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A Private HIE is a Vendor Neutral Archive Applied to EHR

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?

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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 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare IT
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EMRs Help Identify High-Risk Pregnancies

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.

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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.

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

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
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Google EMR, Healthcare Innovation, and EMR Social Media

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.

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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 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Filed Under: ARRA  EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare IT
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Christmas Scavenger Hunt Inspires EMR Wish List

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.

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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 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  EMR Technology  Healthcare
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EHR Holiday Giving, Teen EMR, and Doctor Emails

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.

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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 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

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

Filed Under: EHR  EHR Market  Electronic Health Record  Electronic Medical Record  EMR  EMR Technology  Healthcare IT  Healthcare IT Market  HIE
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Greenway Medical (GWAY) Keeps Momentum Post-IPO

As readers may know, Greenway Medical Technologies is a health IT vendor that sells an integrated EMR and practice management solution, as well as interoperability tools.  The mid-sized vendor excited some criticism earlier this year when it decided to launch an IPO, as few vendors in its size class have done so to date. Naysayers argued that the moment wasn’t right for a company its size to compete with big health IT players for investors.

A few quarters later, Greenway’s stock is doing well, at about $18 per share, having started out at a $10 per share offering price. Analysts, myself included, aren’t surprised to see a well-positioned company in the ambulatory care space do well, but the $550 million firm has done better than expected.

Wall Street was taken by surprise by Greenway’s release of its 4th quarter results for fiscal 2012, in which the company reported revenue growth at 24 percent and raw profit margins at 60 percent (though overall profit stood at 16 percent after all other factors were considered).

What ‘s keeping the stock going seems to be nothing more than plain old fashioned dealmaking — and notably, larger deals that extend beyond lighting up one physician office at a time:

*  Greenway cut a deal with HIT vendor Relay Health (a McKesson subsidiary)  in which the two are offering HIE services.

*   Walgreens chose Greenway’s EHR to wire up its pharmacies for immunizations and health testing.

* Greenway snagged an agreement with Michigan Health Connect, the state’s largest HIE, to provide its technology for practices and clinics using the vendor’s solution.

If you’re seeing a pattern here, you’re not alone. Greenway isn’t just flogging its EMR/PMS to hospitals and medical practices, it’s providing the “last mile” HIE connectivity which has most providers scratching their heads.

Without a doubt, Greenway has formidable competition on the HIE technology side — a story we don’t have space for here — but it seems to me that the combo of having a EMR, PMS and HIE technology to offer is a huge plus.  Like the Wall Street folks, I’m interested to see if this combo keeps Greeway afloat. Things look pretty good at the moment.

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October 23, 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.

Filed Under: EHR  EHR Market  Electronic Health Record  Electronic Medical Record  EMR  EMR Technology  Healthcare  Healthcare IT  Healthcare IT Market  HIE
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HIMSS Pushes For National Patient Identifier System

Well, here’s some trade organization efforts that aren’t just a lot of smoke and mirrors and self-interest. Apparently, HIMSS is pushing Congress hard to establish a national patient identifier system usable for sharing digital records between facilities.

HIMSS execs estimate that as many as 14 percent of all medical records include wrong, potentially dangerous information due to patient misidentification, a problem which is likely to get worse as more systems transition data from paper to EMRs, according to a story in InformationWeek magazine.

As if that wasn’t bad enough, HIMSS says, when organizations begin to share data under Meaningful Use Stage 2, the problem is likely to get much worse. (And doesn’t a system that makes mismatches and lost data likely more or less completely defeat the purpose of setting up HIEs in the first place?)

In reality, a single patient identifier won’t do the job on its own. In fact, it could contribute to errors of its own, HIMSS notes, so adding biometrics and probabilistic matching records will be necessary to really get things right. But getting moving on the identifier is a start.

To get things standardized, HIMSS would like to see Congress request a report from the Government Accountability Office on the subject to help legislators better understand the issues. (They got so far as getting the House to file a resolution in support of the concept last year, but no further.)  HIMSS has since been working with other associations, think tanks, CMS and ONC to raise awareness of the issue.

To get what it wants, HIMSS will have to convince Congress to change existing law, reports InformationWeek. Since 1999, it’s been illegal to establish such an identifier, as Congress apparently felt the public would view it as a privacy risk.

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October 2, 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.

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  HIE  Meaningful Use  Privacy
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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 is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Filed Under: Healthcare IT  HIE
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