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A Next Step For Personalized Medicine? Vendor Brings Genomics To Ambulatory EHR

Posted on October 8, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Most physicians have some sense of the value personalized medicine can bring to their practice, but I doubt that many have ready access to the tools they’d need to harness its power.

In an effort to close that gap – and of course, to make its platform irreplaceable – a vendor serving medical practices has struck a deal giving physicians the ability to order genetic tests and leverage them to improve care.

The vendor, DrChrono, offers a suite of electronic systems for physicians, including an EHR which can be customized by bundling in affiliated apps. Its new partner is Genomind, a personalized medicine platform offering genetic testing for psychiatry practices.

Physicians using DrChrono will have access to two Genomind test kits, along with some analytics tools they can use to make use of the testing data.

One of the tests is Mindful DNA Professional, a genetic test used by clinicians to help them guide wellness decisions. The test targets aspects of a patient’s genetic details which could have an impact on overall health, such as variants suggesting that they could have sleep issues or a predisposition to anxiety, depression or impaired cognition.

DrChrono users will also have access to the Genecept Assay, the results of which can guide the treatment of psychiatric conditions. Once test results become available on the Genomind system, doctors can use its gene-drug-environmental interaction tool, the Genomind Drug Interaction Guide, to inform their treatment decisions. With the help of the Guide, clinicians can analyze the patient’s current medication regimen and flag gene-drug interactions.

An interesting side note to all of this is that the final test results from Genomind will be stored in the DrChrono information library for the patient and become part of the patient’s medical record.

Looked at one way, sharing the Genomind test results seems almost like a no-brainer in a world where casual genetic testing (think 23andMe) is becoming the norm. On the other, though, I don’t want to gloss over the fact that using genetic data to search for relatives is one thing and putting it into your personal medical record is quite another. It suggests that of consumer-driven demand for precision treatment is maturing, and that Genomind is on the right side of this trend.

This takes me back to DrChrono, which while not itself reinventing the wheel has struck a smart deal here. Not only has it brought a tool on board which could offer some benefit to physicians, its supporting the collection of information (genetic data) that patients are beginning to want. If DrChrono can give patients their genetic info via a decent portal, the company may find itself to be in demand with patients. Way to stay abreast of the times.

DrChrono App Store Illustrates Important Point

Posted on July 16, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In a recent post, my colleague John Lynn argued that EHRs won’t survive if they stick to a centralized model.  He contends — I think correctly — that ambulatory practices will need to plug best-of-class apps into their EHR system rather than accepting whatever their vendor has available. If they don’t create a flexible infrastructure, they’ll be forced to switch systems when they hit the wall with their current EHR, he writes.

Demonstrating that John, as usual, has read the writing on the wall correctly, I present you with the following. I think it illustrates John’s point exactly. I’m pointing to EHR vendor DrChrono, which just announced that billing and collections company Collectly would be available for use.

Like its peers, Collectly built on the DrChrono API, and will be available in the DrChrono App Directory on a subscription basis. (The billing company also offers custom pricing for large organizations.)

Other apps featured in the app directory include Calibrater Health, which offers text-based patient surveys; Staple Health, a machine learning platform that providers can use to manage at-risk patients and Genius Video, which sends personalized video via text message to educate patients. Payment services vendor Square is also a featured partner.

Collectly, for its part, digitizes paper bills and sends billing statements and collection notices to patients via text or email. The patient messages include a link to the patient portal which offers a billing FAQ, benefits and insurance info and a live chat feature where experts offer info on patient insurance features and payment policy. The live chat staffers can also help patients create an approved payment schedule on behalf of a practice.

While some of the DrChrono apps offer help with well-understood back-office issues – such as Health eFilings, which help practices submit accurate MIPS data –  those functions may be duplicated or at least partially available elsewhere. However, apps like Collectly offer options that EHRs and practice management platforms seldom do. The number of best of breed apps that an EHR won’t be able to replicate natively is going to continue to increase.

Integrating consumer-facing apps like this acknowledges that neither medical practice technology nor its staff is terribly well-equipped to bring in the cash from patients. It may take outside apps like Collectly, which functions like an RCM tool but talks like a patient, to bring in more patient payments in for DrChrono’s customers. In other words, it took a decentralized model to get this done. John called it.

How Are Ambulatory Practices Going to Compete with Health Systems?

Posted on July 9, 2018 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.

We’ve all seen the stories about the explosion of data and the way healthcare is getting more personalized. However, David Chou recently pointed out how the data is one thing, but figuring out the role everyone plays in your healthcare organization is just as important as the data itself. It gets complex quickly as this graphic David shared shows:

This is a great graphic of the healthcare analytics roles and responsibilities that will be needed to make the personalized medicine future a reality. Plus, it will be key to getting a lot of the value out of our past EHR investments. Many hospitals and health systems already have these roles filled or are working to have them filled. We’ve seen this first hand when we see data jobs being posted to our healthcare IT job board.

While this work is extremely exciting and shows a lot of promise, I imagine a graphic like the one above is just completely overwhelming to consider for a small ambulatory practice. Even a large group practice would likely find the above graphic challenging to consider in their relatively small healthcare organization. How can they compete with a large health system with that kind of complexity? Do graphics like the one above just provide one other illustration of why small practices are going to soon be extinct?

I don’t think so and I hope not. However, graphics like the one above do illustrate the tremendous challenges that ambulatory practices face when they don’t have a massive health system behind them. What’s the path forward for smaller practices then?

The first thing to remember is that even though a health system is large, it doesn’t mean it’s going to do things well. In fact, it’s easy to argue how large organizations are much less efficient. It’s not hard to see how a large health system will focus all of their analytics work on the acute care environment and leaves out ambulatory practices. Smaller healthcare organizations are going to have to use this to their advantage.

While it’s unlikely that ambulatory practices will do all of the healthcare analytics work on their own, it is possible for ambulatory practices to tap into third party vendors that do the work for them and hundreds of other ambulatory practices. Smaller healthcare organizations partnering with corporate and entrepreneurial vendors is going to be the best way for these healthcare organizations to compete with the large health system. In fact, it’s a huge opportunity for them to show why patients should visit their practice instead of the large health system.

One thing that’s holding these efforts back is EHR vendors’ decision to close the doors to outside vendors. There are a few EHR vendor exceptions and areas where every EHR vendor is more open (ie. labs, pharmacy, etc), but it won’t be enough going forward. My friend Jeremy Coleman recently described why in this series of tweets:

I don’t see any healthcare future where centralization will survive. Sure, it will put up a good fight for a while, but the number and variety of applications that are coming out in healthcare are going to be so varied and dramatically important for doctors to incorporate into the care they provide that EHR vendors won’t have a choice but to create APIs that facilitate all of these applications.

An EHR vendor that embraces this approach is going to be essential for every ambulatory practice. Eventually, ambulatory practices will be stuck with the need to switch EHR systems or sell to the health system (which generally means switching EHR systems too). However, an ambulatory EHR that provides an open ecosystem for the latest and greatest in health IT will allow ambulatory practices to thrive even against the much larger health systems.

A Look At Share Everywhere, Epic’s Patient Data Sharing Tool

Posted on September 28, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Lately, it looks like Epic has begun to try and demonstrate that it’s not selling a walled garden. Honestly, I doubt it will manage to convince me, but I’m trying to keep an open mind on the matter. I do have to admit that it’s made some steps forward.

One example of this trend is the launch of App Orchard, a program allowing medical practices and hospitals to build customized apps on its platform. App Orchard also supports independent mobile app developers that target providers and patients.

Marking a break from Epic’s past practices, the new program lets developers use a FHIR-based API to access and Epic development sandbox. (Previously, Epic wouldn’t give mobile app developers permission to connect to its EMR unless a customer requested permission on its behalf.) We’ll have to keep an eye on the contracts they require developers to sign to see if they’re really opening up Epic or not.

But enough about App Orchard. The latest news from Epic is its launch of Share Everywhere, a new tool which will give patients the ability to grant access to their health data to any provider with Internet access. The provider in question doesn’t even have to have an EHR in place. Share Everywhere will be distributed to Epic customers at no cost in the November update of its MyChart portal.

Share Everywhere builds on its Care Everywhere tool, which gives providers the ability to share data with other healthcare organizations. Epic, which launched Care Everywhere ten years ago, says 100% of its health system customers can exchange health data using the C-CDA format.

To use Share Everywhere, patients must log into MyChart and generate a one-time access code. Patients then give the code to any provider with whom they wish to share information, according to a report in Medscape. Once they receive the code, the clinician visits the Share Everywhere website, then uses the code once they verify it against the patient’s date of birth.

As usual, the biggest flaw in all this is that Epic’s still at the center of everything. While patients whose providers use Epic gain options, patients whose health information resides in a non-Epic system gain nothing.

Also, while it’s good that Epic is empowering patients, Direct record sharing seems to offer more. After all, patients using Direct don’t have to use a portal, need not have any particular vendor in the mix, and can attach a wide range of file formats to Direct messages, including PDFs, Word documents and C-CDA files. (This may be why CHIME has partnered with DirectTrust to launch its broad-based HIE.)

Participating does require a modest amount of work — patients have to get a Direct Address from one of its partners — and their provider has to be connected to the DirectTrust network. But given the size of its network, Direct record sharing compares favorably with Share Everywhere, without involving a specific vendor.

Despite my skepticism, I did find Share Everywhere’s patient consent mechanism interesting. Without a doubt, seeing to it that patients have consented to a specific use or transmission of their health data is a valuable service. Someday, blockchain may make this approach obsolete, but for now, it’s something.

Nonetheless, overall I see Share Everywhere as evolutionary, not revolutionary. If this is the best Epic can do when it comes to patient data exchange, I’m not too impressed.

USAA Tapping EHR To Gather Data From Life Insurance Applicants

Posted on August 10, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I can’t believe I missed this. Apparently, financial giant USAA announced earlier this year that it’s collecting health data from life insurance applicants by interfacing with patient portals. While it may not be the first life insurer to do so, I haven’t been able to find any others, which makes this pretty interesting.

Usually, when someone applies for life insurance, they have to produce medical records which support their application. (We wouldn’t want someone to buy a policy and pop off the next day, would we?) In the past, applicants have had to push their providers to send medical records to the insurer. As anyone who’s tried to get health records for themselves knows, getting this done can be challenging and is likely to slow down policy approvals.

Thanks to USAA’s new technology implementation, however, the process is much simpler. The new offering, which is available to applicants at the Department of Veterans Affairs and Department of Defense, allows consumers to deliver their health data directly to the insurer via their patient portal.

To make this possible, USAA worked with Cerner on EHR retrieval technology. The technology, known as HealtheHistory, supports health data collection,  encrypts data transmission and limits access to EHR data to approved persons. No word yet as to whether Cerner has struck similar deals elsewhere but it wouldn’t surprise me.

USAA’s new EHR-based approach has paid off nicely. The life insurer has seen an average 30-day reduction in the time it takes to acquire health records for applicants, and though it doesn’t say what the average was back in the days of paper records, I assume that this is a big improvement.

And now on to the less attractive aspects of this deal. I don’t know about you, but I see a couple of red flags here.

First, while life insurers may know how to capture health data, I doubt they’re cognizant of HIPAA nuances. Even if they hire a truckload of HIPAA experts, they don’t have much context for maintaining HIPAA compliance. What’s more, they rarely if ever have to look a patient in the face, which serves as something of a natural deterrent to provider data carelessness.

Also, given the industry’s track record, is it really a good idea to give a life insurer that much data? For example, consider the case of a healthy 36-year-old woman with no current medical issues who was denied coverage because she had the BRCA 1 gene. That gene, as some readers may know, is associated with an increased risk of breast and ovarian cancer.

The life insurer apparently found out about the woman’s makeup as part of the application process, which included queries about genetic information. Apparently, the woman had had such testing, and as a result had to disclose it or risk being accused of fraud.

While the insurer in question may have the right, legally, to make such decisions, their doing so falls into a gray area ethically. What’s more, things would get foggier if, say, it decided to share such information with a sister health insurance division. Doing so may not be legal but I can easily see it happening.

Should someone’s genes be used to exclude them life or health insurance? Bar them from being approved for a mortgage from another sister company? Can insurers be trusted to meet HIPAA standards for use of PHI? It’ll be important to address such questions before we throw our weight behind open health data sharing with companies like USAA.

Provider-Backed Health Data Interoperability Organization Launches

Posted on April 12, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In 1988, some members of the cable television industry got together to form CableLabs, a non-proft innovation center and R&D lab. Since then, the non-profit has been a driving force in bringing cable operators together, developing technologies and specifications for services as well as offering testing and certification facilities.

Among its accomplishments is the development of DOCSIS (Data-over-Cable Service Interface Specification), a standard used worldwide to provide Internet access via a cable modem. If your cable modem is DOCSIS compliant, it can be used on any modern cable network.

If you’re thinking this approach might work well in healthcare, you’re not the only one. In fact, a group of powerful healthcare providers as just launched a health data sharing-focused organization with a similar approach.

The Center for Medical Interoperability, which will be housed in a 16,000-square-foot location in Nashville, is a membership-based organization offering a testing and certification lab for devices and systems. The organization has been in the works since 2011, when the Gary and Mary West Health Institute began looking at standards-based approaches to medical device interoperability.

The Center brings together a group of top US healthcare systems – including HCA Healthcare, Vanderbilt University and Community Health Systems — to tackle interoperability issues collaboratively.  Taken together, the board of directors represent more than 50 percent of the healthcare industry’s purchasing power, said Kerry McDermott, vice president of public policy and communications for the Center.

According to Health Data Management, the group will initially focus on acute care setting within a hospital, such as the ICU. In the ICU, patients are “surrounded by dozens of medical devices – each of which knows something valuable about the patient  — but we don’t have a streamlined way to aggregate all that data and make it useful for clinicians,” said McDermott, who spoke with HDM.

Broadly speaking, the Center’s goal is to let providers share health information as seamlessly as ATMs pass banking data across their network. To achieve that goal, its leaders hope to serve as a force for collaboration and consensus between healthcare organizations.

The project’s initial $10M in funding, which came from the Gary and Mary West Foundation, will be used to develop, test and certify devices and software. The goal will be to develop vendor-neutral approaches that support health data sharing between and within health systems. Other goals include supporting real-time one-to-many communications, plug-and-play device and system integration and the use of standards, HDM reports.

It will also host a lab known as the Transformation Learning Center, which will help clinicians explore the impact of emerging technologies. Clinicians will develop use cases for new technologies there, as well as capturing clinical requirements for their projects. They’ll also participate in evaluating new technologies on their safety, usefulness, and ability to satisfy patients and care teams.

As part of its efforts, the Center is taking a close look at the FHIR API.  Still, while FHIR has great potential, it’s not mature yet, McDermott told the magazine.

Do Vendor Business Models Discourage EMR Innovation?

Posted on April 4, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Despite the ever-mounting levels of physician frustration, in some ways EMRs have changed little from their mass-market rollout. EMR interfaces are still counterintuitive, data sharing possibilities are limited, important information still lives in isolated silos and endless data entry is the rule rather than exception.

In theory, we could do better if we had a reasonable vision of what should come next. For example, I was intrigued by ideas proposed by Dr. Robert Rowley of Flow Health. He describes a model in which EMRs draw on a single, external data source which isn’t confined to any one organization. Providers would access, download and add data through a modern API.  Given such fluid access to data, providers would be able to create custom front-ends based on a collection of apps, rather than rely on a single vendor-created interface.

Unfortunately, EMR vendors are unlikely to take on a completely different approach like Rowley’s, for reasons inherent to their business model. After all, they have little reason to develop new, innovative EMRs which rely on a different data architecture. Not only that, the costs associated with developing and rolling out a completely new EMR model would probably be very high. And what company would take that chance when their existing “big iron” approach still sells?

Not only that, EMR vendors would risk alienating their customers if they stray too far off the ranch. While an innovative new platform might be attractive to some buyers, it might also be incompatible with their existing technology. And it would probably require both providers and vendors to reinvent workflows and transform their technical architecture.

Meanwhile, in addition to finding a way to pay for the technology, providers would have to figure out how to integrate their existing data into the new system, integrate the platform with its existing infrastructure, retrain the staff and clinicians and cope with reduced productivity for at least a year or two. And what would become of their big data analytics code? Their decision support modules? Even data entry could be a completely new game.

Smaller medical practices could be pushed into bankruptcy if they have to invest in yet another system. Large practices, hospitals and health systems might be able to afford the initial investment and systems integration, but the project would be long and painful. Unless they were extremely confident that it would pay off, they probably wouldn’t risk giving a revolutionary solution a try.

All that being said, there are forces in play which might push vendors to innovate more, and give providers a very strong incentive to try a new approach to patient data management. In particular, the need to improve care coordination and increase patient engagement – driven by the emergence of value-based care – is putting providers under intense pressure. If a new platform could measurably improve their odds of surviving this transition, they might be forced to adopt it.

Right now, providers who can afford to do so are buying freestanding care coordination and patient engagement tools, then integrating them into their existing EMRs. I can certainly see the benefit of doing so, as it brings important functions on board without throwing out the baby with the bathwater. And these organizations aren’t forced to rethink their fundamental technical strategy.

But the truth is, this model is unlikely to serve their needs over the long term. Because it relies on existing technology, welding new functions onto old, clinicians are still forced to grappled with kludgy technology. What’s more, these solutions add another layer to a very shaky pile of cards. And it’s hard to imagine that they’re going to support data interoperability, either.

Ultimately, the healthcare industry is going to be bogged down with short-term concerns until providers and vendors come together and develop a completely new approach to health data. To succeed at changing their health IT platform, they’ll have to rethink the very definition of key issues like ease of use and free data access, care coordination, patient engagement and improved documentation.

I believe that’s going to happen, at some point, perhaps when doctors storm the executive offices of their organization with torches and pitchforks. But I truly hope providers and vendors introduce more effective data management tools than today’s EMRs without getting to that point.

Epic Launches FHIR-Based App Platform

Posted on March 2, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

It looks like Epic is getting on the FHIR train. According to an article in Modern Healthcare, Epic is launching a new program – serving physician practices and hospitals – to help them build customized apps. The program, App Orchard, will also support independent mobile app developers who target providers and patients.

The launch follows on the heels of a similar move by Cerner, which set up its own sandbox for developers interested in linking to its EMR using FHIR. The Cerner Open Developer Experience (code_), which launched in early 2016, is working with firms creating SMART on FHIR apps.

App Orchard, for its part, lets developers use a FHIR-based API to access an Epic development sandbox. This will allow the developers to address issues in connecting their apps to the Epic EMR. Previously, Epic wouldn’t let mobile app developers connect to its EMR until a customer requested permission on their behalf.

In addition to providing the API, App Orchard will also serve as an online marketplace along the lines of Google Play or the Apple app store. However, end users won’t be able to download the app for their own use — only software developers and vendors will be able to do that. The idea is that these developers will create the apps on contract to customers.

Meanwhile, according to the magazine, Epic will screen and pick an initial group of developers to the program. Brett Gann, who leads the Epic-based team developing App Orchard, told Modern Healthcare that factors which will distinguish one developer from the other include app safety, security, privacy, reliability, system integrity, data integrity and scalability.

As part of their participation, developers will get documentation listing these criteria and what they mean to Epic. The Epic team will expect the developers to commit to following these guidelines and explain how they’ll do so, Gann said.

While Epic hasn’t made any predictions about what types of apps developers will pursue, recent research offers a clue. According to new research by SMART and KLAS, providers are especially interested in apps that help with patient engagement, EMR data viewing, diagnostics, clinical decision support and documentation tasks.

One thing to watch is how Epic decides to handle licensing, ownership, and charges for participation in their Orchard Program. If they have a true open API, then this will be a good move for the industry. If instead they choose to take ownership of everything that’s created, put restrictive licenses on developers, and/or charge huge sums to participate, then it’s unlikely to see much true innovation that’s possible with an open API. We’ll see how that plays out.

Meanwhile, in other Epic news, Becker’s Hospital Review notes that the vendor is planning to develop two additional versions of its EMR. Adam Whitlatch, a lead developer there, told the site that the new versions will include a mid-range EMR with fewer modules (dubbed “utility”), and a slimmer version with fewer modules and advanced features, to be called “Sonnet.”

Whitlatch said the new versions will target physician practices and smaller hospitals, which might prefer a lower-cost EMR that can be implemented more quickly than the standard Epic product. It’s also worth noting that the two new EMR versions will be interoperable with the traditional Epic EMR (known as “all-terrain”).

All told, these are intriguing developments which could have an impact on the EMR industry as a whole.

On the one hand, not only is Epic supporting the movement towards interchangeable apps based on FHIR, it appears that the vendor has decided to give in to the inevitable and started to open up its platform (something it hasn’t done willingly in the past).  Over time, this could affect providers’ overall Epic development plans if Epic executes it well and enables innovation on Orchard and doesn’t restrict it.

Also, the new versions of the Epic could make it available to a much wider audience, particularly if the stripped-down versions are significantly cheaper than its signature EMR. In fact, an affordable Epic EMR could trigger a big shakeup in the ambulatory EMR market.

Let’s see if more large EMR vendors decide to offer an open API. If access to EMR APIs became common, it would represent a major shift in the whole health IT ecosystem.

Switching Out EMRs For Broad-Based HIT Platforms

Posted on February 8, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I’ve always enjoyed reading HISTalk, and today was no exception. This time, I came across a piece by a vendor-affiliated physician arguing that it’s time for providers to shift from isolated EMRs to broader, componentized health IT platforms. The piece, by Excelicare chief medical officer Toby Samo, MD, clearly serves his employer’s interests, but I still found the points he made to be worth discussing.

In his column, he notes that broad technical platforms, like those managed by Uber and Airbnb, have played a unique role in the industries they serve. And he contends that healthcare players would benefit from this approach. He envisions a kind of exchange allowing the use of multiple components by varied healthcare organizations, which could bring new relationships and possibilities.

“A platform is not just a technology,” he writes, “but also ‘a new business model that uses technology to connect people, organizations and resources in an interactive ecosystem.’”

He offers a long list of characteristics such a platform might have, including that it:

* Relies on apps and modules which can be reused to support varied projects and workflows
* Allows users to access workflows on smartphones and tablets as well as traditional PCs
* Presents the results of big data analytics processes in an accessible manner
* Includes an engine which allows clients to change workflows easily
* Lets users with proper security authorization to change templates and workflows on the fly
* Helps users identify, prioritize and address tasks
* Offers access to high-end clinical decision support tools, including artificial intelligence
* Provides a clean, easy-to-use interface validated by user experience experts

Now, the idea of shared, component-friendly platforms is not new. One example comes from the Healthcare Services Platform Consortium, which as of last August was working on a services-oriented architecture platform which will support a marketplace for interoperable healthcare applications. The HSPC offering will allow multiple providers to deliver different parts of a solution set rather than each having to develop their own complete solution. This is just one of what seem like scores of similar initiatives.

Excelicare, for its part, offers a cloud-based platform housing a clinical data repository. The company says its platform lets providers construct a patient-specific longitudinal health record on the fly by mining existing EHRs claims repositories and other data. This certainly seems like an interesting idea.

In all candor, my instinct is that these platforms need to be created by a neutral third party – such as travel information network SABRE – rather than connecting providers via a proprietary platform created by companies like Excelicare. Admittedly, I don’t have a deep understanding of Excelicare’s technology works, or how open its platform is, but I doubt it would be viable financially if it didn’t attempt to lock providers into its proprietary technology.

On the other hand, with no one interoperability approach having gained an unbeatable lead, one never knows what’s possible. Kudos to Samo and his colleagues for making an effort to advance the conversation around data sharing and collaboration.

Rival Interoperability Groups Connect To Share Health Data

Posted on December 27, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Two formerly competitive health data interoperability groups have agreed to work together to share data with each others’ members. CommonWell Health Alliance, which made waves when it included Cerner but not Epic in its membership, has agreed to share data with Carequality, of which Epic is a part. (Of course, Epic said that it chose not to participate in the former group, but let’s not get off track with inside baseball here!)

Anyway, CommonWell was founded in early 2013 by a group of six health IT vendors (Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies and RelayHealth.) Carequality, for its part, launched in January of this year, with Epic, eClinicalWorks, NextGen Healthcare and Surescripts on board.

Under the terms of the deal, the two will shake hands and play nicely together. The effort will seemingly be assisted by The Sequoia Project, the nonprofit parent under which Carequality operates.

The Sequoia Project brings plenty of experience to the table, as it operates eHealth Exchange, a national health information network. Its members include the AMA, Kaiser Permanente, CVS’s Minute Clinic, Walgreens and Surescripts, while CommonWell is largely vendor-focused.

As things stand, CommonWell runs a health data sharing network allowing for cross-vendor nationwide data exchange. Its services include patient ID management, record location and query/retrieve broker services which enable providers to locate multiple records for patient using a single query.

Carequality, for its part, offers a framework which supports interoperability between health data sharing network and service providers. Its members include payer networks, vendor networks, ACOs, personal health record and consumer services.

Going forward, CommonWell will allow its subscribers to share health information through directed queries with any Carequality participant.  Meanwhile, Carequality will create a version of the CommonWell record locator service and make it available to any of its providers.

Once the record-sharing agreement is fully implemented, it should have wide ranging effects. According to The Sequoia Project, CommonWell and Carequality participants cut across more than 90% of the acute EHR market, and nearly 60% of the ambulatory EHR market. Over 15,000 hospitals clinics and other healthcare providers are actively using the Carequality framework or CommonWell network.

But as with any interoperability project, the devil will be in the details. While cross-group cooperation sounds good, my guess is that it will take quite a while for both groups to roll out production versions of their new data sharing technologies.

It’s hard for me to imagine any scenario in which the two won’t engage in some internecine sniping over how to get this done. After all, people have a psychological investment in their chosen interoperability approach – so I’d be astonished if the two teams don’t have, let’s say, heated discussions over how to resolve their technical differences. After all, it’s human factors like these which always seem to slow other worthy efforts.

Still, on the whole I’d say that if it works, this deal is good for health IT. More cooperation is definitely better than less.