I’ve been inundated with two things as of late – HIMSS12 planning and all things business intelligence. I’ve spent the last few weeks helping prepare the Porter Research team for a webinar on providers’ perceptions of business intelligence, which I’m sure will be a big theme at HIMSS. As I’ve been looking over data from the latest Porter Research survey on BI, I’ve realized that providers know they need it but many aren’t quite sure how to define it, what they need out of it, how to implement it, or how to go about making it meaningful for their organization’s particular needs. And vendors in the healthcare space seem to be (or so I thought) just getting into the game of developing these sorts of tools – be they on a departmental or enterprise level.

Micky Tripathi, President and CEO of the Massachusetts eHealth Collaborative (MAeHC) – a nonprofit healthcare IT advisory and consultancy firm – alerted me to an interesting business intelligence tool called popHealth during my recent interview with him for a Porter Research feature on that state’s developing health information exchange. The MAeHC team, which includes among its services the MAeHC Quality Data Center, will be part of the Interoperability Showcase at HIMSS12, and will help to highlight the functionality and accuracy of the popHealth tool.

“popHealth was originally created as an open-source quality measurement tool by the Primary Care Information Project in New York City,” explained Tripathi, “which was headed at the time by Dr. Farzad Mostashari. Now that he’s the national coordinator for health IT, he’s been promoting it at a national level as a free, open-source tool that any organization in the country can use to send their clinical data to and get Meaningful Use clinical quality measures out of.”

Since then, the ONC has contracted with the Mitre Corporation to further develop the platform for a national user base.

You can of course check out the popHealth website for more info, but in a nutshell, the tool is “an open source reference implementation software service that automates the reporting of Meaningful Use quality measures. popHealth integrates with a healthcare provider’s electronic health record (EHR) system using continuity of care records. popHealth streamlines the automated generation of summary quality measure reports on the provider’s patient population.

“popHealth supports healthcare providers and EHR vendors by reporting clinical quality measures from electronic health record continuity of care files. Providers are empowered to better understand, and analyze the health of their patient population, and meet Meaningful Use reporting objectives, through reports of clinical quality measures. EHR vendors and healthcare providers are free to download, use, and integrate the popHealth software in their systems.”

The popHealth team will at HIMSS also to announce the winner of their tool development challenge. Announced last fall, the competition challenges participants to “develop an application that leverages the popHealth open source framework, existing functionality, standards and sample datasets to improve patient care and provide greater insight into patient populations.”

As the need for business intelligence tools and demand for open source solutions grow, I’ll be interested to see if popHealth ushers in a new era of reporting – one that everyone can take advantage of thanks to its non-existent price tag.

Earlier this year I had the good fortune (and the support of my employer) to join the Technology Association of Georgia (TAG), an organization that offers interest groups for every possible IT niche you can think of. I’ve attended a few of their health society events, and at every one I’m confronted with statistics and anecdotes surrounding the dearth of qualified healthcare IT professionals in the city and surrounding areas. Much attention at these events is also given to the fact that these professionals are needed now more than ever to help smaller physician practices and larger healthcare systems demonstrate Meaningful Use and achieve associated electronic medical record (EMR) adoption goals.

I’ve commented before on the disconnect between the increasing number of healthcare IT educational opportunities being created by the government and vendors’ willingness (or unwillingness, as the case may be) to hire fresh grads. EJ Fechenda of HIMSS JobMine posed a question related to this conundrum better than I ever could have: “With federal deadlines looming, healthcare organizations need to get moving and there are a lot of job seekers out there ready for the challenge. Are there organizations or companies willing to extend opportunities to these candidates? Is there a training or job-shadowing program that can be used as a best practice for other organizations to implement? Who are the champions already doing this or willing to lead the charge?”

I may have found a champion in Rich Wicker, HIMS Director at Shore Memorial Hospital in New Jersey. Wicker is also an adjunct professor at two HITECH-affiliated community colleges, teaching students who already have strong backgrounds in healthcare or IT the basics of process, analysis, redesign, installation and ongoing maintenance to prepare them for second careers in physician office EMR implementations.

He certainly seems to have a passion for the subject. “I’m devoted to the EMR,” he told me during a recent phone interview. “That’s why I started teaching, really, because I want to see that [adoption] happen so badly.”

He tells me his students are guardedly optimistic about their future job opportunities, which he believes will surge this summer alongside an expected increase in physician adoption of EMRs – six months before the deadline to qualify for Meaningful Use incentives.

As we discussed the state of the HIT job market, we both wondered if what type of organization might have a greater role to play in ensuring that graduate from programs like Wicker’s find jobs.

“We had to really battle our way to get one [software] copy from one EMR vendor,” he explains. “I wish they were more amenable to providing educational software/packages like Apple does throughout all their PCs. I know a few different schools have joined with a vendor. One place I know of is showing Vista, another is showing eClinicalWorks, and another partnered with a local hospital that happens to use Sage.

“I have a relatively limited view, but from what I can see, the vendors are not really engaged with the HITECH student development program. I think they’d probably rather do it themselves.”

“Here’s an idea that I came up with,” he adds. “I’ll throw out the RECs (Regional Extension Centers). That’s another entity that’s funded – it’s kind of their job to get the docs to convert. If they could partner with the colleges and the graduates to possibly divert some of their funding to supplementing the graduates’ income while they worked at a physician practice … So the physician, let’s say, for $5 an hour, they could hire a qualified, certified person. These people are pretty good, too. They know what it is to work. They’ve probably worked 10 or 20 years already, either in IT or in healthcare. So they’re mature employees and highly motivated. They would be great to go in and do a 6-month installation. I think it would be great for the physician if, for $5 an hour, you get somebody that would probably cost you $30 an hour somewhere else.

“Let’s say the student can get another $10 an hour supplemented from the REC or somehow through the government. So they get $15 an hour to go in there … they get four or five months of experience doing an installation and then the physician can make a decision … maybe they ultimately hire the person. That’s just a crazy idea that I had that seemed like the pieces are out there that kind of potentially could work. I sent it into the ONC a couple of days ago.”

Could the RECs have a bigger role to play in ensuring that HITECH graduates gain on-the-job experience and employment? I’d love to hear from any readers out there who may work for or with RECs . Is Wicker’s idea doable? Have we found our champion?

I’ve had the good fortune in the past year or two to watch one of my daughters’ favorite babysitters blossom into a full-time nursing student at the University of West Georgia. Not only do my girls benefit from her great bedside manner, including an infinite amount of patience, but I get an occasional inside glimpse into the world of digital medical record keeping in the greater Atlanta area.

Her training at West Georgia has taken her to Children’s Healthcare of Atlanta – Egleston, Wellstar Cobb and Austell, Fayette Piedmont, Tanner Medical Center and Gentiva Healthfield Hospice. She graciously offered to share her rookie’s perspective on the electronic medical records – including SCM/Quest (Allscripts Sunrise Clinical EHR system) and Meditech – she has used at several of the facilities she has trained in.

How long have your healthcare training facilities had EMRs in place?
All except Gentiva Healthfield Hospice – in-home hospice care, for the most part, sticks with paper charting. If they were to make the switch to an EMR, they would have to have access to a central database from their personal computers/iPads/Blackberries, etc. All others have had some sort of electronic database for at least five years.

How intuitive did you find them to be in your first training sessions/rounds?
Once I had been trained in the first system I encountered, the rest seemed very user-friendly. They have been in use long enough now that they are efficient and fairly self-explanatory.

They all allow an employee to cluster patient care and spend enough time with the patient because the time stamp on documentation can be changed to the time that the intervention was completed. For example, I could complete a full assessment on a patient, bathe them and administer their medications without having to document in the computer every few minutes. I could just open their EMR after completing their care and add the correct time stamp on my documentation.

What were the easiest to use, and what were the most difficult?
Meditech was the most difficult to use, perhaps because I had limited access as a student. It was difficult to find complete admission notes and patient histories.

Speaking from a “rookie’s” perspective, what would you tell vendors of these systems to better their products?
Add a patient verification requirement before each documentation session, i.e. each set of vital signs, medications given, etc. (Something simple, like a box with the patient’s name and DOB and an “Ok” button)

Did your supervisors express any enthusiasm or dissatisfaction with any particular systems?
All expressed enthusiasm, but they also were concerned any time a system was to be updated with even minor changes. Fayette Piedmont uses one EMR system for Labor and Delivery, and a completely different system for the rest of the hospital. This means, for the staff, that a new baby’s records have to be re-entered into a new system once they are discharged from labor and delivery and admitted to the NICU or postpartum unit. It also means the pharmacy has difficulty accessing vital information when, for instance, they need to know a baby’s weight to send the appropriate dose of medication to the NICU.

How aware are you of post-implementation training that goes on with EMRs, based on the facilities you’ve trained at? Do your supervisors ever mention it?
Once an employee is hired, they usually must display proficiency with the charting system within a specified training period. When Fayette Piedmont updated SCM/Quest, they did not retrain each employee, but they did send out a packet with a detailed description of the changes. From what I have seen, the older nurses who may have preferred paper charting at one point do not seem to have any problems with the electronic charting.

Have you been made aware of any increase/decrease in positive clinical outcomes as a result of physicians/nurses using these systems? Any examples you feel comfortable sharing?
The major changes to these systems each time they are updated usually involve the addition of safeguards. For example, the newest version of SCM/Quest has the patient’s name, weight, room number and allergies on every page of the charting system, and in multiple locations on the page.

For the employees who pay attention, this has reduced many documentation errors. There is also an embedded link to drug guides in every electronic medication order with explicit instructions and safe dose ranges. For the employee who knows these features are there, they are a tremendous help, and they do serve to protect the patient. It is still possible to document in the wrong patient’s chart, without realizing it, in any system.

Needless to say, it will be interesting to see how her experience with EMRs changes as she continues her studies and then moves into the professional world of nursing, which will likely coincide with healthcare facilities continuing to move through the various stages of Meaningful Use.

Stay tuned for next week’s post, in which I’ll profile an EMR educator, and find out what other students are facing when it comes to EMR training. In the meantime, what sort of healthcare IT-related challenges will our new workforce face in the coming year? Please share your thoughts in the comments below.

There’s a lot of talk in the healthcare industry right now about bringing health management tools to the consumer. Whether it’s apps for your iPhone or iPad, games to play on your Wii, or free-standing health-and-wellness kiosks at your local pharmacy, digital applications seem to the delivery method of choice right now. I think those of us in the healthcare IT industry sometimes take for granted that not everybody in the US has a smartphone, computer or even Internet access, which to me always begs the question: How great are these bright and shiny health apps if the populations that need them most don’t have access to them? And aren’t Meaningful Use and Accountable Care incentives/payments targeted towards government-sponsored healthcare recipients? The most likely patient population to NOT have reliable access to the Internet?

It’s this concept of a digital divide in healthcare that I am starting to believe will truly bend the curve when it comes to absolute interoperability – the secure sharing of information between patient, provider, payer, vendor, government, etc., anytime, anywhere. Only those patients who have access to these digital healthcare technologies will begin to clamor for them at their next doctors’ visits. Only patients’ whose doctors in turn have reached out to them via email, text or social media regarding the switch to electronic medical records, development of health information exchange and the benefits to care these will hopefully bring will be ready and willing to go with the digital flow.

I was intrigued by a recent news story on NPR the other morning that detailed a recently unveiled government plan – the Connect to Compete Initiative – to offer cheaper broadband access and computers to low-income families. The story pointed out that “about one-third of Americans – that would be 100 million people, give or take – do not have Internet access in their homes.” (I’d be interested to know how many of that population are on Medicare or Medicaid, or have no insurance at all.) Participating companies will offer broadband service to eligible families for $10 a month, while others will offer computers for as little as $150.

Further investigating into the story dug up a more detailed report from Reuters, which explained that eligible families will be those who have at least one child enrolled in the National School Lunch Program. According to a recent Commerce Department report on U.S. broadband adoption, only 43 percent of households with annual incomes below $25,000 had broadband access at home, while 93 percent of households with incomes exceeding $100,000 had broadband.

I think this is a step in the right direction, and am pleasantly surprised that it’s being enacted by the government – who got this digital healthcare ball rolling downhill fast in the first place.

As more and more low-income/average/middle-class Americans – or whatever we want to call ourselves – begin to speak out about the systemic inequalities we experience in this country’s financial, healthcare and educational systems, it’s nice to think (naively perhaps) that somebody just might be listening. As we see an increase in adoption of digital technologies in the consumer space, so too do I think we’ll see a correlating increase in adoption of healthcare IT by the providers that care for them.

Amid all the dog-bites-man type health IT news, here are some not-so-positive EMR/EHR stories that have been reported:

- An EMR in Lifespan hospital group gave incorrect prescriptions to some 2000 patients. The article in the Providence Journal says that

The hospitals have placed calls to nearly all the affected patients, although not all have called back, Cooper said. Most patients reached had already obtained the correct medication because the error was noticed by someone at the hospital, or a pharmacist or doctor outside, she said. So far, Cooper said, there is no evidence that any- one was harmed.

Thank goodness for that.

- Incorrectly calculated MU thresholds (GE Centricity). I’m not going to rehash the story, but you can check out Neil Versel’s article in InformationWeek, the spirited discussion on my previous EMR and EHR blog post and John’s EMR and HIPAA blog post.

It might be just be my skewed viewpoint, but GE Centricity related issues are nowhere on par with people being prescribed the wrong prescription. In one case, a few practices may not be able to demonstrate Meaningful Use. Wrong medication could actually be life-threatening to you. So if I had to rank my problems, I’d rather be short by 44K than worry about my EMR inadvertently killing my patients off.

What we need is a governing body, similar to the National Transportation Safety Board, to police EMRs, says Paul Cerrato in a recent InformationWeek Healthcare article.

Cerrato writes:

“An NTSB-like organization for EHRs would at the very least provide a reporting mechanism to keep track of incidents and life-threatening consequences of misusing e-records. More importantly, it could police vendors and healthcare providers who repeatedly ignore these dangers.”

Cerrato goes on to say there are only 120 EHR-specific problems reported to the FDA over the last 18 years. That figure, if correct, to me shows:

• EMR users don’t know how/where they can report EMR related errors or don’t expect any action to be taken – this certainly is credible, because from all quarters, it seems as if the focus is just to get the healthcare field into electronic data capture, not on whether the experience delivers any tangible and useful benefits
• Maybe they’re willing to give EMRs a pass assuming the healthcare IT to be in infancy
• They’re too overwhelmed with the EMRs’ capabilities/inabilities to really see what’s going on

For a national database of EMR problems to be truly relevant, here’s the information I would look for, on problems I’m facing:

• How critical was the error? How many people did it affect, and in what ways – medically, financially?
• How was it handled?
• How common is it – are there others who’ve faced similar problems?
• If the problem was not sorted, what raps on the fingers did the vendors face?

Read the article here.

A little video to brighten your weekend.

*Thanks to Carl Bergman from EHR Selector for pointing it out to me. For those unfamiliar with Gilbert and Sullivan, here’s their wikipedia page.

If you’re someone who loves watching EMR and Healthcare IT related videos as opposed to reading about it, be sure to check out this EMR & EHR Video website.

Here are the lyrics in case you want to take your time reading them:
I am the model user of an EMR that’s meaningful
My patient’s information is computerized and digital
Each visit note and test result is easily retrievable
With speed and accuracy that is almost inconceivable!
It’s shared by every health provider who should need to see it all
And yet it’s safely kept behind a well-protected firewall
If somebody should hack into it that would be a federal crime
And if I share my password it’s for sure I’ll do some prison time

The demographic information I collect may seem absurd
There’s date of birth, race, gender, ethnic group and languages preferred.
In short, in matters medical, computerized and digital
I am the model user of an EMR that’s meaningful.

I reconcile each medication, noting every single pill
Except for controlled substances, I electronically refill
I check for interactions for each single drug I may prescribe
And allergies to medications that my patients may describe.
I take blood pressure, weight and height, and calculate their BMI
And check the box that says I told them if it is too low or high.
The system plots a growth chart I don’t need to do it manually
I ask each patient’s smoking status and update it annually.

I keep a current and updated patient diagnosis list
I send reminders to my patients to prevent appointments missed
I’m typing better than my Mom who once worked in a steno pool
I am a model user of an EMR that’s meaningful.

At each encounter’s end I print an after visit summary
I’m tracking 14 core objective measurements of quality
Plus 5 of 10 more menu set objectives chosen just for me
Will this improve the care I give or is it just frivolity?
It does not matter, ’cause my data pretty soon will be online
And patients who can see it will be judging me in no short time
Deciding if I am a doctor who provides them decent care
Based only on the numbers that the CMS report puts there.

It’s been 5 years since I have looked a patient straight into the eyes
Without my finger on the keys or else a laptop on my thighs
Though I have carpel tunnel syndrome, trigger thumb and shoulder pull,
I am a model user of an EMR that’s meaningful.

If you have been using GE Healthcare’s Centricity Practice Solution or Centricity Electronic Medical Record solution to demonstrate Meaningful Use, you might be in for something of a rude shock. According to an InformationWeek Healthcare story by Neil Versel,

“Some customers of GE Healthcare may not be able to achieve Meaningful Use with their current electronic health records (EMR) systems, as the vendor has discovered “inaccuracies” in its software’s reporting functions.”

According to Versel, GE admitted the problem in a letter that went out to users of the two Centricity products on Thursday and promised a solution by end-November. At the time the InformationWeek story was written, this GE link was not working, but is now. In the document, GE details exactly where its reporting was going wrong. It appears as if the problems lay in the following areas:
- the default race and ethnicity provided by GE’s Centricity products didn’t always map exactly to OMB’s race and ethnicity categories (as an example, GE’s Centricity provided for a single Multi-Racial category, whereas OMB requires that a multiracial person be allowed to select as many races as s/he wants)
- inaccurate recording of smoking status
- inadequate training of doctors on educating their patients about medications
[Link]

Among the recommendations put forward by GE:

- If you’ve already attested for 2011, run reports again for attestation period once GE issues its software update. If the results don’t match up,
a) check if you clear all applicable Meaningful Use thresholds for the original period
b) check if you meet thresholds for all applicable measures

- If you haven’t attested for 2011, hold off on attesting till GE issues its updates.

- Prospectively follow GE’s recommendations for the rest of the year

While the GE letter points out there is still time till Feb 29, 2012 for 2011 attestations, these were my first reactions to reading this piece of news:
- Even a Stage 1 Meaningful Use certified software from a well-known company is not immune to inaccuracies in reporting

- It might seem like a trivial change to move from “Multi-racial” to allowing multiple check-boxes for races, but it could mean the difference between demonstrating MU and not being able to. From GE’s perspective, I would want to know why these small-seeming errors were not caught at the time these Centricity products were Stage 1 MU certified

- How many/what percentage of Centricity EMR and Practice Solution users were affected? It’s not very clear/GE doesn’t say.

- The letter and recommendations don’t show up on GE Healthcare website, and to me it’s also quite interesting that a story like this doesn’t have any hits beyond the InformationWeek article.

- Are there any recourses apart from following GE directives? Maybe if you have softwares other than GE’s Centricity, maybe you can cross-check your results. But I don’t know how many practices actually can afford two or more EMRs. So this really might be a worthless suggestion, unless you can press one of those free EMRs into service!

Full Disclosure: GE is an advertiser on this site, but I’m not sure Priya Ramachandran knew that when she wrote this article.

There seem to be three big acronyms when it comes to healthcare IT and interoperability – EMR (electronic medical record), HIE (health information exchange) and ACO (accountable care organization). Implementing one does not always necessarily lead to the implementation of another. I’m sure everyone will agree, however, that an EMR most likely leads to connectivity to a HIE, which increases the likelihood of participating in an ACO or coordinated care program. I consider these technologies and concepts to be the interoperability triumvirate, if you will.

Of these three, the HIE seems to have seen its day in the sun. Enthusiasm for the concept and its surrounding technologies – at a fever pitch at tradeshows and in the media last year, in my opinion – seems to have been eclipsed by Meaningful Use incentive payments for EMRs and the general consternation related to ACOs. Which is why my interest was piqued when I came across news from a company called NexJ and its new Health Exchange solution.

In order to learn more about the product, touted by the company as one that “brings together the numerous electronic health records systems and applications that exist within healthcare organizations – many of them old, out-dated legacy systems – into one place so that healthcare providers can deliver better, safer, more comprehensive care,” I reached out to Oz Huner, Vice President of Health Solutions at NexJ Systems.

JD: What type of healthcare facility would be the typical customer for your new HIE solution?
OH: “The NexJ Health Exchange solution facilitates the sharing of patient information between healthcare organizations such as hospitals and healthcare providers, ACOs, HIEs, and public health and government agencies.

“Our customers are choosing our solution because it enables them to move from paper-based workflows to electronic workflows and gain such benefits as complete access to accurate information, improved quality of care and patient empowerment.”

Can you give me a specific example of how this HIE can potentially (or has already) improve patient outcomes at a client facility?
“In a current project we’re working on, NexJ is helping meet the challenges emergency department physicians and staff face by providing timely access to the patients’ primary care provider records when they arrive at the hospital admitting department. The NexJ Health Exchange solution connects the patient’s medical record directly with the emergency department systems, improving information sharing between community health providers and the hospital, and improving patient safety.”

Is there a limit to the number of EMRs and applications that can be connected within the NexJ health exchange?
“No, there is no limit to the number of EMRs and applications that can be connected using NexJ Health Exchange. It is highly scalable and can address the needs of the even largest healthcare organizations.”

Does it work with some EMRs better than others?
“No. NexJ Health Exchange provides open, standards-based integration to any EMR system. Its secure, Web-based portal and flexible architecture enables connectivity with legacy and proprietary systems, support for global messaging standards (HL7v2.x and HL7v3.x), exchanging of clinical document formats (CCR and CCD), and support for multiple standardized clinical terminologies (SNOMED, LOINC).

Based on your interactions with providers, do you feel that more and more are finally coming around to the idea of adopting EMRs and eventually HIEs? Or do you find that many providers still think they aren’t worth the expense?
“It is our opinion that EMRs have historically been of great value to healthcare organizations, but since they’re often siloed, such information technology has not been ubiquitously adopted. As an element of a HIE, however, we believe there will be greater EMR adoption as government incentives and programs encourage healthcare providers across the country make the switch to EMRs. As more physicians move to EMRs and become net receivers of patient information, they will realize the benefits of access to accurate information, improved quality of care and patient empowerment.”

Are you working with any regional extension centers around the country to promote your EMR and HIE solutions?
“Indirectly, yes. Through our partnership with Open Health Tools, NexJ is a member of the Platform Implementation Project (PIP), which is working on an open HIE solution for state agencies. The focus is currently on southeast Texas, but is by no means limited to that region.”

NexJ will be at the Health 2.0 conference in San Francisco next week. If you plan on going, stop by their booth and let me and your fellow readers know what you think about this new health exchange solution. Is HIE the buzzword worth bringing back?

We all know that the largest “insurance company” in the US (Medicare and Medicaid) is on board the meaningful use bandwagon. One of the major questions in the healthcare industry is whether insurance companies are going to hop on the meaningful use train as well.

I came across this post on Fierce Health Payer from August of 2010 (that’s a year ago for those keeping track) that talks about four major insurers aligning their pay-for-performance programs with meaningful use. The four payers mentioned are Aetna (NYSE: AET), Highmark, UnitedHealth Group (NYSE: UNH) and WellPoint (NYSE: WLP).

The interesting thing for me is that a year later, I still haven’t seen any real solid movement or announcements from the insurance companies about meaningful use. I may have missed it, so let me know if you’ve seen something, but I imagine one of my readers or someone on Twitter would have pointed out any major meaningful use announcement by private insurance companies.

I suspect that the major insurance companies are sitting back and watching the government’s meaningful use program first. I imagine they’ll be looking at which pieces of meaningful use are actually (excuse the term) meaningful and then use those as a basis for any initiatives that they launch. I’ll be really surprised if any insurer steps out and uses the meaningful use guidelines. They may use some elements, but I’ll be pretty shocked if they support all of meaningful use.

What do you think? How will insurance companies move forward when it comes to EHR and meaningful use?

John’s recent post about ONC trained participants finding it difficult to find jobs struck a chord. A different post over at HIMSS had me thinking in overdrive.

Dr. Noam Arzt has a post on Meaningful Use and public health reporting. In it he discusses the problems faced by providers in submitting health information to public health bodies in ways that are also Meaningful Use Stage 1 compliant.

Health records in provider offices are sometimes stored in disparate silos that are cannot/do not communicate with one another. As Dr. Arzt explains with an immunization records example, there is no demonstrable Meaningful Use if an uncertified system makes the data submissions to public health.

Of course, adding additional functionality to the EHR system with a simultaneous revamping of uncertified system to provide Meaningful Use share data with one another is one (costly) solution. Getting the secondary data system certified is another one. A third approach, which Dr. Arzt touches on, is for Health Information Exchanges to act as/provide for certified intermediaries that bridge the data flow between an uncertified system and one that is Meaningful Use certified.

Here’s what HHS had to say about the subject a month ago:

If an intermediary performs a capability specified in an adopted certification criterion and a provider intends to use the capability the intermediary provides to satisfy a correlated meaningful use requirement (submission to public health according to adopted standards), the capability provided by the intermediary would need to be certified as an EHR Module

This intermediary need can be filled, especially by innovative software vendors or those looking to break into the EHR IT industry. From plain data conversions to web services, IT companies have plenty of tricks up their sleeve to assist HIEs. The technology is there, all we need are savvy techies (companies, people) to see the opportunity this presents and act on it.