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No, The Market Can’t Solve Health Data Interoperability Problems

Posted on July 6, 2016 I Written By

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

I seldom disagree with John Halamka, whose commentary on HIT generally strikes me as measured, sensible and well-grounded. But this time, Dr. Halamka, I’m afraid we’ll have to agree to disagree.

Dr. Halamka, chief information officer of Beth Israel Deaconess Medical Center and co-chair of the ONC’s Health IT Standards Committee, recently told Healthcare IT News that it’s time for ONC and other federal regulators to stop trying to regulate health data interoperability into existence.

“It’s time to return the agenda to the private sector in the clinician’s guide vendors reduce the products and services they want,” Halamka said. “We’re on the cusp of real breakthroughs in EHR usability and interoperability based on the new incentives for outcomes suggested by MACRA and MIPS. {T}he worst thing we could do it this time is to co-opt the private sector agenda more prescriptive regulations but EHR functionality, usability and quality measurement.”

Government regs could backfire

Don’t get me wrong — I certainly appreciate the sentiment. Government regulation of a dynamic goal like interoperability could certainly backfire spectacularly, if for no other reason than that technology evolves far more quickly than policy. Regulations could easily set approaches to interoperability in stone that become outmoded far too quickly.

Not only that, I sympathize with Halamka’s desire to let independent clinical organizations come together to figure out what their priorities are for health data sharing. Even if regulators hire the best, most insightful clinicians on the planet, they still won’t have quite the same perspective as those still working on the front lines every day. Hospitals and medical professionals are in a much better position to identify what data should be shared, how it should be shared and most importantly what they can accomplish with this data.

Nonetheless, it’s worth asking what the “private sector agenda” that Halamka cites is, actually. Is he referring to the goals of health IT vendors? Hospitals? Medical practices? Health plans? The dozens of standards and interoperability organization that exist, ranging from HL7 and FHIR to the CommonWell Health Alliance? CHIME? HIMSS? HIEs? To me, it looks like the private sector agenda is to avoid having one. At best, we might achieve the United Nations version of unity as an industry, but like that body it would be interesting but toothless.

Patients ready to snap

After many years of thought, I have come to believe that healthcare interoperability is far too important to leave to the undisciplined forces of the market. As things stand, patients like me are deeply affected by the inefficiencies and mistakes bred by the healthcare industry’ lack of interoperability — and we’re getting pretty tired of it. And readers, I guarantee that anyone who taps the healthcare system as frequently as I do feels the same way. We are on the verge of rebellion. Every time someone tells me they can’t get my records from a sister facility, we’re ready to snap.

So do I believe that government regulation is a wonderful thing? Certainly not. But after watching the HIT industry for about 20 years on health data sharing, I think it’s time for some central body to impose order on this chaos. And in such a fractured market as ours, no voluntary organization is going to have the clout to do so.

Sure, I’d love to think that providers could pressure vendors into coming up with solutions to this problem, but if they haven’t been able to do so yet, after spending a small nation’s GNP on EMRs, I doubt it’s going to happen. Rather than fighting it, let’s work together with the government and regulatory agencies to create a minimal data interoperability set everyone can live with. Any other way leads to madness.

7% of Medical Records are Mismatched or Duplicates

Posted on January 15, 2016 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.

Patient Matching Problem

Anyone that’s worked in healthcare knows that patient matching is a major problem. It’s interesting to see that ONC has quantified the problem as 7 out of 100 medical records having issues. It’s not hard to see how this can, will and does lead to medical errors. Doctors need the right information at the right time. If they are missing information or have the wrong information, then it can lead to deadly consequences.

One challenge I have with this problem is that I’ve heard many suggest that the reason this is such a problem is that we don’t have a national patient identifier. Next week CHIME is going to announce the details of their $1 million National Patient ID Challenge. We should have Anne Zieger onsite to report on the event, but here’s the challenge:

Ensure 100% accuracy of every patient’s health info to reduce preventable medical errors and eliminate unnecessary hospital costs/resources.

While I applaud CHIME’s efforts to push the national patient id forward, the issue of patient matching won’t just be solved by having a national patient ID. We’ll see what the challenge produces, but the challenge is so complex that I don’t think anyone will be able to achieve 100% accuracy. While I don’t think we’ll ever be perfect when it comes to patient matching in healthcare, I do think we can do better. Maybe CHIME’s efforts will help inspire organizations to do better.

Burned In EHR Workflows

Posted on November 7, 2014 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.

One of the hospital CIOs at The Breakaway Group focus group at the CHIME Fall Forum talked about what he called “Burned IN EHR Workflows.” I thought the concept was really interesting and no doubt something we can all relate with. We all know when the workflows we do are finally burned into our psyche. We often call it our daily routine and we all hate when our routine is disrupted.

As I thought about this idea, I wondered at what point the EHR workflow is finally “burnt in.” There are a lot of factors that go into burning in the EHR workflow. I’d say it rarely happens during EHR training. Although, with the right EHR training it could be the case. The key question is how well your EHR training emulates the actually environment and workflow of the user. Are you just training them on the EHR software or are you training them on the EHR workflow with the new EHR software? I always did the later and found it so much more effective.

As another CIO at CHIME said, “Users don’t want to know the 10 ways to do the same thing. They want to know the single most effective way to do it.” Of course, figuring out the most effective way to do something is the hard part and why so many EHR trainings fall short.

The good thing about burnt in EHR workflows is that if you’ve implemented a great workflow, then it’s great. The problem is that we often burn in sub optimal EHR workflows. I had this happen to me all the time. I’d ask one of my EHR users why they did something a certain way when it would be so much easier to do it another way. It was just the way the EHR workflow was burnt in.

Changing that already burned in EHR workflow is really hard. Although, it’s not impossible and is often necessary. You just have to burn in a new workflow. However, it also often requires an explanation of why the new workflow is better. Good luck changing someone’s workflow when they liked the old workflow. You better have a good reason or they’re unlikely to change.

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 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.

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.

Big Healthcare Companies Won’t Disrupt Themselves

Posted on November 7, 2013 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’ve been really interested in something Jay Walker, curator and chairman of TEDMED, told me at Xerox Healthcare event at CHIME. I’m not exactly sure how we got into the conversation, but Jay made the comment that “big companies never disrupt themselves.”

I’d love to have had a chance to dive in more to what Jay Walker was really thinking on this subject. No doubt I could tell he’d given it a lot of thought. However, the concept is incredibly intriguing to me and the more I dig into it I realize that Jay is really on to something.

There are so many reasons why a big organization won’t or can’t disrupt itself. This isn’t to say that big companies aren’t without their value. It turns out that large organizations are really really good at optimizing existing business, services and processes. They can squeeze the value out of a current business like no other. However, optimizing your current business is very different than disrupting your business and changing a market. There are just too many incentives for a large healthcare organization to not disrupt themselves.

When it comes to healthcare IT, I think we will see this same concept play out as well. We can look to the large healthcare IT organizations to see how something is going to be optimized, but we shouldn’t expect any sort of disruptive innovation to come from these larger healthcare IT companies. They have so many reasons not to disrupt themselves.

I give Jonathan Bush, CEO of athenahealth, a lot of credit when it comes to understanding this. He literally built a program at athenahealth that he calls “More Disruption Please.” My take on it is that Jonathan Bush wanted a way to spend a bunch of money on things that could disrupt the athenahealth business. This program would allow him to do just that without having to explain that spend to the public markets. When they ask why he spend millions of dollars on these disruptive companies, he can just say “That’s what I told you I was going to do. It’s called More Disruption Please for a reason!” I think it’s pure genius.

Although, even this effort which I call genius really just highlights that the disruption to healthcare is likely going to come from outside large companies. If anything, this program is a way for athenahealth to tap into that disruption so that they’re well positioned to ride that wave of disruption which will surely come.

What disruptions do you see coming to healthcare? And if you tell me it’s coming from a big company, I’ll take a look, but now you’ll know I’m skeptical. Although, I’m certainly happy to be proven wrong.

Leadership Discussions at Healthcare CIO Conference

Posted on October 9, 2013 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 week I get to enjoy the company of 750 attendees at the healthcare CIO conference organized by CHIME (officially called the CHIME Fall CIO Forum). It’s always an amazing experience to break bread and learn from people who are dealing with some of the hard challenges of healthcare IT.

One topic that’s always present at CHIME events is a discussion of leadership. So, it was extremely appropriate that Jim Collins was the opening keynote. The guy just exudes leadership. Here’s some of the tweets I sent out during his keynote.

CHIME Seeks Year-Long Meaningful Use Stage 2 Extension

Posted on May 8, 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Recently, six senators wrote a letter to HHS Secretary Kathleen Sebelius criticizing the Meaningful  Use program.  The letter, which came with a white paper listing their concerns about federal health IT policy, questioned whether the $35 billion allocated to Meaningful Use was being spent effectively, especially given the fact that provider interoperability is still minimal.

This week, the College of Healthcare Information Management Executives (CHIME) sent a letter to the six senators responding to their concerns, one which largely defends Meaningful Use though advocating for a one year extension of Stage 2.

In the letter, CHIME leaders concede that that there is some reason to be concerned with the current state of interoperability. However, they note, “we strongly believe that EHR incentive payments under the policy of Meaningful Use have been essential in moving the nation’s healthcare system into the 21st Century.”  The incentive payments providers are receiving are critical to the business plans and interoperability solutions they’re developing, CHIME says.

And while we may not have interoperable EMRs in place just yet, the MU program has helped make progress in that direction, they say. “The work accomplished through Meaningful Use to reach consensus on transport, vocabulary and content standards is foundational to advancing interoperability and exchange,” the letter argues.

All that being said, it would be a good idea to extend Stage 2 of Meaningful Use for another year before moving ahead with Stage 3, CHIME contends:

A year extension of Stage 2 will give providers the opportunity to optimize their EHR technology and achieve the benefits of Stage 1 and Stage 2; it will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policymakers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules.

Personally, I hope that HHS agrees to CHIME’s request and moves Stage 2 up a year. After all, the existing timelines aren’t holy writ, and if changing the deadline allows providers and vendors to consolidate their gains significantly, it’s probably worth the wait.

John’s working on an interview with CHIME to discuss their letter. Watch for that over on Hospital EMR and EHR.

Highlights from Ed Marx Hospital CIO Strategy Talk at #CHIME12

Posted on October 19, 2012 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 was really excited when I found out that Ed Marx’s, CIO of Texas Health Resources, talk at CHIME 2012 was one of the encore presentations since I’d missed it earlier in the week. Thankfully he didn’t disappoint. Here are some tweets I sent during his talk with some additional commentary on what he said.


I loved his comment on the need for hospitals to have a strategy when it comes to mobile health. He acknowledged that even with a strategy in place it’s a pretty crazy environment right now, but he said that he couldn’t imagine where they’d be if they had no strategy. It’s a good acknowledgement that mobile health is here to stay and it’s better to have a proactive approach to mobile health.


Great advice. Far too often I see people trying to swing for the fences instead of being happy with a single. Many hospital organizations could use a quick win for morale sake. Then, with that confidence they can work on the bigger, longer term goals.


There are a lot of ways to learn. Ed Marx pointed out that every hospital CIO should be on social media. I’d argue that the reason they should be on social media is to learn. Learn from customers. Learn from colleagues. Twitter is an amazing platform for learning and listening. You don’t have to broadcast on social media if you don’t want.


I love the transparency that Ed strives to achieve. Putting your performance review for all to read is a brave choice. Although, he made a good point. His performance review wasn’t just a reflection of him, but was a reflection of the entire organization in many ways.


Such a great way to describe the idea of getting out of the office and working with people from other departments. The challenge with this is that many people aren’t very good at this type of social interaction. Some people have this naturally, but others have to work really hard to make it happen. This type of description can help some who have this challenge I think.


I was amazed that he said this was the most important thing. I’ve always loved the value of looking to multiple sources for inspiration. Very important and useful!


Ed suggested that most CIO’s could identify the CEO’s top priority, but not the top 10.


I think it’s true that many hospital CIO’s live in partial fear for their jobs. I guess we all do to some extent. I’m not sure this tweet is going to change things, but hopefully it’s a challenge for many who have avoided risks. Thoughtful risks can work out very well if done right.


Beautiful description of leadership, but hard to achieve.

One other major point that Ed made that I didn’t tweet about had to do with the idea of a project not being an IT project. Ed described the need for IT to make themselves open and available to lead those projects. Although, in order for that to happen, they have to create a trusted leadership role within the organization.

For example, instead of talking to the CEO, CFO, board, etc about project timelines, projects completed, and missed schedule, talk to them about ROI and improved patient care. However, to do so takes a real focus on measuring the costs and benefits of each project.

Can Paraprofessionals Solve The Health IT Talent Shortage?

Posted on April 23, 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.

As anyone reading this blog knows, there’s not enough HIT specialists available to  manage  the massive wave of EMR implementations under way.  In fact, many CIOs fear that they won’t be able to find enough EMR help to get stimulus funding, according to a CHIME survey from late last year.

More than 70 percent CIOs responding to the survey said that they might not be able to bring enough staff on board to get HITECH incentives, CHIME reports.  Many are turning to third-party consultants to get the job done, but as we all know, outsourcing the implementation of a mission-critical system like an EMR comes with problems of its own.

So, wouldn’t it be nice if there was a way to reduce the need for scarce health IT veterans and fob off at least some of the work on paraprofessionals?  It seems that at least one organization has exactly that in mind.

A group of impressive HIT experts, led by Steven Lazarus of the Boundary Information Group, have come together to offer a series of certification courses which train students to handle some EMR management functions.   The certifications include:

*  Certified Professional in Electronic Health Records (CPEHR)

*  Certified Professional in Health Information Technology (CPHIT)

Certified Professional in Health Information Exchange (CPHIE)

The organization, known simply as Health IT Certification, has already partnered with three Regional Extension Centers. It’s also working with several trade organizations, including the MGMA and WEDI.

The group frankly acknowledges that these certifications are no substitute for in-depth health IT expertise, but argues that people who meet its certification requirements can be a big help nonetheless.

My guess is that such paraprofessionals would be especially attractive to small medical practices, which seldom — if ever — have a traditional IT expert on staff and can ill-afford high-end EMR consulting.

However, I don’t know if they’d make a dent in a hospital or health system’s staffing problems, as I doubt that even the best-informed paraprofessional could handle the implementation of high-end enterprise EMR systems.

That being said, it’s hard to tell what will and won’t work as the EMR juggernaut descends upon the industry.  Maybe these certified folks — call them HIT extenders? — can make a real impact.  What do you think?