, but not as big of a win as the agency might have preferred. Let’s see the numbers for patient data sharing up in the hundreds of millions and then I’ll really be impressed.

July 23, 2013 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 @annezieger on Twitter.

Some Interesting Thoughts from the EHR Summit

I enjoyed all day at the EHR Summit that’s being held by HBMA in Phoenix. It’s been a really interesting event for me. I had some sound bites from the Ron Sterling keynote queued up, but it’s not connecting to Twitter. So, I’ll see if I can post those tomorrow. Today, I thought I’d post some of my other tweets from the other session. I think you’ll find them interesting, enlightening, thought provoking or some other adjective. I really look forward to the discussion on this post.

EMR software has many versions of the same data. #interesting #EHRSummit11 Think about an HIE as well. They have a version of the data too

HIE’s aren’t good at getting the receiving doctor the second version of a clinical document. #interesting #EHRSummit11

Think about the records retention issues when you switch EHR software companies. Good thought. #EHRSummit11

If you haven’t lost a client to a hospital this year….you will next year. #EHRSummit11 #HBMA

How many EHR companies are billing companies? They have 7 listed on screen. Do you know of others? #EHRSummit11
They have MED3000, Allscripts, Greenway, NextGen, Athena, GE Centricity, Ingenix. Any other EHR companies do billing as well? #EHRSummit11

Shame on you if you hire an EHR Company and don’t check the references. Ask for a list of 10 in that specialty and size. #EHRSummit11

Pre-existing conditions, No lifetime maximum and kids on parents plan for longer are going to increase our insurance costs. #EHRSummit11

Definitely interesting to consider how the healthcare billing industry will be affected by things like ACO’s and concierge. #EHRSummit11

Super bills are going to go away once we get ICD-10. #EHRSummit11 #HBMA

The healthcare billing sales cycle is 12-18 months. #EHRSummit11

Since I’m putting some of my tweets. I also enjoyed a number of the tweets coming out of the ONC Meeting today. Here’s one that really hit me:

RT @INHSbeacon If you’ve seen one CCD, you’ve seen one CCD. Everyone interprets different, we need to find a standard to succeed #ONCMeeting

November 17, 2011 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

A Network of Networks – Major EHR Developments Per Halamka

In my ongoing series of Major EHR Developments from John Halamka (see my previous EHR In The Cloud and Modular EHR Software posts), his third major EHR development from the Technology Review article is: A Network of Networks.

Halamka basically says:
-Most people think doctors and hospitals exchange healthcare information (they don’t)
-New standards are being integrated with EHR that will make it happen
-There won’t be one large database of health records
-Many regional data exchanges are happening
-There will be multiple Health Information Service Providers (HISPs)

I agree with most of these ideas. Although, I think it still faces two major challenges.

The first challenge is the standards challenge. Sure we have CCD. Oh wait, we have CCR. Oh wait, they merged, kind of. Oh wait, now CCD has multiple flavors. Oh wait, what kind of standard is it if there are multiple standards of the standard? I think you see my point.

The second challenge is whether HISPs and the other regional data exchanges have a viable future. I’ve talked to a lot of people about these exchanges and I have yet to hear someone clearly articulate a viable model for these exchanges. My favorite was the HIE expert who told me they’d figured out the model for HIE. So, I asked what it was and they gave me some convoluted answer that made no sense to me. Maybe I’ve just missed it, but I’d love to hear someone try to describe a viable HIE model.

I do predict we’ll see Fax slowly phase out over time. Although, I think it will more likely be replaced with a fax like service on the internet (Direct Project?) as opposed to some other sort of Data Exchange. It will probably best be described as Fax 2.0.

October 18, 2011 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Are EMRs And Paper Records Incompatible?

I just caught a blog post by the indefatigable Fred Trotter (a high-profile Open Source guy focused on HIT) which raised an important issue.  In his article, Trotter argues credibly that once a healthcare organization implements an EMR, its records are more or less incompatible with standard paper records.

Trotter cites the troubling case of two primary care groups which, despite the using same major EMR system, can only share data by printing out massive paper transcripts of a patient’s electronic record.

Apparently, each have a custom version of the system in place, which means that the two groups couldn’t share data directly. So when a patient from Practice A moves to Practice B, Practice A’s only option is to generate what — from a photo included in the article  – looks like thousands of pages of data.

Not only are such paper printouts awkward to store and manage, they’re painfully difficult to use. While traditional handwritten records provide a familiar, and relatively concise, source of medical data, this blizzard of paper could actually bury critical information.

After all, while the data might make sense when access via the EMR’s digital templates, doctors may not know where to find what they’re looking for when confronted with the print equivalent of a massive Excel spreadsheet.

Not only that, when Practice B scans this paper monster into its system, the problem just gets worse. When caring for the patient, B’s doctors will doubtless begin entering data into their own EMR system, piling structured data on top of incompatible scanned data. How clinicians will figure out what’s up with the patient is a mystery to me.

As commentors to Trotter’s item noted, the two practices could probably have shared a summary in Continuity of Care Document format. However, unless practices are willing to make do with a summary over the long term, they’re likely to confront paper printouts for quite some time.  Not a pretty picture, is it?

July 15, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Halamka’s Top 10 Healthcare IT Takeaways from HIMSS10

Anyone that works in Healthcare IT knows who John Halamka is and so of course I was interested in his post of his top 10 impressions after HIMSS. It’s an interesting list and I think he does a pretty good job of looking at things from a very high level. Here they are as posted on his blog:

1. Meaningful Use is everywhere. Vendors are promising EHRs, modules, appliances, and services to help clinicians achieve it. I had dinner on Monday night in a small Indian vegetarian restaurant. Sitting next to me were 3 engineers from Bangalore who were arguing about the details of Meaningful Use in between bites of vegetable curry. I could not escape Meaningful Use anywhere!

2. Certification is everywhere. It’s particularly ironic that many vendors claimed their systems were certified, even though the certification NPRM was just released today, making compliance with the new certification process in time for HIMSS impossible.

3. Cloud computing, Software as a Service and ASP models are popular tactics to accelerate EHR rollouts. There are still lingering concerns about how to ensure privacy in a cloud environment.

4. Several firms such as Intersystems, Axolotol, and Medicity are offering HIE platforms that include many of the standards noted in the IFR. The marketplace for HIE products is just emerging and it’s hard to predict who will become the market leader.

5. The Continuity of Care Document is gaining traction. I found many vendors supporting CCD exports from their EHRs. A company called M*Modal , has developed natural language processing technology that captures dictated content in its original context (ontology-driven
rules) as a CDA document.

6. Consultants abound. It’s clear that Regional Extension Centers and Health Information Exchanges will require expertise and staffing from professional firms. They all had large booths at HIMSS.

7. 30,000 people attended, including 10,000 I did not recognize (just kidding). It’s clear to me that many IT professionals, even those with limited healthcare domain expertise, attended HIMSS to better understand how they could participate in the euphoria of HITECH stimulus dollars.

8. Self service kiosks for patient identification and self-registration are now mainstream. Just as we print our airline boarding passes, we can now use credit cards or biometrics to check into ambulatory care appointments and automatically settle all co-pay balances.

9. Image exchange in the cloud is being offered by several vendors. As I mentioned in Monday’s blog, Symantec announced an appliance for small clinician offices that cloud enables all imaging modalities using a facebook-like social networking invitation to share/view images.

10. PHRs and patient engagement are becoming more mainstream. Google and Microsoft continue to innovate in the non-tethered PHR marketplace.

March 4, 2010 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Chilmark Declares CCD Winner in Standards Battle

I’ve been really interested in the various standards of interoperability in healthcare. I previously posted a bunch of random items related to CCR and CCD in healthcare. I remember when CCR first came out. It was a very exciting movement to try and make EMR software interoperable.

So, today I was really interested to read Chilmark essentially declaring CCD the winner in the EMR interoperability battle. Officially he says that CCD is gaining traction and CCR is fading, but if you read his post you’ll see that in his opinion (which I trust a lot) CCD will be the winner in the battle between CCR and CCD.

The cool part is that I don’t think those that helped develop CCR will mind at all. Partially because CCD is a derivative of CCR and CDA. Plus, from what I understand, the people behind CCR were mostly interested in facilitating the flow of healthcare information between EMR software. If that is achieved by CCD, then the goal was achieved.

I’ll be interested to hear what the chatter will be around CCD and CCR at HIMSS to see if Chilmark’s feelings are shared by others.

February 17, 2010 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.