Health Information Exchange

Bill Gates Puts a New Spin on the Great EMR Debate

I heard an interesting interview on NPR the other day with Bill Gates on the subject of polio eradication. The Bill & Melinda Gates Foundation has been working for a number of years now on the effort, and are intent on seeing that no child ever becomes paralyzed as a result of the disease. The interview got me thinking about money, as NPR host Robert Siegel grilled Gates about the cost of this hopefully final vaccination push in the three countries that still show cases of it each year – Afghanistan, Pakistan and Nigeria.

According to Gates, a nice tidy sum of $5.5 billion will be necessary to vaccinate enough children to finally push out the disease. The question arose as to whether or not this money will be spent wisely. Could it be put to better, more effective use fighting other healthcare conditions, such as malaria, that affect greater numbers of people? Gates made the point that once polio is eradicated, the enormous amount of money already being spent on fighting it can then be spent on these other issues – a statement that to me didn’t seem to sit well with Siegel.

Now, if you’re in healthcare, chances are money crosses your mind a few times a day. And if you use an EMR, you’ve likely voiced an opinion or two on whether it has lived up to its promised value. I think Gates’ point above on cost effectiveness of disease eradication – the most expensive disease gets eradicated first to free up its funds for other healthcare causes – can be applied to the EMR ROI debate.

Yes, healthcare is expensive. Yes, current and possibly future EMRs may not have the best interfaces or give the ideal user experience. But, given time (perhaps a lot of time), they will ultimately help springboard immense cost savings throughout the industry. I consider them the backbone of interoperability, especially when it comes to health information exchange and accountable care – two notions that might just become the norm once EMR utilization finally reaches critical mass.

Stage 2 Meaningful Use will likely see a shift in the market, and from what I’ve read thus far, is causing providers to think about Meaningful Use in a new way. It might be a hiccup in this journey to cost savings, but it will likely separate the wheat from the chaff as far as vendors go. Hopefully, only effective products will be left standing, which will in turn make it easier for providers to use EMRs in the most effective way.

Money will of course be on everyone’s minds at the upcoming HFMA ANI show in Orlando. This has got to be one of my favorite events as it is smaller than HIMSS but still has that bustling, breaking news vibe. I’ll be interested to hear from providers their opinions on the recent push for greater price transparency when it comes to hospital costs, and how they are feeling about EMRs as of late. It will also be interesting to see how vendors are helping these providers meet Stage 2 and patient engagement head on.

Will you be at the ANI show? Drop me a line in the comments below and let me know what you’re looking forward to learning about or seeing the most.

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May 13, 2013 I Written By Jennifer Dennard

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company’s social media strategies for its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

Filed Under: EMR Healthcare

Tags:Bill Gates EMR EMR Benefits Health Information Exchange HIE LinkedIn Meaningful Use

Are Cloud-Based Health Record Banks Better Than HIEs?

This week a group of researchers published an opinion in the Journal of the American Medical Association suggesting that cloud-based record banks are a better way to share patient health data than HIEs. I think their view is interesting and sensible, and so here’s a short recap.

The authors argue that cloud-based health record banks are a more logical way to share such data than HIEs, reports MedCityNews. After all, as they note, interoperability challenges make it “inefficient” to share patient data, as every organization has to be able to communicate with every other organization where a patient has been treated.

But cloud-based health record banks wouldn’t pose the same challenges, they note. These record banks would be more scalable and easier for end institutions to use, according to the authors. Though local providers could keep copies of a patient’s health record, the electronic health record would be stored in a cloud-based bank in the patient’s community, they say. When patients moved, their records would travel to a different community health data bank.

This approach isn’t just a theoretical discussion. It’s backed by a group called the Health Record Banking Alliance, which was founded by one of the article’s authors, Dr. William Yasnoff, MD, PhD, FACMI, former senior advisor for the National Health Information Infrastructure. The group has developed white papers outlining a proposed architecture and a business model for community health record banking.

My take on all of this is that the cloud-based community health record bank is a very worthwhile idea. After all, in theory it can greatly reduce the amount of infrastructure build out and interoperability issues providers face in connecting to HIEs.

That being said, the HIE concept is firmly planted in the industry’s mind, and despite all of the issues involved in building out HIE networks, I don’t see providers changing gears to embrace a completely new model. What about you?

Motivating Factors for Doctors and Hospitals to Participate in HIE

While attending the Digital Health Conference in New York, I had the chance to sit down and talk with Paul Wilder, Director of Product Marketing and Adoption for the New York eHealth Collaborative (NYeC). I was really impressed by Paul’s understanding of the benefits and challenges of an HIE. He knows them first hand with NYeC’s SHIN-NY project which is connecting all of the various HIE’s and RHIO’s in New York.

I pulled out my camera and asked Paul to talk about the motivating factors for doctors and hospitals to participate in an HIE. I think you’ll enjoy Paul’s answer in the video below. He brings up some ideas related to HIE that I hadn’t heard articulated that way before.

From #AMIA: Interoperability Held Back By Politics

When a recent AMIA panel was asked why health IT interoperability was still in its infant stages, members’ responses were the same we’ve been hearing for, I don’t know, a decade or more. Let’s say that there didn’t seem to have been a lot of hope in the room.

According to Healthcare IT News, true interoperability between health systems is still beyond us due to the same-old, same-old reasons: Hospitals with hundreds of systems, vendors with proprietary databases, varied standards, health systems that don’t want to share data and a lack of interoperability support from policymakers.

Ultimately, the fact that these obstacles haven’t been overcome is as much a matter of politics as integration problems, the magazine reports:

Charles Jaffe, MD, CEO of standards development organization Health Level Seven International (HL7) described a “circle of blame” involving government agencies and regulators, hospitals and healthcare systems, technology vendors, clinicians, academicians like those at AMIA and, yes, standards development organizations (SDOs), such as HL7. “The policy always preempts the technology,” said Jaffe.

My feeling is that this circle of blame would dissolve in a millisecond if a compelling financial case could be made for interoperability. Anything might help at this point.

Hey, just prove that interoperability saved a health system $2 a patient somehow, and they might be made to invest in needed changes. Or convince vendors that they’d move even a few units of their product if their systems were freely interoperable, and they’d probably be more cooperative.

At this point though, you’ve got cross-cutting turf wars going on, with vendors and health systems and standards organizations each pursuing an agenda of their own. And honestly, why shouldn’t they?

With plenty of financial and institutional risk involved, and questionable rewards, I’m not sure how gung-ho I’d be on interoperability if I were a healthcare CIO or vendor exec.

Bottom line: If you want interoperability, it’s got to have a more tangible payoff for everyone involved.

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November 12, 2012 I Written By Anne Zieger

Filed Under: EHR EHR Market Electronic Health Record Electronic Medical Record EMR EMR Technology Healthcare IT Healthcare IT Market HIE

Tags:AMIA AMIA 2012 Charles Jaffe Health Information Exchange Healthcare Interoperability Healthcare IT News HIE hl7 Hospital CIO

Great Video Explanation of HIE at Work

I recently saw this great video demonstrating the value of an HIE. In this case it was created by the New York HIE, SHINY. Check out the video embedded below:

What a great video! I’m looking forward to learning even more about SHINY when I attend the Digital Health Conference in New York City next month. It was a great event last year, and this video is emblematic of the professionalism of the NYeC.

I’ve often said that the problem with HIE isn’t that we don’t see value in it. This video is something any regular patient can understand and see the value of a health information exchange. The problem is in making the exchange a reality. Seems like SHINY is making this a reality for New York state with things like the announcement of the largest New York RHIO, Healthix, Inc, joining SHINY.

I applaud the efforts of SHINY and wish that every state had something similar. We will eventually, but it’s going to take some time as we worth through the processes. Scott Joslyn, CIO of MemorialCare Health System, said it well in an interview on EMR and HIPAA:

New policies and regulations need to be put in place at the Federal level for HIE to truly work. Today, providers are reluctant to consider or embrace HIE because of the financial and reputational risks associated with the idea of sharing patient information. Issues of patient consent management, opt-in vs. opt-out, and privacy create both real and imagined barriers. We need to create a legal and regulatory environment that is receptive and supportive of HIE rather than potentially risky and punitive. As an organization, we participate in local, public HIE efforts while we endeavor connect our systems to affiliated providers to safely and securely make available patient information as our physicians and patients currently demand and expect in the current environment. We’re encouraged by the progress and ongoing regional and national dialog with regard to HIE though we do think it will evolve slowly and unpredictably.

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September 14, 2012 I Written By John Lynn

Filed Under: Healthcare IT HIE

Tags:Health Information Exchange Healthix HIE MemorialCare Health System New York HIE NYeC Scott Joslyn SHINY

Bringing up Your EMR in an Era of Meaningful Use

By now I assume most of you have read the recently released final rules for Stage 2 of Meaningful Use – or at least the plethora of synopses available online. (It wouldn’t hurt to read what Lynn Scheps wrote about meaningful use stage 2 over at EMRandHIPAA.com.)

Whatever level of knowledge you may possess about these rules and how near or far they deviate from those proposed, I think we can all agree that the EMR industry (developers and end-users) is suffering immense growing pains as vendors and physicians adjust to the Meaningful Use scheme. (I use that term in the British sense, by the way.)

Julie McGovern, CEO of Practice Wise, cleverly equated implementation of an EMR to being pregnant in a recent blog:

“In the beginning, you are tired and often feel like you have morning sickness. The first trimester is the hardest. In the second trimester, you start to get your legs under you, your energy starts to return, and you feel less beaten down by the EHR. By the third trimester, you start to see the light at the end of the tunnel, it’s starting to be second nature, the product is making more sense (hopefully), you’ve got good workflows and everyone is starting to forget how hard the first trimester was.”

I’ll go one step further and equate utilization (i.e. the regular use of an EMR after go-live) as relates to the various stages of Meaningful Use with bringing up that baby. I might even disagree with her – pregnancy is often the easy part (provided you’ve had no complications along the way, of course, be they IT, managerial, administrative, cultural or otherwise). You’ve got the PR-friendly ribbon-cuttings, parties and press releases that hospitals often initiate around their go-lives. Well-deserved events, to be sure. But then come the hard parts, when you and your colleagues integrate that new bundle of joy into your daily lives (i.e. workflows).

Eventually the EMR will develop its own personality, form bonds with its users, bring joy to many for the clinical outcomes it improves, and hopefully not cause too many tears of frustration along the way. Hopefully it will gossip with its peers at other hospitals, and even aspire to interoperate in the same circles as its distant cousin – health information exchange. You can bet that it will end up costing more money than you had anticipated – upgrades, add-ons, etc.

The years will go by – 2014 and 2016 will be here before you know it. Hopefully, the EMR that caused so much joy when it was first brought into this world shiny, new and virus-free will still bring a smile to the face of its users, and better care to the patients whose information it so closely guards.

Patient Perspectives of Physician Communication

Head nurse Diane L Gilworth said, “Patients think we talk to each other much more than we do.” The promise of EHRs and information interchange hasn’t been realized. -source

I’ve heard this type of statement on multiple occasions recently and I think it’s a really important observation to consider. Most patients believe that their doctors exchange a lot more healthcare information than they actually do.

While those of us steeped in the details of healthcare IT, EHR, and health information exchange know many of the intricacies and challenges associated with exchanging healthcare data, most patients have no idea. Plus, I can easily argue that this perception is only going to get worse.

The next generation is being trained that all information is available anywhere. Take something as simple as watching TV. There’s technology that lets you watch TV on your computer, transfer it to your TV set, and then off to your iPad or mobile device. In many ways I have this same experience on my computer as well. I sync my web browser and everything is automatically updated with all my settings. With Dropbox, all of my files are automatically synced between all of my devices as well. I could go on and on.

The point is that society is starting to have their personal settings and information follow them wherever they go. However, as we all know, in healthcare this isn’t even close to happening. I know we could easily blame HIPAA or financial impediments to this problem, but those feel more like excuses. I’m still not sure how to get past those excuses, but I’ll be really happy the day we finally do. It’s time for a patient’s perspective to become reality.

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August 1, 2012 I Written By John Lynn

Filed Under: EHR Electronic Health Record Electronic Medical Record EMR Healthcare IT HIE

Tags:Diane Gilworth Health Data Exchange Health Information Exchange Personalized Healthcare Physician Communication

Hospital Competition Hinders HIE – Some Solutions to the Problem

In response to my post about the Real HIE Problem, Tim Dunnington provided this powerful insight into a major challenge that are faced by HIEs. However, more importantly, Tim provided some suggestions on how to solve the problems.

I work for an HIE system vendor, ICA. One of the challenges we see our HIE’s face is FUD (Fear, Uncertainty and Doubt) around sharing patient data. The fear arises in sharing data with other participants that are direct competitors. The competition between participants can lead some participants to refuse to share “their” patient data with other participants, creating complex sharing rules based on these relationships, and meaning that the view of a patient’s record will change depending on what facility you happen to be in. This results in the patient’s medical record not being complete. The patient, meanwhile, is not aware of these nuances and is not aware that their record is incomplete due to these competitive issues. I can’t say we have an answer as to how to solve this, but it’s definitely a potentially large roadblock, larger I think that EMR adoption itself.

I would say in response to these issues:
* The EMR determines what data is shared, so you (as a customer of the EMR) should have some control over what exactly is shared and when
* The HIE will not by any means have a “complete dump’ of your database; the EMR sends out a limited amount of data about the patient or the encounter
* The interoperability standards are set up to keep participants from attempting what I call “patient surfing,” keeping the availability of data to those patients for which you have an established relationship. This means that your competition cannot simply download every one of your patient records, as they have no access to a means to query for all your patients.
* Auditing and regulatory measures ensure that attempts to access records for purposes other than direct patient care are caught and properly sanctioned.

I’d love to hear your thoughts and perspectives on the challenge of data sharing in a HIE. Do you think that Tim’s suggestions are good?

PA Group Kicks Off Direct Project-Based Data Sharing

You know, the whole Direct Project approach seems brain-dead simple compared to the elaborate EMR rollout we’re suffering through in this county. I don’t know why we didn’t try something like it first, before we consumed the resources of HIT CIOs from sea to shining sea. Really, the convolutions we’ve gone through seem so unnecessary! (climbing down off soapbox)

Anyway, I thought you’d be interested to hear that the Pennsylvania eHealth Collaborative is doing its part to move the direct approach forward. The group has issued a grant encouraging providers to use Direct Project-based approaches to exchange patient health information. The idea is to capture providers who haven’t yet had the funds, time or willingness to roll out an EMR. Not only will this make life easier for providers, it will help them meet a portion of Stage 1 Meaningful Use requirements, definitely an added blessing.

How the grant money will flow is as follows. The group has selected an approved health information service provider, whose job it is to actually handle the direct messaging traffic. The intermediary gets $250 for each provider which uses them to send direct messages.

According to Information Week, which spoke to the group’s officials, as many as 8,000 providers could potentially sign up for the program. This includes both providers that do and don’t have EMRs in place already. As state HIT coordinator Robert Torres told the magazine, providers with EMRs already in place can simply select out data and send it using the direct protocols, which support patient care records, referrals, discharge summaries and other clinical documents.

Bottom line, the Direct Project model rolls on. I say, more power to ‘em.

Beth Israel Deaconess Asking Patients To Opt In To HIE Data Sharing

One of the less-obvious, but critical, issues in rolling out an HIE is how management handles patient consent for widespread use of the data. Providers who don’t ask for detailed permissions as to which HIE partners may use patient data when may someday find themselves at the barrel end of a high-caliber lawsuit.

To avoid such entanglements, Beth Israel Deaconess Medical Center (BIDMC) CIO John Halamka, MD has announced that it will require its 1,800 affiliated ambulatory care providers get patient opt-in for data sharing among clinicians on their case. The permission slip Halamka wants patients to sign will cover not only care within BIDMC but also care provided by outside clinicians.

The process BIDMC has developed is quite interesting, both in what it demands from clinicians and how the IT department is involved:

* Doctors who have a need to see patient info for treatment, payment or operations can electronically request a view from a community practice. To make the query, doctors hit what BIDMC is calling a “magic button” which works as follows (info below from Halamka’s blog):

1. The clinician clicks on a button inside their EHR. This click launches a query containing Name, Gender, Date of Birth, and Zip Code to a responding EHR. The physician does not need to respecify the patient or log in to a separate portal since the patient identity information and security credentials are sent from the querying EHR automatically.
2. The responding EHR checks the security, looks up the patient, and responds with a medical record number if the patient is found.
3. The querying EHR sends a new query incorporating the returned medical record number.
4. The responding EHR launches a web-page which displays clinical data for that medical record number.
5. All transactions are audited in the responding EHRs.

* Doctors can only get data for patients shared between the two organizations

* All requests will be audited

* There will be no “break the glass” feature allowing clinicians to override patient preferences

* Patients can opt-in later if they choose not to now

The audit aspect of this is especially interesting. How often? By whom? What protocols are in place to respond when something seems to be out of order?

But I must say the whole thing is intriguing. It seems to me that BIDMC is making the right choice, but anything involving consumers has a bunch of fail points that don’t pop up at first. I wonder how consumers will feel about this plan six to twelve month after it’s enacted. Much to learn here.

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July 9, 2012 I Written By Anne Zieger

Filed Under: Electronic Health Record Electronic Medical Record EMR Healthcare IT HIE

Tags:Beth Israel Deaconess Medical Center BIDMC EHR Electronic Health Record Electronic Medical Record EMR Health Information Exchange HIE John Halamka MD

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Bill Gates Puts a New Spin on the Great EMR Debate

Are Cloud-Based Health Record Banks Better Than HIEs?

Motivating Factors for Doctors and Hospitals to Participate in HIE

From #AMIA: Interoperability Held Back By Politics

Great Video Explanation of HIE at Work

Bringing up Your EMR in an Era of Meaningful Use

Patient Perspectives of Physician Communication

Hospital Competition Hinders HIE – Some Solutions to the Problem

PA Group Kicks Off Direct Project-Based Data Sharing

Beth Israel Deaconess Asking Patients To Opt In To HIE Data Sharing

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