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When Healthcare Faxing Goes Wrong

Posted on January 11, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently wrote a tongue in cheek post about The Perfect Interoperability Solution. Go and read it and you’ll see what I mean. We’ll be here when you get back.

For those of you too lazy to click over and read the post, the punchline is that I was talking about all the beautiful parts of faxes in healthcare. Faxes have a lot of really redeeming qualities. That’s why they’ve survived so long in healthcare. However, we should learn from their great qualities and take interoperability to the next level.

In the comments on that post, regular reader R Troy offered this tragic story about why we should do better than faxing in healthcare:

At best, fax should be a method of nearly last resort, voice calls being the only thing that is worse (highly prone to miscommunication). Sure, there are solutions such as Brian noted, and I’m not suggesting that it go away because it does help to make the best of a poor method of communication. It’s just that in real life fax’s are often partially or completely unreadable, can’t get through, don’t reach the right person or entity, or even something as stupid as someone forgetting to press SEND or OK. Of course, if the fax came from an EHR, quality would likely be fine – but typically, someone fills in something on a photocopied form – perhaps legibly, and then that sheet is put into a fax machine and maybe even gets both sent and received.

Real life scenario; doctor sends a patient to the ER for an emergency transfusion, to be followed up by related infusions (which were going to be done on an outpatient basis the next day until the situation worsened). The doctor writes up the orders to have someone fax to the ER, but along the way, something unknown happens and the ER never gets the fax. Patient arrives, ER has no clue what to due, figuring the orders will eventually arrive. One nurse figures that the problem is with the pharmacy. The patient’s family pushes hard and finally – 6 hours later, discovers that no orders have arrived; doctor is phoned, and 10 minutes later the ER has the instructions.

What should have happened? In very plain terms, the doctor should have logged into the EHR (albeit a different system than the hospital uses), put in orders, and those orders should have gone straight to the ER’s EHR (I gather via Direct Messaging) so that when the patient arrived the ER would know what to do. OR – the doctor should have logged into the hospital’s EHR remotely and entered the orders. But that’s not what happened, and the patient waited many hours for badly needed blood, and a valuable ER bed was occupied for those same hours with no treatment being done.

Fax does have its uses – but IMO they should be limited to situations where there is no other choice, not be ‘how we do things’.

BTW, the scenario above actually happened. Oh, and the ER in question is now being expanded, an expansion that might not be needed if 1. it had decent communications with doctors feeding it patients, 2. it’s EHR was fully connected to that used by the rest of the hospital, 3. It had a viable and efficient work flow revolving around the EHR. Instead, patients are stacked up in the hallways and waiting room waiting for treatment, for techs to come, for orders to hopefully show up. The hospital is spending 10’s of millions to expand but not addressing the root causes of their problems, the biggest of which is poor communication based primarily on phones and fax machines.

The sad part is these miscommunications happen all day, every day in healthcare. Stories like this is why we can and need to do better than fax for healthcare interoperability.

Patients Frustrated By Lack Of Health Data Access

Posted on January 3, 2017 I Written By

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

A new survey by Surescripts has concluded that patients are unhappy with their access to their healthcare data, and that they’d like to see the way in which their data is stored and shared change substantially.  Due to Surescripts’ focus on medication information management, many of the questions focus on meds, but the responses clearly reflect broader trends in health data sharing.

According to the 2016 Connected Care and the Patient Experience report, which drew on a survey of 1,000 Americans, most patients believe that their medical information should be stored electronically and shared in one central location. This, of course, flies in the face of current industry interoperability models, which largely focus on uniting countless distributed information sources.

Ninety-eight percent of respondents said that they felt that someone should have complete access to their medical records, though they don’t seem to have specified whom they’d prefer to play this role. They’re so concerned about having a complete medical record that 58% have attempted to compile their own medical history, Surescripts found.

Part of the reason they’re eager to see someone have full access to their health records is that it would make their care more efficient. For example, 93% said they felt doctors would save time if their patients’ medication history was in one location.

They’re also sick of retelling stories that could be found easily in a complete medical record, which is not too surprising given that they spend an average of 8 minutes on paperwork plus 8 minutes verbally sharing their medical history per doctor’s visit. To put this in perspective, 54% said that that renewing a driver’s license takes less work, 37% said opening a bank account was easier, and 32% said applying for a marriage license was simpler.

The respondents seemed very aware that improved data access would protect them, as well. Nine out of ten patients felt that their doctor would be less likely to prescribe the wrong medication if they had a more complete set of information. In fact, 90% of respondents said that they felt their lives could be endangered if their doctors don’t have access to their complete medication history.

Meanwhile, patients also seem more willing than ever to share their medical history. Researchers found that 77% will share physical information, 69% will share insurance information and 51% mental health information. I don’t have a comparable set of numbers to back this up, but my guess is that these are much higher levels than we’ve seen in the past.

On a separate note, the study noted that 52% of patients expect doctors to offer remote visits, and 36% believe that most doctor’s appointments will be remote in the next 10 years. Clearly, patients are demanding not just data access, but convenience.

Rival Interoperability Groups Connect To Share Health Data

Posted on December 27, 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.

Two formerly competitive health data interoperability groups have agreed to work together to share data with each others’ members. CommonWell Health Alliance, which made waves when it included Cerner but not Epic in its membership, has agreed to share data with Carequality, of which Epic is a part. (Of course, Epic said that it chose not to participate in the former group, but let’s not get off track with inside baseball here!)

Anyway, CommonWell was founded in early 2013 by a group of six health IT vendors (Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies and RelayHealth.) Carequality, for its part, launched in January of this year, with Epic, eClinicalWorks, NextGen Healthcare and Surescripts on board.

Under the terms of the deal, the two will shake hands and play nicely together. The effort will seemingly be assisted by The Sequoia Project, the nonprofit parent under which Carequality operates.

The Sequoia Project brings plenty of experience to the table, as it operates eHealth Exchange, a national health information network. Its members include the AMA, Kaiser Permanente, CVS’s Minute Clinic, Walgreens and Surescripts, while CommonWell is largely vendor-focused.

As things stand, CommonWell runs a health data sharing network allowing for cross-vendor nationwide data exchange. Its services include patient ID management, record location and query/retrieve broker services which enable providers to locate multiple records for patient using a single query.

Carequality, for its part, offers a framework which supports interoperability between health data sharing network and service providers. Its members include payer networks, vendor networks, ACOs, personal health record and consumer services.

Going forward, CommonWell will allow its subscribers to share health information through directed queries with any Carequality participant.  Meanwhile, Carequality will create a version of the CommonWell record locator service and make it available to any of its providers.

Once the record-sharing agreement is fully implemented, it should have wide ranging effects. According to The Sequoia Project, CommonWell and Carequality participants cut across more than 90% of the acute EHR market, and nearly 60% of the ambulatory EHR market. Over 15,000 hospitals clinics and other healthcare providers are actively using the Carequality framework or CommonWell network.

But as with any interoperability project, the devil will be in the details. While cross-group cooperation sounds good, my guess is that it will take quite a while for both groups to roll out production versions of their new data sharing technologies.

It’s hard for me to imagine any scenario in which the two won’t engage in some internecine sniping over how to get this done. After all, people have a psychological investment in their chosen interoperability approach – so I’d be astonished if the two teams don’t have, let’s say, heated discussions over how to resolve their technical differences. After all, it’s human factors like these which always seem to slow other worthy efforts.

Still, on the whole I’d say that if it works, this deal is good for health IT. More cooperation is definitely better than less.

The Perfect Option for Healthcare Interoperability

Posted on December 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.

I’ve come up with the perfect option to take care of healthcare interoperability. I realize that this is a major problem and solving that problem would improve care, lower costs, and make healthcare great again (sorry, I couldn’t help it).

This approach is unique because every healthcare organization out there already supports it. In fact, I don’t know any healthcare organization that would need to spend more money to implement this solution. In fact, the standard this option would use is already out there and everyone has already adopted the standard.

Furthermore, every provider and hospital already have a unique credential and their identity is shared with most of the people that need to share information with them in healthcare. In most cases the information to make the health data sharing between offices and hospitals is already on their website. Plus, this option is something that is easily learned by everyone involved. Most people in healthcare already know how to use it well.

The healthcare interoperability solution I’m describing is: The Fax.

Yeah. It’s shocking I know. That long list of benefits that I describe already exist in the fax. In fact, healthcare data sharing has been happening with faxes for a long time. Why then isn’t fax enough to make healthcare interoperability a reality?

While Fax has plenty of upside (there’s a reason it’s stuck around so long in healthcare), faxes also have a lot of downsides. First is that faxes still have to be sorted and assigned to a patient. This doesn’t happen automatically. It’s still a manual process. Second, faxes are often low quality and readability can really be a problem. Certainly, they’ve gotten better as we’ve started faxing printed reports, but faxes can still be very hard to read.

If you’ve ever worked in medical records, you know how hard it can be to make sure you’re attaching a fax to the right patient. It can be a real challenge. Plus, it’s not surprising that faxes often get attached to the wrong patient.

Another problem with faxes is that they can use up a lot of paper. There are definitely fax servers and other forms of secure electronic fax out there, but it’s shocking how many practices still print regular faxes and then scan and attach them into their EMR. Plus, is the fax really that secure? They can be, but in many cases they’re not. No one is tracking who looks at the faxes that are received. There aren’t restricted permissions on who can and can’t look at the faxes. It’s just an open stack of faxes that anyone can look at and read.

Another big problem with faxes is that they don’t provide any granular data. This is why it’s often hard to identify the correct patient for the fax. However, it’s also a problem as we start wanting to do more predictive analytics and population health efforts that require granular health data on a patient. Sure, you could use OCR (Optical Character Recognition) and NLP (Natural Language Processing) to pull out the details from these unstructured faxes, but that’s not as good as granular data that’s more precise.

Of course, we all love the way the fax produces a Blarrrrrring NOISE!!

While this post is somewhat tongue in cheek, I think it’s important to look back at these “legacy” technologies that have been so popular. Understanding why they have been so popular and in many ways still are so popular can help us understand what the solutions of the future need as a baseline to be a successful replacement. Healthcare Interoperability efforts can certainly learn a lot from the success of faxes in healthcare.

Creating Healthcare Interoperability Bundles

Posted on October 25, 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.

At this point in the evolution of healthcare data, you’d think it would be easy to at least define interoperability, even if we can’t make it happen. But the truth is that despite the critical importance of the term, we still aren’t as clear as we should be on how to define it. In fact, the range of possible solutions that can be called “interoperable” is all over the map.

For example, a TechTarget site defines interoperability as “the ability of a system or a product to work with other systems or products without special effort on the part of the customer.” When defined down to its most basic elements, even passive methods of pushing data from one to another count is interoperability, even if that data doesn’t get used in clinical care.

Meanwhile, an analysis by research firm KLAS breaks interoperability down into four levels of usefulness, ranked from information being available, to providers having the ability to locate records, to the availability of clinical view to this data having an impact on patient care.

According to a recent survey by the firm, 20% of respondents had access to patient information, 13% could easily locate the data, 8% could access the data via a clinical view and just 6% had interoperable data in hand that could impact patient care.

Clearly, there’s a big gap between these two definitions, and that’s a problem. Why? Because the way we define baseline interoperability will have concrete consequences on how data is organized, transmitted and stored. So I’d argue that until we have a better idea of what true, full interoperability looks like, maybe we should map out interoperability “bundles” that suit a given clinical situation.

A Variety of Interoperabilities

For example, if you’re an ACO addressing population health issues, it would make sense to define a specific level of interoperability needed to support patient self-management and behavioral change. And that would include not only sharing between EMR databases, but also remote monitoring information and even fitness tracking data. After all, there is little value to trying to, say, address chronic health concerns without addressing some data collected outside of clinic or hospital.

On the other hand, when caring for a nursing home-bound patient, coordination of care across hospitals, rehab centers, nurses, pharmacists and other caregivers is vital. So full-fledged interoperability in this setting must be effective horizontally, i.e. between institutions. Without a richly-detailed history of care, it can be quite difficult to help a dependent patient with a low level of physical or mental functioning effectively. (For more background on nursing home data sharing click here.)

Then, consider the case of a healthy married couple with two healthy children. Getting together the right data on these patients may simply be a matter of seeing to it that urgent care visit data is shared with a primary care physician, and that the occasional specialist is looped in as needed. To serve this population, in other words, you don’t need too many bells and whistles interoperability-wise.

Of course, it would be great if we could throw the floodgates open and share data with everyone everywhere the way, say, cellular networks do already. But given that such in event won’t happen anytime in the near future, it probably makes sense to limit our expectations and build some data sharing models that work today.

Is Interoperability Worth Paying For?

Posted on August 18, 2016 I Written By

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

A member of our extended family is a nurse practitioner. Recently, we talked about her practice providing care for several homebound, older patients. She tracks their health with her employer’s proprietary EHR, which she quickly compared to a half-dozen others she’s used. If you want a good, quick EHR eval, ask a nurse.

What concerned her most, beyond usability, etc., was piecing together their medical records. She didn’t have an interoperability problem, she had several of them. Most of her patients had moved from their old home to Florida leaving a mixed trail of practioners, hospitals, and clinics, etc. She has to plow through paper and electronic files to put together a working record. She worries about being blindsided by important omissions or doctors who hold onto records for fear of losing patients.

Interop Problems: Not Just Your Doc and Hospital

She is not alone. Our remarkably decentralized healthcare system generates these glitches, omissions, ironies and hang ups with amazing speed. However, when we talk about interoperability, we focus on mainly on hospital to hospital or PCP to PCP relations. Doing so, doesn’t fully cover the subject. For example, others who provide care include:

  • College Health Systems
  • Pharmacy and Lab Systems
  • Public Health Clinics
  • Travel and other Specialty Clinics
  • Urgent Care Clinics
  • Visiting Nurses
  • Walk in Clinics, etc., etc.

They may or may not pass their records back to a main provider, if there is one. When they do it’s usually by FAX making the recipient key in the data. None of this is particularly a new story. Indeed, the AHA did a study of interoperability that nails interoperability’s barriers:

Hospitals have tried to overcome interoperability barriers through the use of interfaces and HIEs but they are, at best, costly workarounds and, at worst, mechanisms that will never get the country to true interoperability. While standards are part of the solution, they are still not specified enough to make them truly work. Clearly, much work remains, including steps by the federal government to support advances in interoperability. Until that happens, patients across the country will be shortchanged from the benefits of truly connected care.

We’ve Tried Standards, We’ve Tried Matching, Now, Let’s Try Money

So, what do we do? Do we hope for some technical panacea that makes these problems seem like dial-up modems? Perhaps. We could also put our hopes in the industry suddenly adopting an interop standard. Again, Perhaps.

I think the answer lies not in technology or standards, but by paying for interop successes. For a long time, I’ve mulled over a conversation I had with Chandresh Shah at John’s first conference. I’d lamented to him that buying a Coke at a Las Vegas CVS, brought up my DC buying record. Why couldn’t we have EHR systems like that? Chandresh instantly answered that CVS had an economic incentive to follow me, but my medical records didn’t. He was right. There’s no money to follow, as it were.

That leads to this question, why not redirect some MU funds and pay for interoperability? Would providers make interop, that is data exchange, CCDs, etc., work if they were paid? For example, what if we paid them $50 for their first 500 transfers and $25 for their first 500 receptions? This, of course, would need rules. I’m well aware of the human ability to game just about anything from soda machines to state lotteries.

If pay incentives were tried, they’d have to start slowly and in several different settings, but start they should. Progress, such as it is, is far too slow and isn’t getting us much of anywhere. My nurse practitioner’s patients can’t wait forever.

CommonWell and Healthcare Interoperability

Posted on June 27, 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.

UPDATE: In case you missed the live interview, you can watch the recorded interview on YouTube below:

2016 June - CommonWell and Healthcare Interoperability-headshots

For our next Healthcare Scene interview, we’ll be sitting down with Scott Stuewe, Director at Cerner Network and Daniel Cane, CEO & Co-Founder at Modernizing Medicine on Wednesday, June 29, 2016 at 3 PM ET (Noon PT). Cerner was one of the Founding Members of CommonWell and Modernizing Medicine just announced they were joining CommonWell. No doubt these diverse perspectives will provide an engaging discussion about the work CommonWell is doing to improve healthcare data sharing.

You can join my live conversation with Scott Stuewe and Daniel Cane and even add your own comments to the discussion or ask them questions. All you need to do to watch live is visit this blog post on Wednesday, June 29, 2016 at 3 PM ET (Noon PT) and watch the video embed at the bottom of the post or you can subscribe to the blab directly. We’re hoping to include as many people in the conversation as possible. The discussion will be recorded as well and available on this post after the interview.

As we usually do with these interviews, we’ll be doing a more formal interview with Scott Stuewe and Daniel Cane for the first ~30 minutes of this conversation. Then, we’ll open up the floor for others to ask questions or join us on camera. CommonWell has become a big player in the healthcare interoperability space with most of the major EHR vendors involved, so we’re excited to learn more about what’s happening with CommonWell.

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

Healthcare Interoperability Tort Reform

Posted on November 12, 2015 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.

The more I learn about health care the more I think that health care would really benefit from tort reform. In many ways we’ve needed this for a while. I’ve never seen this study, but I’d love to see someone study how many health care costs are associated with unneeded tests and procedures that were ordered by doctors in order to help them avoid liability.

This happens all the time in health care and you can’t blame the doctors for doing it. Them ordering a likely unneeded extra test in order to avoid possible liability is a common practice. It only takes one time that they don’t order the test for the doctor to start over ordering tests and procedures. It’s unfortunately the lawsuit happy society that we live in and that’s why tort reform could help

Turns out that technology actually exacerbates this problem in many ways. A great example of this is in interoperability of health records. We all love the idea that everyone’s health information is pushed to the doctor so it’s available whenever the doctor needs it. I think we can all agree that the doctor having all of the information on a patient will lead to improved care for many patients. However, pushing all this new health information to the doctor raises a lot of questions.

From the doctor’s perspective they’re asking the question “Will I be held liable for health information that’s pushed to me?” “What if that health information shows suicidal tendencies for my patient and I don’t do anything about it because the information was pushed to me and I never actually saw it?” We could highlight a few hundred other scenarios where the doctor could be held liable if they don’t act on some information that’s forwarded to them. Any rational person could see how the doctor shouldn’t be responsible, but most lawsuits aren’t very rational.

Another example would be a doctor who has access to an HIE but doesn’t use it. Should the doctor be held liable for not using that information? What if the HIE had the allergies of a patient and could have prevented the doctor prescribing a drug to the patient because they were allergic? Should the doctor be held liable for information that was available in the HIE, but for whatever reason she chose not to access that information and ended up doing something bad?

I’m not a lawyer and I don’t play one on TV, but there are so many examples of potential liability that it’s quite scary. Is it any wonder why doctors are so frustrated with medicine? I think the right tort reforms could help. If we don’t, I think the cost of health care will continue to rise.

DeSalvo Says We Need Common Interoperability Standards – I Think There’s More To It

Posted on September 17, 2015 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 came across an article on FierceHealthIT which has a really fascinating quote from Karen DeSalvo, National Coordinator for Health IT. Here it is:

“What seems that it would have been helpful is if we had agreed as an ecosystem–the government, the private sector–that we would have a set of common standards that would allow us to have more seamless sharing of basic health information,” she said. “We’re moving toward that with the industry, but I think what that’s created is a complexity and aggregation of data … In hindsight, maybe some more standardization, or a lot more,” was necessary.

Is lack of a standard what’s keeping healthcare from being interoeprable?

I personally don’t think that’s the biggest problem. Sure a standard would help, but even with the best standards in the world if organizations see data sharing as contrary to their best interest then no standard will overcome that view. It’s been said many times that we have an issue of desire and will to share data. It’s not a technical problem. Sure, a standard would be helpful once there is a will to share data, but if organizations wanted to share data they’d figure out the standard.

Later in the article, CommonWell Executive Director Jitin Asnaani said “Standards are not standards because we say they are; standards are standards because everybody uses them.

This is the problem. People don’t want to share health data and so no standard is being used. I still wish they’d blow up meaningful use and use the rest of the money to incentivize organizations to start sharing. People went bat crazy implementing an EHR as they chased government money. I’d love to see healthcare organizations go bat crazy becoming interoperable as they chased the rest of the government meaningful use money.

Experiences Crafting a New API at Amazing Charts

Posted on August 21, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

A couple months ago, Amazing Charts announced an upcoming API for their new electronic health record, InLight. Like athenahealth, whose API I recently covered, Amazing Charts is Software as a Service (SaaS), offering its new EHR on the Web.

The impetus toward an API wasn’t faddish for Amazing Charts; they had a clear vision of what they wanted to achieve by doing so. They found that their interactions with various health care providers–payers, labs, radiologists, and others, along with accepting medical device data–has been hampered by reliance on common standards that involve HL7 messaging and EDI. The HL7 standards are inconsistently implemented and EDI is non-standardized, so each interface requires weeks of work.

I talked to Prayag Patil, product manager of patient engagement solutions at Amazing Charts. (They also offer patient portals to the institutions they serve.) For all their data exchanges, he said, they expect a RESTful API to provide standardization, speed, and simplicity in implementation. It should also be more suited to quick, fine-grained data transfers.

One of the common complaints of the older HL7 standards such as the CCD-A is that they are monolithic. EHR vendors and healthcare providers shove a lot into them without deciding what the recipient really needs. As Patil says, “it makes the 80% use case hard to do.” Nor is the standard used consistently by all correspondents (labs, practice management systems, devices, etc.), so extracting what’s really important at the receiving end is harder.

They’ve found that sluggish exchange has real effects on patient safety. For instance, a set of lab results, medications, and other information from a hospital discharge should be available immediately. If you wait, the patient their primary care provider won’t have it just after discharged, when its value is often critical, and the patient might lose interest and not bother to look at it later.

Amazing Charts, like athenahealth, also recognizes the value of a third-party marketplace. Patil says that innovation tends to “come from the smaller, scrappier vendors” that are enabled to produce useful apps by open APIs. The company already has a third party marketplace for apps in care coordination, revenue cycle management, patient engagement, and other tasks. But up to now the APIs weren’t published, so their developers had to work individually with any vendor who came to them, offering tools and the help needed to integrate with Amazing Charts’ service.

The company plans to introduce a patient engagement platform that will be open and accessible, with a focus on using standardized RESTful APIs to enable third party app developers to offer solutions. The company also plans to increase participation by creating thorough documentation for the APIs, and standardizing them. They are looking forward to standards such as FHIR, SMART-on-FHIR, and OpenID/OAuth, which are better specified and more consistently implemented than the currently available interfaces.

Here are the lessons I draw for others who are looking enviously at projects with APIs: going forward without all the pieces in place will be like driving on one flat tire. You just won’t get the results that you hoped for when investing in the project.

I applaud Amazing Charts for taking the difficult first steps toward API access, and doing it with good goals in mind. Their experience shows that an open API is still a hard process to get going–even as more and more companies take the leap–and one that calls for coordinated efforts throughout the organization in software design, publicity, documentation, and support.