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A New Look at Plan of Care and Patient Instructions

Posted on October 30, 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 don’t know Jess Jacobs, she’s a passionate patient advocate that use to work for the federal government. Although, she might be best known for her tweets from the hospital. If you scroll back through her Twitter feed, I’m sure you’ll find them.

Today Jess offered up this tweet to reframe our discussion on plans of care and patient instructions:

I’m sure that most doctors will mock these instructions, but it definitely illustrates a very different relationship between doctor and patient. How many doctors go to this extent to make sure that their patients are well? I’m sure many of them are asking “I’d love to go that deep with patients, but how do I get paid for it?”

I’ve regularly argued that we need deeper interactions with a healthcare professional if we want to be truly healthy and not just continue to treat the sicknesses we have. However, I don’t think these interactions will happen with a doctor. This type of relationship needs someone that’s more social worker than doctor.

Where will all this go? I’m not sure, but seeing these patient instructions sure caused me to rethink the doctor-patient relationship.

Quality Metrics Have A Negative Impact on the Quality of Care

Posted on October 29, 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.

A few months ago I asked the question about whether ACOs were more about good accounting than they were improving care. Here’s a summary of the fear:

I think this is a massive challenge with value based reimbursement. We require certain data to “prove” that there’s been a change in how organizations manage patients. However, I can imagine hundreds of scenarios where the organization just spends time managing how they collect the data as opposed to actually changing the way they care for patients in order to improve the data.

I recently came across an article from HealthLeaders Media which says things may be even worse than I described. Not only do quality metrics not improve care, but they may actually have a negative impact on the care provided.

The article cites a survey by the Commonwealth Fund and Kaiser Family Foundation which highlights this result. Here’s an excerpt from the article:

Of the 1600 primary care physicians surveyed, 55% said the growing use of quality metrics to assess provider performance is having a negative impact on the quality of care. Less than a quarter said that quality metrics have a positive impact on healthcare quality.

Fifty-five percent of the nation’s primary care physicians are currently receiving financial incentives based on quality or efficiency measures. Fifty-two percent cited concerns around programs that impose financial penalties for unnecessary hospital readmissions.

Amy Mullins, MD from the American Academy of Family Physicians also has this zinger of a quote, “It often seems [payers] are measuring to measure, not measuring to improve quality.”

This is one of the major challenges associated with trying to legislate or regulate payment based on quality. If you get it right, then the incentives will encourage providers to improve care. If you get it wrong, doctors will jump through the hoops and care will not improve and may even get worse.

I recently wrote that Digital Health is Hard. I think building appropriate quality metrics that actually encourage improved quality care is even harder. Many say that this is the time when we learn from our experiences. I just feel bad for all the guinea pigs who are being tested on without a choice.

Shake the Flu Off Video

Posted on October 28, 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.

You know that I can’t resist a good healthcare parody video and so I had to share this parody video of Shake It Off that was done by Beth Israel Deaconess Medical Center. I love the message of the video and I love how videos like this bring an organization together in a really cool shared experience. What do you think?

Here’s the lyrics for the song:
I’ve got body aches
I got a fever and the shakes
So what was my mistake?
Did I forget to vaccinate?

Was it that guy who shook my hand?
Is that where it began?
I just don’t understand
Just don’t understand

I had the blues and
Doc said “it’s the flu, man”
She said, “I’ve got some news here –
My advice – if you wash, it’ll be alright.”

There’s a rule you must obey, bey, bey, bey, bey
To keep the flu away, way, way, way, way
Gotta wash ‘em like you’re cra-cra, cra-cra, cra
Then shake ‘em off, shake ‘em off
There’s no reason to delay, lay, lay, lay, lay
Get your flu shot right away, way, way, way, way
And show off your Band-aid, aid, aid, aid, aid
Then shake it off, shake it off

Now I’m squeaky clean
The soap dispenser fiend
I’m the Cal Stat pumping queen
I’m the Cal Stat pumping queen

Take your time, it’s not a race
Don’t wanna leave a trace
And please don’t touch your face
Please don’t touch your face

Cover up your cough, man
Sneeze into your sleeve, man
Stay home if you’re sick, and
My advice – if you wash, it’ll be alright.

There’s a rule you must obey, bey, bey, bey, bey
To keep the flu away, way, way, way, way
Gotta wash ‘em like you’re cra, cra, cra, cra, cra
Then shake ‘em off, shake ‘em off
If you think they look Okay, kay, kay, kay, kay
You should wash ‘em anyway, way, way, way, way
Get your flu shot right away, way, way, way, way
Then shake it off, shake it off

Hey, hey, hey
Just think while you were getting sick
And spreading all
Those dirty dirty germs everywhere
You could have just avoided getting
Sick… this… week…

My best friend put the flu to an end
Cuz she pumps going out
And she pumps going in
For the patient over there
With the hella good hair
You could wash a little more
And then you shake, shake, shake

There’s a rule you must obey, bey, bey, bey, bey
To keep the flu away, way, way, way, way
Gotta wash ‘em like you’re cra, cra, cra, cra, cra
Then shake ‘em off, shake ‘em off
If you think they look Okay, kay, kay, kay, kay
Wash ‘em anyway, way, way, way, way
And make sure to vaccinate, ate, ate, ate, ate

Then shake it off, shake it off

Is Healthcare an Art or Science?

Posted on October 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.

At this morning’s Healthcare IT Transformation Assembly one of the panelists commented that providers need to stop treating healthcare as an art and treat it as a science. I was a little surprised how strong the panelist was in this comment. What do you think? Is healthcare an Art or a Science?

My take is that healthcare is more science than it is art. However, the problem we have right now is that healthcare is being treated as more art than science.

When you look at the history of healthcare, it makes sense why many providers treat the care they provide as art. For a long time the science of healthcare wasn’t there and so doctors had to practice the art of medicine because the science of healthcare wasn’t there yet and the science of healthcare wasn’t being shared easily with all of healthcare.

Think about how this has changed over the years. We have hundreds of new ways to measure the quality and effectiveness of the care we provide. We also have the systems to be able to measure the effectiveness of the care we provide. Furthermore, we have drastically more effective ways to communicate the results of the studies and data collection we do. We no longer have to wait months for the journal to come out and be sent to doctors who then have to find the time to read it. We’re in an instant communication environment.

The CMIO of Intermountain, Stanley M. Huff, MD, made a fascinating observation about our ability as humans to understand the impact of the choices we make. He said, “The human mind doesn’t have the ability to identify the difference between a 3 in 100 and 4 in 100 difference in results.” A difference like this is so subtle that we are unable to note the difference. If you ask that 1 person who got a better result, they certainly note the difference. If you look at the cost of that 1 person who has a bad outcome, that makes a huge difference in healthcare costs as well.

We need more scientific tracking of outcomes like this and then we need to implement workflows and communication that ensures that the best treatment is being used. Unfortunately we don’t have this type of tracking and understanding about every aspect of healthcare. That’s why it’s true that healthcare is more science than art. However, over time healthcare will become more and more science. Our healthcare IT solutions should better help us know and implement the science of healthcare.

Could a Virtual Scribe Solve EHR Usability Problems?

Posted on October 26, 2015 I Written By

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

Jibo: A Home Robot Promises a New Level of AI Use

I ran across a new, five pound, home robot called Jibo in an IEEE publication my wife gets. Jibo, whose first planned product run has sold out at $750 each, promises to ship this Spring. It bills itself as the first social robot.

Started as an INDIEGOGO project that banked close to $4 million, Jibo recently added $36 million from investors.  Its technology smarts come from its founder, chief scientist and MIT Associate Professor, Dr. Cynthia Breazeal.
Jibo’s driven by an ambition to bring artificial intelligence capabilities to the home market. Though it’s not mobile, it’s touch sensitive, gesture sensing and can dip and swivel 360 degrees to capture events. Jibo’s natural language processing uses two high res cameras to recognize faces, do your selfies and run video calls.

Dr. Cynthia Breazeal and Friend

Dr. Cynthia Breazeal and Friend

With these capabilities, Jibo is far smarter than smart thermometers, vacuum cleaners or security systems. It’ll use these to learn your phrases and gestures, so it can act as your calendar, inbox, media organizer and general personal assistant. Importantly, Jibo has a significant, developer program. That’s what gave me the idea for a virtual scribe.

An EHR Virtual Scribe?

High end EHRs have been using natural language processing for years. You dictate and the system figures out what and where to put the text. These pricey add-ons aren’t widely used.

Less versatile, but far more used is Dragon Voice. Other smart assists are various macro systems and front ends. These improve an often frustrating, mind numbing EHR interface, but are only a partial solution. Their major disadvantage is that the user is tethered to a machine. Ideally, a doctor should be able to talk with their patient, and seamlessly use the record as needed.

If new, smart devices such as Jibo really can aid around the house, it should be possible in another generation or so, to free practioners from their tablets or keyboards. An EHR virtual scribe with cameras and projector could do these tasks:

  • Workflow. Set up workflow based on patient history and appointment type.
  • Encounter Record. Record doctor-patient audio and video unobtrusively.
  • History. Project the patient’s history and labs, etc., as requested.
  • Updates. As the user dictates, the scribe could show the entries to both.
  • Assessment. As the user builds the note, the scribe could show how it compares to similar cases or when asked do searches.
  • Plan. The scribe could produce potential plans and let the user modify them.
  • Orders. Based on the plan, past orders, etc., it could propose new orders.
  • Education. Provide tailored materials, references, etc.
  • Appointment. Set up appropriate follow on appointments.
  • Claims. Interface with claiming and reporting systems as needed.

Products such a Jibo hold the potential for a technical fix for EHRs seemingly intractable usability problems and do it at reasonable cost. Their combination of adaptable hardware, AI abilities and unobtrusive size may just be the ticket.

A Lawyer’s Perspective on EHR Vendors Holding EHR Data Hostage

Posted on October 23, 2015 I Written By

The following is a guest blog post by Bill O’Toole is the founder of O’Toole Law Group.
William O'Toole - Healthcare IT and EHR Contracts
The recent post, EHR Data Hostage Wouldn’t Exist if EHR Were Truly Interoperable, on EMR & HIPAA got me thinking, and I wanted to offer a few observations from my experience as an HIT lawyer.

The goal is wonderful. However, it would take years and years to achieve such a goal. Data extraction and subsequent import take time, sometimes lots of it. What if there were a standardized specification to which vendors could design extraction tools and programs? Follow that with contractual commitment that the vendor adheres to those specifications. We did it with HL-7, why not data transport?

Thankfully I have not yet represented a vendor that withheld data solely due to the departure of a customer. I have however been involved in very tough situations where the vendor treads a fine line in not releasing data until customers fulfill their obligations (such as paying for use of the software). I like to believe that there is more to the story in the vast majority of data hostage disputes, and in my experience, this has always been the case.

The emergence of the hosted subscription model has resulted in a control shift to the vendor, as opposed to the on premises model where the customer is in control and a vendor can be shut out. That said, vendor assistance is usually required to extract data.

“HIPAA vs. vendor rights” is a very hot topic for me. Providers must provide patient data on request. Vendors have a right to be paid. The contractual right of a vendor to suspend customer access to a hosted EHR butts head-on against HIPAA. I have discussed this with ONC and while the problem is recognized, there is no solution at the present time.

Bill O’Toole is the founder of O’Toole Law Group of Duxbury, MA. You may contact him at wfo@otoolelawgroup.com

Usability Principles for Health IT Tools

Posted on October 22, 2015 I Written By

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.

Andy also writes often for O’Reilly’s Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O’Reilly’s Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

A recent article of mine celebrated a clever educational service offered on the Web by the US Department of Health and Human Services. I ended with a list of three lessons for the health care field regarding usability of health IT Tools, which deserve further explanation.

Respecting contemporary Web practices

Communications can be improved by using the advanced features provided by the Web and mobile devices. In the HHS case, developers went to great lengths to provide a comfortable, pleasant experience to anyone who viewed their content, even if the viewers were visiting a different web site and the HHS content was merely embedded there.

This commitment to modern expectations is rare in the health care field. Web sites and electronic records are famously stuck in the 1990s. Doctors have been warned that they can’t use unencrypted email or text messages to communicate sensitive information to patients, so they use patient portals that are self-contained and hard to access. The tools on my family practice’s portal, provided by eClinicalWorks, don’t even come up to the standards of email systems developed in the 1980s. They lack such fundamental features as viewing messages by sender or viewing threads of multiple messages.

Worse happens if a clinician needs to perform complex tasks in an EHR or to work in multiple windows at once. There are whole areas of health IT (such as the notions of health information exchanges and patient portals) that reflect its primitiveness. Access to data should be fundamental to health IT products.

Why? EHR vendors are focused on HL7 standards, clinical decision support, and other nuts and bolts of data-crunching. They don’t possess the most advanced design and Web coding teams. Given their small market size–compared to social networks or e-commerce sites–one shouldn’t be surprised that health sites and EHRs don’t invest in cutting-edge Web technology. It’s no surprise, for instance, that when athenahealth (the most forward-looking proprietary EHR vendor, in my personal view) decided to reach out to the mobile world, they purchased an existing mobile app development company.

Another barrier may be the old software and hardware used at many health care sites, as described in item 6 of an Open mHealth round-up.

The problem is that health care applications and web sites need to make things easy for the user–at least as easy as retailers do. Both clinicians and patients tend to visit such sites when the are feeling pressured, tense, and depressed about what they’re dealing with. Mistakes have serious negative consequences. So interfaces should be as usable as possible. It also helps if their interactive elements behave like others that the users have encountered in other apps and web sites; hence the value of keeping up with current user interface practices.

Consider the people at the other end

I’ve already explained how the mood and mindset of the app user or web visitor has a critical effect on user interface design. Designers never know in advance–even when they think they do–what the users are asking for. And users vary widely as well. Therefore, sites must be prepared to evolve continuously with input and feedback from users. This requirement leads directly to the next suggestion.

Open source meets more needs

Most health care developers (and app buyers) assume that software must be kept closed to establish viable businesses. In other industries, large institutions are thriving on Linux, open source Java technologies, free databases such as MySQL and various NoSQL options, and endless free libraries for software development. Yet proprietary software still rules in electronic health records, medical devices, consumer products, and mobile apps.

Releasing source code in the open seems counter-intuitive, but it can lead to greater business success by promoting a richer ecosystem of tools. The vendors of health apps and software still haven’t realized–or at least, haven’t really pursued to its logical conclusion–the truth that health prospers only when many different parts of the health care system work together. Under the shepherdship of the Department of Health and Human Services, doctors are groping their way toward working with other doctors, with nursing homes and rehab facilities, with behavioral health clinics, and with patients themselves. Technology has to keep up, and that means eliminating barriers to interoperability.

APIs are a fine way to allow data sharing, but they don’t open up the tools behind the APIs. Creating a computing environment for health that ties together different systems requires free and open source software. It enables deep hooks between different parts of the system. Open source EHRs, open source device software, and open source research tools can be integrated to make larger systems that offer opportunities to all players.

Platforms for innovation

Instead of picking off bits of the existing health care infrastructure to serve, developers and vendors should be making platforms with vast new horizons and new opportunities for business. Platforms that encourage outsiders to build new functions are the concept that ties together the three observations in this article. These platforms can be presented to users in different ways by leading Web developers, can incorporate enhancements suggested by users, and can rely on open source to make adaptation easy.

Two platforms I have discussed in previous articles include SMART and Shimmer. SMART is an API that provides a standard to app developers working with patient data. Shimmer is a new tool for processing data from fitness devices. Each is starting to make a mark in the health care field, and illustrate what the field can achieve when parties work together and share results.

Using APIs at the Department of Health and Human Services to Expand Web Content

Posted on October 21, 2015 I Written By

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.

Andy also writes often for O’Reilly’s Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O’Reilly’s Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Application Programming Interfaces (APIs) appeal mostly to statisticians and researchers whose careers depend on access to data. But these programming tools are also a useful part of a Web that is becoming increasingly supple and sophisticated. I have written a series of articles about the use of APIs to share and run analytics on patient data, but today I’ll cover a cool use of an API developed by the Department of Health and Human Services for disseminating educational material.

The locus for this activity started with the wealth of information created by the Centers for Disease Control for doctors, public health workers, and the general public. Striving to help the public understand vaccinations, West Nile fever, Ebola (when that was a major public issue), and even everyday conditions such as diabetes, the CDC realized they had to make their content simple to embed in web sites for all those audiences.

The CDC also realized that it would be helpful to let outsiders quickly choose content along a number of dimensions. Not only would a particular web site be interested in a particular topic (diabetes, for instance), but they would want to filter the content to offer information to a particular audience in a particular language. One Web page might offer content aimed at doctors in English, while another might offer content for the general public in English and yet another offer content in Spanish. To allow all these distinctions, a RESTful API called from JavaScript allows each Web page to bring in just what is needed. Topics and languages are offered now, and filtering by audience will be supported soon. At some point, the API will even recognize ICD-10 codes and find any content related to those disease conditions.

We are all familiar with Web pages that embed dynamic content from other sites, such as videos from YouTube or Vimeo. Web developers embed the content by visiting the desired page, clicking on an Embed button, and copying some dense HTML to their own pages. The CDC offers several ways for visitors to syndicate content in this manner to their own web sites. If they are using a popular content management system (WordPress, Drupal, or Joomla!) they can install a plug-in that uses familiar practices to embed the content. Mobile app support is also provided. But the API developed by the CDC takes the process to a much more advanced level.

First, as already described, the API lets each page specify filters that extract content on the desired topic for the desired audience. Second, if a new video, e-card, or microsite is added to the CDC site, the API automatically picks it up when a user revisits the embedding page. Thus, without fussing with HTML, a site can integrate CDC content that’s tailored pretty precisely to its needs.

This API is also in use at the FDA–see for instance their Center for Tobacco Products–and at HHS more broadly. A community is starting to build around the code, which is open source, and soon it will be on GitHub, the most popular site for code sharing. A terse documentation page is available.

The API from Health and Human Services offers several lessons for health IT. First, communications can be improved by using the advanced features provided by the Web. (In addition to the API, the CDC tools make sophisticated use of HTML5 and iFrames to offer dynamic content in ways that fit in smoothly with the sites that choose to embed it.) Second, sites need to consider the people at the other end of the transaction in order to design tools that deliver an easy-to-use and easy-to-understand experience. And finally, releasing code as open source maximizes its value to the health care community. These trends need to be more widely adopted.

Are Patients Becoming Price and Quality Sensitive?

Posted on October 20, 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.

Yesterday I was watching the live stream of Jonathan Bush, CEO of athenahealth speaking and then on a panel at US News’ Hospital of Tomorrow event. Jonathan Bush was as good as ever and offered some really amazing insights into the changing culture of health care as we know it. He also introduced the LetDoctorsBeDoctors.com website along with the ZDoggMD Jay Z parody video called EHR State of Mind.

At one point in the panel discussion he made a point that really stuck with me. He suggested that a few years ago you could cut the price of your services in half and you’d still get the same number of patients in your office. Then he said that you could double the price of your services and you’d still get the same number of patients. He went on to say that you could provide better care to your patients and you’d still get the same number of patients.

Certainly that’s not a direct quote, but you get the gist of what he’s saying. Essentially, a few years back patients weren’t price or quality of care sensitive. Sure, maybe on a really macro scale some really doctors would be found out, but for the most part patients didn’t care what the price of healthcare was since they just paid the co-pay and they had no way of knowing the quality of care the doctor provided.

Jonathan suggested that over the past couple years this has started to change. Patients were becoming more price and quality of care sensitive. He didn’t explain why this is the case, but I’d suggest that it’s due to more availability of information and high deductible plans.

I think this shift in how patients select their healthcare is going to have wide ranging impacts on the health care system. Michael Robinson, Vice President, U.S. Health and Life Sciences, Microsoft, was on the panel with Jonathan Bush and suggested that technology was the enabler for a lot of these changes. That’s not true for all of the changes, but no doubt it plays a role in a lot of them.

Shimmer Addresses Interoperability Headaches in Fitness and Medical Devices

Posted on October 19, 2015 I Written By

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.

Andy also writes often for O’Reilly’s Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O’Reilly’s Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The promise of device data pervades the health care field. It’s intrinsic to patient-centered medical homes, it beckons clinicians who are enamored with hopes for patient engagement, and it causes data analysts in health care to salivate. This promise also drives the data aggregation services offered by Validic and just recently, the Shimmer integration tool from Open mHealth. But according to David Haddad, Executive Director and Co-Founder of Open mHealth, devices resist attempts to yield up their data to programmers and automated tools.

Every device manufacturer has its own idiosyncratic way of handling data, focused on the particular uses for its own device. According to Haddad, for instance, different manufacturers provide completely different representations for the same data, leave out information like time zones and units, and can provide information as granular as once per second or as vague as once per day.. Even something as basic as secure connectivity is unstandardized. Although most vendors use the OAuth protocol that is widespread on the Web, many alter it in arbitrary ways. This puts barriers in the way of connecting to their APIs.

Validic and Shimmer have to overcome these hurdles one by one, vendor by vendor. The situation is just like the burdens facing applications that work with electronic health records. Haddad reports that the cacophony of standards among device vendors seems to come from lack of attention to the API side of their product, not deliberate obstructionism. With all the things device manufacturers have to worry about–the weight, feel, and attractiveness of the object itself, deals with payers and retailers offering the product, user interface issues, etc.–the API always seems to be an afterthought. (Apple may be an exception.)

So when Shimmer contacts the tool makers at these vendors, most respond and take suggestions in a positive manner. But they may have just one or two programmers working on the API, so progress is slow. It comes down to the old problem in health care: even with government emphasis on data sharing, there is still no strong advocate for interoperability in the field.

Why did Open mHealth take on this snake’s nest and develop Shimmer? Haddad says they figured that the advantages of open source–low cost of adoption and the ease of adding extensions–will open up new possibilities for app developers, clinical settings, and researchers. Most sites are unsure what to do with device data and are just starting to experiment with it. Being able to develop a prototype they can throw away later will foster innovation. Open mHealth has produced a detailed cost analysis in an appeal to researchers and clinicians to give Shimmer a try.

Shimmer, like the rest of the Open mHealth tools, rests on their own schemas for health data. The schemas in themselves can’t revolutionize health care. Every programmer maintains a healthy cynicism about schemas, harking back to xkcd’s cartoon about “one universal standard that covers everyone’s use cases.” But this schema took a broader view than most programs in health care, based on design principles that try to balance simplicity against usefulness and specificity. Of course, every attempt to maintain a balance comes up against complaints the the choices were too complex for some users, too simple for others. The true effects of Open mHealth appear as it is put to use–and that’s where open source tools and community efforts really can make a difference in health care. The schemas are showing value through their community adoption: they are already used by many sites, including some major commercial users, prestigious research sites, and start-ups.

A Pulse app translates between HL7 and the Open mHealth schema. This brings Open mHealth tools within easy reach of EHR vendors trying to support extensions, or users of the EHRs who consume their HL7-formatted data.

The Granola library translates between Apple’s HealthKit and JSON. Built on this library, the hipbone app takes data from an iPhone and puts it in JSON format into a Dropbox file. This makes it easier for researchers to play with HealthKit data.

In short, the walls separating medicine must be beaten down app by app, project by project. As researchers and clinicians release open source tools that tie different systems together, a bridge between products will emerge. Haddad hopes that more widespread adoption of the Open mHealth schema and Shimmer will increase pressure on device vendors to produce standardized data accessible to all.