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The Patient Voice

Posted on May 11, 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.

For years I’ve been hearing over and over from various places that we need more of the patient voice in healthcare. These messages have come largely from prominent patient advocates like Regina Holliday and ePatientDave. The Society for Participatory Medicine has also had a strong voice in the fight to include the voice in healthcare and in particular in healthcare IT. While each of these people and organization have compelling stories to share, I’ve wondered if they’re really making the impact they want to achieve.

One problem I’ve seen with this effort is that Regina and ePatientDave are seen over and over and over again at conferences. While it’s great that each of them is advocating for the patient voice to be included in healthcare, I wonder if the healthcare IT community has basically tuned out the message because they’ve heard it over and over and from the same two people. If this was a really massive movement, then why don’t we have dozens or even hundreds of patients that are sharing their stories in prominent places?

I’m sure there are some really compelling reasons why we don’t hear from more patients and not the least of which is that they’re not invited. I don’t think that Regina and ePatientDave really want the lime light. They just want the message they espouse to be heard. So, I wonder if their goal wouldn’t be better served if they started sharing their spotlight with hundreds of other patients. I realize this can be a tricky proposition.

However, I first saw this happening at HIMSS where Regina worked together with HIStalk to have a number of patients attend HIMSS and share the patient voice with the healthcare IT Community. I thought this was a great idea and a really good step forward to diversifying the number of patient voices we hear.

As I’ve thought about this a bit, I decided that I wanted to do more to share the patient voice on my network of blogs as well. So, I decided to reach out to a number of patients and provide them a platform where they can tell their story. In some cases this will be about healthcare IT and how it impacted patients. In other cases it might just be a story about the healthcare system in general. Some will be good. Some will be bad. I told them that my goal was to add a little more of the humanity back into what we think about when we think about healthcare.

I’ve got a couple of these patient stories queued up for this week and hopefully we can make this a monthly (at least) fixture across the network of Healthcare Scene blogs. If you are a patient with a story to share, or know someone who does, we’d love to hear about it on our contact us page. I’m especially interested in hearing stories from lesser known patients. Hopefully we can use this platform to share more of the patient perspective. Be sure to let me know what you think of the patient stories this week.

Slickest Solution I Saw at HIMSS15

Posted on April 22, 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.

This probably says something about me, but I’m always intrigued by really slick solutions that leverage creativity to solve a problem. While at HIMSS amidst all the vendor noise, I saw a solution that I fits this description. The solution came from a scanning company called Ambir and the solution is called nForm. Yes, I was a bit surprised that it came from a scanner company too, but that’s the beauty of HIMSS. You never know where you going to find something interesting.

In any office, one of the biggest annoyances during an EHR implementation is that you can’t go fully electronic. There are still a large number of forms that require a patient signature. In 95% of cases this means that you’re handing the patient a stack of paper forms which they can sign. Most organizations then scan those forms into their EHR. It makes for an awful workflow and we all know it.

The nForm solution from Ambir solves this problem and makes the process electronic. You can literally scan in any form and nForm will make that paper form an electronic form that can be completed electronically on an iOS, Android or the nForm 410x tablet device. The patient can literally fill out the form on the screen as if they were filling out the form on paper. Then, once the patient completes the form, nForm will upload it to your EHR using the same workflow you’d been using when you’d scan the form into your EHR.
nForm
To me the most powerful part of this solution is that it uses your paper form workflow without requiring any sort of new integration from your EHR vendor. Even if you usually print out your intake forms from your EHR, you can “print” them to nForm and then when the patient fills out the forms they’ll get pushed back to the EHR. If you’re a clinic that just has a stack of intake paperwork that you attach to a clipboard for the patient, you can have those already queued up on nForm and just hand the tablet to the patients to complete.

While I’ve talked about the intake forms, you can also use this for other forms you might need signed later in the office visit as well. We all know those pesky consent for treatment forms that we’re still doing on paper and hopefully scanning in later.

I love that this is a slick solution for healthcare, but I’m also interested in the product for my own personal use. The only things I print these days are when I need to sign something. How much nicer will it be for me to just print to nForm, sign it and then send it to the receiving party? Saves the hassle of going to the printer. Saves ink and paper which will make all you eco friendly people happy.

While nForm supports you writing anything on a form (it literally is like an electronic piece of paper), I’m skeptical about how well it will do for a really detailed form. Obviously in healthcare we’re moving these forms to a patient portal so we can get the granular data elements stored as unique data elements. So, we’re not handing a patient a lengthy paper form as much anymore.

With that said, I’m not sure how a lengthy health history form would look using nForm. People’s bad handwriting together with the digital input might make it hard to read. For signatures or basic forms it won’t be an issue at all. Plus, they’ve made it so the virtual pen color is different from the background of the form. It’s actually really easy to look at a form and see what was completed (or not completed) by the patient. In that way, it makes the form more legible than a paper form. Although, it still depends on the quality of their handwriting.

All in all, I’m really impressed with the nForm solution. I’ve implemented a Topaz style signature pad solution before, but that required integration with the EHR (which very few have done) and still felt awkward since you weren’t actually signing on the document itself. nForm has all the advantages of the paper form, but in a nice electronic solution. I love slick solutions like this.

Full Disclosure: Ambir is a Healthcare Scene advertiser.

From Around the #HIMSS15 Twittersphere

Posted on April 8, 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.

Yep, I have HIMSS on the mind. What can I do? I’ll be there for a week with more meetings and events than I care to count. It’s going to be fun. I thought it would be fun to highlight some tweets (like I do regularly) and add a little bit of my own snark (another regular occurrence).


A little self serving (I know), but these hidden gems really are worth it and people don’t even know that they happen. Now you’ve been told.


Would you rather hang out with Bennett at the parties or with Chuck at the workflow tech companies? That’s a tough one. Although, you have to credit Chuck on being true to form. Plus, I hear he’s going to be displaying his robot, 3D Printing, drone, etc at the ClinicSpectrum booth. Should be something different than you’ll find at most booths.


I thought security would be really big at HIMSS as well, but I haven’t seen that to be the case. Or at least I thought it would be much bigger. Sure, the topic will be covered in most sessions and discussions, but I thought we’d see a wave of new HIPAA related vendors at HIMSS, but that doesn’t seem to be the case. Maybe I just haven’t heard from them.


People don’t go to HIMSS? (I told you I’d bring some snark). I think our HIMSS15 Twitter Tricks and Tips will help people out that aren’t attending.


Too far! Hey…they asked. I’m not complaining though. I enjoy walking. I think I lost 5 pounds at HIMSS last year. I chalk it up to all the walking, but also no time to actually eat. One of the best ways to avoid eating is to stay busy. HIMSS keeps me busy. (Look at that health knowledge I’m throwing your way).


Social vendor? How do you measure that? Who throws the best party? Who is the most friendly? Who tweets the most? Who has the best tweets?

I think he probably means which vendor best uses social media. My guess will be CDW healthcare in that regard. The people behind their social accounts (StudioNorth for those keeping track at home) are always up to something. They better not let me down now that I predicted it 😉


I’m lucky to call Shahid my partner, so I take every chance I can get to hear him speak or hear discussions he lead. The topic of getting clinical value and ROI out of data is going to be such an important one for healthcare going forward.


This has to make your heart hurt a little. Looks like Richard is from Bogota, Colombia. I hope someone can help him out. Being out $2k would stink.

I fly out Saturday and I’m there until Friday. I look forward to seeing so many of you at the event. I’ll be doing my full write up of places I’ll be and things to see at HIMSS 2015 over on EMR and HIPAA tomorrow.

#HIMSS15 Mix Tape

Posted on April 2, 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 always inspiring Colin Hung has put together what he’s calling the #HIMSS15 mix tape. He basically reached out to various people on healthcare social media (including myself) asking them which songs we’d add and why. The results were quite entertaining. Here were my three submissions:

Cry – Faith Hill. Suggested by @techguy (John Lynn) “I think there are plenty of reasons to cry at HIMSS”

Just Give Me A Reason – Pink Suggested by @ehrandhit “About doctors love of healthcare”

Ice Ice Baby – Vanilla Ice. Suggested by @ehrandhit See this fantastic blog for the reason why.

I really liked Brad’s creativity (no surprise he’s talking ICD-10):

The Final Countdown – Europe. Suggested by @Brad_Justus “For hopefully the last countdown to ICD-10!”

Who doesn’t like the shoutout to the #HITChicks:

Every Little Thing She Does is Magic – The Police. Suggested by @CyndyNayer “I’m thinking this is the background for #HITChicks wherever we are!”

I can imagine Wen and her team having a dance party to this song (would make me want to be on her team):

Everything is Awesome – Tegan and Sara ft The Lonely Island. Suggested by @HealthcareWen“Because it’s an awesome team song”

So many other good ones, so go and read them all.  However, Mel Smith Jones offers a solid description of HIMSS:

I’m Gonna Be (500 Miles) – The Proclaimers. Suggested by @MelSmithJones “It’s always too long of a wait until I get to see everyone. Then we put ourselves into blissful misery with all of that endless walking. Then I can’t wait until next year as soon as it is over :)”

Word on the street is that Colin is working to play the mixtape during the New Media Meetup at HIMSS15 that we host each year. Of course, a big thanks to Stericycle and their product Patient Prompt (Where Colin works) for sponsoring the New Media Meetup.

The Evolving Security and Privacy Discussion

Posted on April 1, 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.

HIMSS put out the great tweet above. The image itself is worthy of a laugh. Although, only a partial laugh since in healthcare many people don’t understand that a password doesn’t mean it’s encrypted. Plus, that’s just emblematic of how elementary healthcare’s implementation of security is in most healthcare organizations.

Yes, there are the outlier organizations and there are even the outlier security and privacy individuals within a large organization. However, on the whole healthcare is not secure. The hard thing is that it’s not because of bad intentions. Almost everyone I’ve met in healthcare really want to ensure the privacy and security of health information. However, there’s a general lack of understanding of what’s needed.

With that said, I have seen a greater focus on privacy and security in healthcare than I’ve ever seen before. HIMSS featuring so many sessions is just one indicator of that increased interest in the topic. It’s hard to ignore when every other day some major corporation inside and outside of healthcare is getting breached.

One of the biggest security holes in healthcare is business associates. Most don’t have a real understanding of how to be HIPAA compliant and that’s a massive risk for the healthcare organization and the business associate. That’s why I’m excited that people who get it like Mike Semel are offering HIPAA Compliance training for business associates. Doing HIPAA compliance right is not cheap, but it’s cheaper than getting caught in a breach.

Personally, I’ve seen a whole wave of HIPAA compliance products and services coming out. In fact, I’m looking at creating a feature on EMR and HIPAA which lists all of the various companies involved in the space. I’m sure I’ll hear a lot of discussion around this topic at HIMSS.

A Few #HIMSS15 Twitter Tips and Tricks

Posted on March 27, 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.

If you haven’t been keeping an eye on the #HIMSS15 hashtag, it’s been incredibly active and we’re still a little over 2 weeks out from the event. I have no doubt that #HIMSS15 will shattered past years records for tweets at HIMSS.

While I’ve always been a huge fan of social media at conferences, I think it’s going to be used a bit differently at HIMSS 2015 than it’s been used in years past. I believe this, because I’ve seen it happen at other conferences that literally blow up the twitter stream for the conference hashtag. You have to take a different strategy.

Here are a few tips you might want to consider as you approach your use of Twitter at HIMSS 2015.

Get to Know Twitter Advanced Search – If you’re not familiar with Twitter’s advanced search feature, now’s the time to get familiar with it. The #HIMSS15 Twitter stream is so voluminous that advanced searches can be a really powerful way for you to find interesting people. For example, do a search for #HIMSS15 and people that are near whatever city you’re from. There’s nothing like traveling across the country to bond with people in your local area. If you’re looking for other Epic users, do a search for #HIMSS15 and Epic. Simple little filters like that will help you extract value out of the #HIMSS15 Twitter stream.

Create a Twitter List – Spend some time creating a Twitter list of people that you trust and respect that will be at HIMSS. Then, you can just check out the tweets from the people on that list. I’d suggest you add @ehrandhit, @HITMarketingPR and @techguy to that list, but I am a bit biased. A few others I’ll be watching are @nversel, @healthcarewen, and @mandibpro to name just a very few. I’d love to hear your list of #HIMSS15 people we should follow on Twitter in the comments.

Follow @HITConfGuy – The man behind this account does a lot of work to filter through the #HIMSS15 stream, so you don’t have to. I’m pretty sure this year I’ll be relying on this account a lot more than I have any other year. He does a good job keeping it interesting.

Interact with People Directly – Gone are the days that you can just say something on #HIMSS15 and get tons of responses. If you want to get a response from people, then mentioned them directly. Plus, you can tag someone in a tweet as well. You can be sure there will be some side threads happening with a whole group of interesting people tagged in the tweet. While we can’t always watch the full conference stream, most people watch when they’re mentioned or tagged on Twitter.

Check Out the Subtags – Each year, a number of new hashtags come out of the HIMSS conference. In fact, HIMSS puts together their official hashtag guide with all of them. However, even their list can be a bit overwhelming. I think the two hashtags that will be most interesting are #IHeartHIT and possibly #HITWorks. I’m happy that the #HITMC hashtag was also listed by HIMSS for those interested in social media marketing and influencing. I guess this article would technically be appropriate for the #HIMSS15Hacks hashtag.

Shake Hands, Dance, Share a Meal – While I love social media as much as the next person, don’t forget to enjoy all of the in person stuff that happens at HIMSS was well. For me, social media often facilitates many of the in person meetings and events that I attend. However, the opposite can also be the case. If you sit down and meet someone over lunch or on the dance floor at the opening reception, share and connect with them on Twitter. I always love when a year or two later someone tweets me with “Do you remember when…” and then usually “I’ve been following you ever since and…” Twitter is a fantastic way to stay connected with people you meet throughout the show.

There’s a few tips or tricks to get the most out of your interactions on Twitter. If you have other suggestions or if you disagree, I’d love to hear it in the comments.

Healthcare Interoperability in Action

Posted on March 16, 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.


100+ live clinical information systems sharing health data at HIMSS makes for a good headline. What’s not clear to me is how this is really any different than the past 2-3 interoperability showcases at HIMSS. Don’t get me wrong. I love that these systems can interoperate, but they’ve been able to interoperate for a long time. At least that’s what you believe from the headlines coming out of every interoperability showcase at HIMSS.

I’m hoping to learn at HIMSS why there’s such a wide gap between interoperability between systems at HIMSS and the real world. Is it a lack of desire on the part of healthcare organizations? Is it that the sandbox environment is much simpler than trying to share data between EHR systems which have had a series of customizations as part of every EHR implementation?

I also think there’s a major gap between hospital interoperability and ambulatory care. Most doctors I know aren’t working on interoperability at all. They wouldn’t even know where to start. They just assume that their EHR vendor is going to eventually solve that problem for them. Sure, they wish that it would happen, but I don’t think doctors feel like they have any power in making it a reality. I’d love to hear if you think that’s a good or bad assumption on the part of doctors.

Talking HIMSS interoperability showcase headlines, how much more powerful would it be to have the headline say “100s of live clinical information systems sharing data throughout the country.” 100s still feels weak, but at least we’d be talking about interoperability in a real life situation and not just the perfectly designed test systems.

I guess I’m still interested in “A little less healthcare interoperability talk…a lot more action.

Meaningful Use Stage 3 to Come Out Before HIMSS15?

Posted on March 11, 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.

Madelyn Kearns from Medical Practice Insider is reporting that we might see meaningful use stage 3 regulations before HIMSS. Here’s the exact quote from Robert Anthony, deputy director of CMS’ quality measurement and health assessment group:

“We will have two regulations that will come out in time to discuss meaningful use”

It’s hard to imagine that one of these 2 regulations will not be meaningful use stage 3. No doubt CMS and ONC will want to get some feedback from the HIMSS community on meaningful use stage 3. What better place than at the conference?

Madelyn aptly points out that Robert Anthony already has one session scheduled at HIMSS to discuss the meaningful use stage 3 requirements. I have a feeling that is going to be one of the really well attended sessions. Especially if the MU stage 3 rule does come out before HIMSS.

I realize that CMS is bound by laws on when they can announce the various rules and regulations, but I hope they’ve planned out the timeline better than they’ve done in the past. My colleague Neil Versel at Meaningful Health IT News has regularly pointed out how the rules always seem to go public on a Friday. He’s hypothesized that it was the case that they were trying to hide something. I think that’s true for many Washington news stories, but I think it was coincidence in meaningful use’s case.

Even worse than a Friday is the Friday before HIMSS. Talk about ruining the weekend before HIMSS. Although, if I remember right one time they announced the rule in the middle of HIMSS. I remember meeting with a number of EHR vendor’s government relations people who were grumbling about the late night reading of the meaningful use rule that they’d be consuming all night in the middle of the craziness of HIMSS.

Hopefully CMS has learned from past experience and has planned properly to be able to announce the meaningful use stage 3 rule well before HIMSS. Doing so will give people time to look over the rule so they can have a meaningful discussion of the rule at HIMSS as opposed to some frenetic review of what’s been proposed.

Either way, I’m very interested to see what meaningful use stage 3 will look like. My prediction is that it won’t be dramatically different from stage 2. It will be more of the same with maybe 1-2 additions. It’s too bad, because I’d still love to see them blow up meaningful use. Every doctor I know would love to see that as well. Instead I think we’ll be saying “more of the same.”

2015 Healthcare IT Conference Planning

Posted on December 23, 2014 I Written By

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

As the year comes to a close, I’m starting to think about my conference plans for 2015. I traveled quite a bit to some amazing conferences in 2014 and I’m sure I’ll be doing more of the same in 2015.

Ever since August 2014, I’ve been listing my Health IT and EHR conference plans on EMR and HIPAA for others to see. Hopefully it’s a great resource for those trying to navigate the Healthcare IT conferences.

I imagine I’ll probably do a similar schedule of events this year. So far I only have CES, HIMSS, and the Health IT Marketing and PR Conference on my spring conference calendar. Thankfully, the spring conference season is much calmer for me.

I’d love to see and hear what conferences are on your radar for 2015. Are there health IT conferences I should consider adding to my list? I always love to hear about new ones, so please share in the comments or on our contact us page. Along those same lines, let me know which are your must attend health IT conferences. Thanks in advance for sharing with myself and the broader EMR and EHR community.

Could Clinicians Create Better HIE Tools?

Posted on August 13, 2014 I Written By

The following is a guest blog post by Andy Oram.His post reminds me of when I asked “Is Full Healthcare Interoperability a Pipe Dream?

A tense and flustered discussion took place on Monday, August 11 during a routine meeting of the HIT Standards Committee Implementation Workgroup, a subcommittee set up by the Office of the National Coordinator (ONC), which takes responsibility for U.S. government efforts to support new IT initiatives in the health care field. The subject of their uncomfortable phone call was the interoperability of electronic health records (EHRs), the leading issue of health IT. A number of “user experience” reports from the field revealed that the situation is not good.

We have to look at the depth of the problem before hoping to shed light on a solution.

An interoperability showcase literally takes the center of the major health IT conference each year, HIMSS. When I have attended, they physically arranged their sessions around a large pavilion filled with booths and computer screens. But the material on display at the showcase is not the whiz-bang features and glossy displays found at most IT coventions (those appear on the exhibition floor at HIMSS), but just demonstrations of document exchange among EHR vendors.

The hoopla over interoperability at HIMSS suggests its importance to the health care industry. The ability to share coordination of care documents is the focus of current government incentives (Meaningful Use), anchoring Stage 2 and destined to be even more important (if Meaningful Use lasts) in Stage 3.

And for good reason: every time we see a specialist, or our parent moves from a hospital to a rehab facility, or our doctor even moves to another practice (an event that recently threw my wife’s medical records into exasperating limbo), we need record exchange. If we ever expect to track epidemics better or run analytics that can lower health case costs, interoperability will matter even more.

But take a look at extensive testing done by a team for the Journal of the American Medical Informatics Association, recently summarized in a posting by health IT expert Brian Ahier. When they dug into the documents being exchanged, researchers found that many vendors inserted the wrong codes for diagnoses or drugs, placed results in the wrong fields (leaving them inaccessible to recipients), and failed to include relevant data. You don’t have to be an XML programmer or standards expert to get the gist from a list of sample errors included with the study.

And that list covers only the problems found in the 19 organizations who showed enough politeness and concern for the public interest to submit samples–what about the many who ignored the researchers’ request?

A slightly different list of complaints came up at the HIT Standards Committee Implementation Workgroup meeting, although along similar lines. The participants in the call were concerned with errors, but also pointed out the woeful inadequacy of the EHR implementations in representing the complexities and variety of patient care. Some called for changes I find of questionable ethics (such as the ability to exclude certain information from the data exchange while leaving it in the doctor’s records) and complained that the documents exchanged were not easy for patients to read, a goal that was not part of the original requirements.

However, it’s worth pointing out that documents exchange would fall far short of true coordinated care, even if everything worked as the standards called for. Continuity of care documents, the most common format in current health information exchange, have only a superficial sliver of diagnoses, treatments, and other immediate concerns, but do not have space for patient histories. Data that patients can now collect, either through fitness devices or self-reporting, has no place to be recorded. This is why many health reformers call for adopting an entire new standard, FHIR, a suggestion recognized by the ONC as valid but postponed indefinitely because it’s such a big change. The failure to adopt current formats seems to become the justification for keeping on the same path.

Let’s take a step back. After all those standards, all those certifications, all those interoperability showcases, why does document exchange still fail?

The JAMIA article indicated that failure can be widely spread around. There are rarely villains in health care, only people pursuing business as usual when that is insufficient. Thus:

  • The Consolidated CDA standard itself could have been more precisely defined, indicating what to do for instance when values are missing from the record.

  • Certification tests can look deeper into documents, testing for instance that codes are recorded correctly. Although I don’t know why the interoperability showcase results don’t translate into real-world success, I would find it quite believable that vendors might focus on superficial goals (such as using the Direct protocols to exchange data) without determining whether that data is actually usable.

  • Meaningful Use requirements (already hundreds of pages long) could specify more details. One caller in the HIT Standards Committee session mentioned medication reconciliation as one such area.

The HIT Standards Committee agonized over whether to pursue broad goals, necessarily at a slow pace, or to seek a few achievable improvements in the process right away. In either case, what we have to look forward to is more meetings of committees, longer and more mind-numbing documents, heavier and heavier tests–infrastructure galore.

Meanwhile, the structure facilitating all this bureaucracy is crumbling. Many criticisms of Meaningful Use Stage 2 have been publicly aired–some during the HIT Standards Committee call–and Stage 3 now looks like a faint hope. Some journalists predict a doctor’s revolt. Instead of continuing on a path hated by everybody, including the people laying it out, maybe we need a new approach.

Software developers over the past couple decades have adopted a range of ways to involve the users of software in its design. Sometimes called agile or lean methodologies, these strategies roll out prototypes and even production systems for realistic testing. The strategies call for a whole retooling of the software development process, a change that would not come easily to slow-moving proprietary companies such as those dominating the EHR industry. But how would agile programming look in health care?

Instead of bringing a doctor in from time to time to explain what a clinical workflow looks like or to approve the screens put up by a product, clinicians would be actively designing the screens and the transitions between them as they work. They would discover what needs to be in front of a resident’s eyes as she enters the intensive care ward and what needs to be conveyed to the nurses’ station when an alarm goes off sixty feet away.

Clinicians can ensure that the information transferred is complete and holds value. They would not tolerate, as the products tested by the JAMIA team do, a document that reports a medication without including its dose, timing, and route of administration.

Not being software experts (for the most part), doctors can’t be expected to anticipate all problems, such as changes of data versions. They still need to work closely with standards experts and programmers.

It also should be mentioned that agile methods include rigorous testing, sometimes to the extent that programmers write tests before writing the code they are testing. So the process is by no means lax about programming errors and patient safety.

Finally, modern software teams maintain databases–often open to the users and even the general public–of reported errors. The health care field needs this kind of transparency. Clinicians need to be warned of possible problems with a software module.

What we’re talking about here is a design that creates a product intimately congruent with each site’s needs and workflow. The software is not imported into a clinical environment–much less imposed on one–but grows organically from it, as early developers of the VistA software at the Veterans Administration claimed to have done. Problems with document exchange would be caught immediately during such a process, and the programmers would work out a common format cooperatively–because that’s what the clinicians want them to do.