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Risk of Interoperability is Worse Data

Posted on July 17, 2014 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 13 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’m a huge fan of healthcare interoperability. I think it needed to happen yesterday and that we could solve a number of our cost issues with healthcare data interoperability and we could save lives. Both of these are very worthy goals.

While I’m a huge fan of healthcare data interoperability, we also have to be careful that we do it right. While there are huge potential benefits of exchanging healthcare data, there are also huge risks involved in it as well. We have to address those risks so that interoperability doesn’t get a black eye because it was poorly implemented.

A great example of the potential risk of interoperability is making sure that we process and connect the data properly. Some might argue that this isn’t that big of an issue. Healthcare organizations have been doing this forever. They get a medical record faxed to their office and the HIM team lines up that medical record with the proper patient. I’m sure the medical records folks could tell us all sorts of stories about why matching a faxed medical record to a patient is a challenge and fraught with its own errors. However, for this discussion, let’s assume that the medical records folks are able to match the record to the patient. In reality, they’re certainly not perfect, but they do a really amazing job given the challenge.

Now let’s think about the process of matching records in an electronic world. Sure, we still have to align the incoming record with the right patient. That process is very similar to the faxed paper record world. For the most part, someone can take the record and attach it to the right patient like they did before. However, some EHR software are working to at least partially automate the process of attaching the records. In most cases this still involves some review and approval by a human and so it’s still very similar. At least it is similar until the human starts relying on the automated matching so much that they get lazy and don’t verify that it’s connecting the record to the correct patient. That’s the first challenge.

The other challenge in the electronic world is that EHR software is starting to import more than just a file attached to a patient record. With standards like CCDA, the EHR is going to import specific data elements into the patient record. There are plenty of ways these imported data elements could be screwed up. For example, what if it was a rule out diagnosis and it got imported as the actual diagnosis? What if the nurse providing care gets imported as a doctor? Considering the way these “standards” have been implemented, it’s not hard to see how an electronic exchange of health information runs the risk of bad health data in your system.

Some of you may remember my previous post highlighting how EMR perpetuates misinformation. If we import bad data into the EMR, the EMR will continue to perpetuate that misinformation for a long time. Now think about that in the context of a interoperable world. Not only will the bad data be perpetuated in one EMR system, but could be perpetuated across the healthcare system.

Posts like this remind me why we need to have the patient involved in their record. The best way to correct misinformation in your record is for the patient to be involved in their record. Although, they also need a way to update any misinformation as well.

I look forward to the day of healthcare data interoperability, but it definitely doesn’t come without its own risks.

One-Third of Chicago-Area Hospitals Come Together Into HIE

Posted on December 4, 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.

Thirty-four Chicago hospitals have decided to come together into a health information exchange, with plans to begin exchanging data early next year, according to a story in Modern Healthcare.

The group, which calls itself MetroChicago HIE, considers itself to have critical mass, given that it embraces about a third of the region’s 89 hospitals.

To exchange data, the HIE is using Direct protocols permitting basic, encrypted clinical messaging, such as the transmission of referral letters between providers which have established authentication and business relationships, Modern Healthcare notes.

Even with Direct protocols in hand to streamline data sharing, the hospitals will face significant challenges in tightening communications between their various EMRs, which include a number of Epic and Cerner installations, as well as a few Meditech shops. Planners will also face issues when they set out to link the HIE to office-based physicians.

To address the problem of communicating between multiple interfaces, the HIE has hired technology firm SandLot Solutions, a company launched by North Texas Specialty Physicians.

To date, many hospitals have been reluctant to sink big bucks into HIE development. But participating hospitals in Chicago seem confident that there is a business case for spending on an HIE.

The truth is, this may just be a tipping point for hospital-run HIEs generally. For example, a recent study by HIMSS Analytics and ASG Software Solutions concluded that almost 70 percent of the 157 senior hospital IT execs surveyed were involved in HIE efforts.

Now, let’s see how these Chicago hospitals handle data exchange when they move beyond Direct into more advanced sharing. That will really be where the rubber hits the road.

Ideas, Insights and Predictions from Healthcare Social Media Thought Leaders

Posted on July 16, 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 13 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 thought it would be fun to experiment with a new type of blog post. I came up with the idea during the recent #HITsm chat. I decided I’d ask 5 of the #HITsm participants to share an idea, prediction, insight, or thought that I could share in a blog post. I didn’t give them a topic, direction, or ask any questions. I just asked them to share something that thought would be useful or interesting. I found the results quite interesting.

I asked 5 people to tweet something. Only 4 of the 5 responded (probably a lost Twitter DM), but one of the people sent two tweets. So, the following are the 5 tweets with a little bit of commentary from me.


This is a really interesting insight. Chad has a really good point. I’m not sure I’ve seen a truly open HIE that just wanted to be the company sharing the data. I think a few have that goal in mind, but they haven’t gotten there yet. It will be a real game changer when an HIE just wants to be the pipes and not the faucet as well. I will say that most healthcare organizations aren’t quite ready to implement the faucet though either.


Thank you Dr. Nan for bringing some humor to the post. I love it! Although, maybe it’s not that funny since it rings far too close to the truth. I might also share this with my wife so she understands age appropriate behavior for our children.


This was the other tweet that Dr. Nan sent. You can tell it comes from a raw place. I’m actually surprised we don’t talk about doctor depression more. I read a lot of entrepreneur blogs and there’s been a real increase in discussion around entrepreneur depression. I expect that doctors could really benefit from this discussion as well. For some reason there’s a fear of discussing the real challenges and pressures of the job.


Would we expect anything other than workflow from Dr. Webster? I’m not sure I like his prediction. I hope he’s wrong. I don’t want a workaround for EHR workflow. I want something drastically different.


I love this concept and refer to it as treating healthy patients. Although, I love Ryan’s approach of patients taking responsibility for their own health and engaging with those they love in health-generating behaviors. Sure, doctors are miracle workers, but we as patients should be much more involved in our health as well.

That’s all she wrote. If you like this idea, let me know. If you’d like to participate in a future post, be sure to tweet me @ehrandhit.

A Private HIE is a Vendor Neutral Archive Applied to EHR

Posted on June 17, 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 13 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 fascinated by the work many hospital systems are doing to create a private HIE in their organization. As I wrote, I think that private HIE could lead to a nationwide HIE. It’s still a bit of a long shot, but I think it has more promise than the other HIE initiatives I’ve seen in action.

Along with my interest in private HIEs, I’ve also been fascinated by the switch to Vendor Neutral Archives (VNA) in the radiology space. In a VNA, you can store any medical image in the archive and it doesn’t matter what device you use to capture or view the image. Think about the flexibility that this provides. You’re no longer locked into a certain piece of imaging equipment or to a certain viewing application. Instead, you can switch as needed.

As I consider these two areas, it seems that a private HIE is the first step to having a vendor neutral archive. In fact, I’m not sure why more people haven’t applied the principles of vendor neutral archives to the EHR world. I imagine the challenge is in the complexity of the data. Sure, DICOM isn’t a simple piece of data either, but at least there are some DICOM standards that most medical imaging companies follow. The same can’t be said in the EHR world.

The problem now is that the term HIE has so much failure associated with it. I imagine that’s why we moved from RHIO to HIE as well. However, I think that the change from creating an HIE to a vendor neutral archive for EHR data would be a dramatic shift in thinking. This could be an important decision for a large hospital system. Instead of just trying to share data from EHR to EHR, what if they created a vendor neutral archive of all their EHR data such that your future EHR was built around that VNA instead of around a specific piece of software. I’m not sure there are many hospital CIOs brave enough to look this far out.

What do you think of the VNA concept applied to EHR? Is a private HIE the start of a VNA for EHR?

EMRs Help Identify High-Risk Pregnancies

Posted on June 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.

A group of researchers have begun a project in which they use EMRs to identify pregnant mothers who may be at high risk for medical complications.

The researchers, who are being supported by Johns Hopkins University’s Center for Population Health IT (CPHIT), are conducting a pilot using predictive modeling and natural language processing to find indicators of possible risk in the text of records for pregnant Medicaid beneficiaries, according to an article in iHealthBeat.

Maryland, where the pilot is taking place, has had a statewide HIE in place since 2009. The HIE data is useful for spotting trends in the medical histories of individual patients, as it ensures that doctors have the whole story, but obviously, the data doesn’t analyze itself.

That’s where CPHIT comes in. Its job is to find ways to improve public health using existing sources of data.

To find high-risk moms, the researchers are working with CPHIT to find such hints such as whether the mother smokes or lives in an abusive environment. Historically, those beneficiaries don’t receive regular follow-up care, the story notes.

The team of researchers and CPHIT learned which beneficiaries should be considered a risk, in part, by taking a trip to a Johns Hopkins campus in East Baltimore, where a nurse shared warning signs for complicated pregnancies and along the way, shared different phrases which could confuse the search (such as ‘former tobacco user’ or ‘this patient is not a tobacco user’ or ‘this patient lives with a tobacco user.’)

Now armed with this information — and a difficult-to-obtain link between OB, primary care charts and insurance files — the pilot is slowly moving forward. When researchers find mothers who could be at risk for complicated pregnancy, they contact those mothers about receiving care needed to increase the odds of their having a safe, normal pregnancy and delivery.

Bill Gates Puts a New Spin on the Great EMR Debate

Posted on May 13, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

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.

Google EMR, Healthcare Innovation, and EMR Social Media

Posted on March 24, 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 13 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.

We have a wide range of tweets today, but so many of them offer interesting insights and discussion points. I think you’ll agree.


I think the reply to the original tweet is a great response. I honestly can’t imagine Google getting back into the healthcare game through an EMR. They might do something with discovery of health information. They might do something cool with their image recognition technology and healthcare, but they’re not going to build an EMR. EMR is enterprise software, and Google won’t be going there.


I’m a huge supporter of API’s and the innovation they can create. I just don’t see many healthcare IT vendors ready to open up their systems like that. This is possibly because there’s too much money to be made by selling their product as is. Thanks EHR Incentive money.


It’s pretty provocative to consider, but the simple answer is yes it will. Although, it might be the HIE more than the EMR. I guess we’ll see how that plays out. However, I think control of when and where your information is shared will be a feature. Of course, most people won’t ever use that feature. They’ll just leave the default settings.

Christmas Scavenger Hunt Inspires EMR Wish List

Posted on December 27, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Happy holidays, dear readers! I hope my latest blog post finds you well, resting comfortably away from your usual place of employment, and not tied to a device despite being “on vacation” or attempting to take “time off.”

My family and I are a bit further South than usual, visiting family in Jacksonville and engaging in a time-honored tradition in nearby St. Augustine – the Holly Jolly Trolley. Never was there a better excuse to turn Christmas lights into a 3-D psychedelic experience.

We turned our annual light-seeing drive through the Blackhawk Bluff neighborhood into a Christmas lights scavenger hunt, checking off images from our list as we came across them during our drive. Suitable for the younger crowd, our checklist had images of traditional holiday décor – snowmen, stars, candy canes, candles, etc. The gingerbread man gave us the most trouble, and eventually we had to settle for seeing a gingerbread man windsock.

Driving home I got to thinking about what a similar hunt would look like, say, at HIMSS next year. Gather a group of providers, give them a list of EMR attributes and set them loose in the exhibit hall to find as many as possible within a certain amount of time. I wonder how many vendors/booths they’d have to stop at before they checked everything off the list.

For that matter, it would be interesting to turn the check list into a wish list – pinpoint a number of features providers most want in their EMR and see which vendor offers the most in one package. This would then of course lead to a comparison of price and customer reviews, but that’s another blog entirely.

What would such a check list / wish list look like? Based on the major healthcare trends that have come to light over the last year, I’m willing to bet these features (however pie-in-the-sky they might be) would be included:

  • Guaranteed security / protection, especially with regard to mobile EMR applications
  • Innate knowledge of ICD-9 to ICD-10 code translation
  • Ability to connect to any HIE at the click of a button
  • CPOE
  • Pop-up that suggests, on a patient-by-patient basis, how best to digitally engage with that particular person based on their preferred method of communication
  • Suggested protocols culled from evidence-based medicine analytics

What other features would likely be included? What vendors already offer a majority of these features? Do they exist, or will tomorrow’s start up be next year’s true game changer when it comes to success in the EMR marketplace? Please share your thoughts in the comments below.

EHR Holiday Giving, Teen EMR, and Doctor Emails

Posted on December 16, 2012 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 13 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.

We’ve got some really power packed tweets this week. Some really important and terribly challenging topics. Although, first let’s begin with a holiday season EHR tweet:


I always love when EHR is given to clinics for free. As long as they don’t blind side them with support fees. I’ll assume that TECNEX is doing it the right way. I’d love to hear what other healthcare IT vendors are doing to help others this Holiday season.


Sticky doesn’t even begin to address the issues associated with a teen’s patient record. This is a HUGE problem for HIEs as well. This deserves its own post, but answering the question of who controls a teen’s patient record is ugly and complicated in our current cultural climate.


Elin is definitely not alone in this. Very few docs email their patients. This likely won’t drastically change until reimbursement becomes available for that type of communication. Although, if we can simplify the secure email connection enough to help doctors avoid phone calls they’re currently making, we could make some headway. I’m partially working on this problem in my new company Physia. We don’t have the details on the website now, but I’d love to talk with some doctors, practice managers, or hospitals about what we’re working on if you’re interested. Just drop me a note on the EMR and EHR contact page.

From #AMIA: Interoperability Held Back By Politics

Posted on November 12, 2012 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.

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.