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How Connected Medical Device Platforms Can Conquer IoT Difficulties

Posted on October 29, 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.

The following is a guest blog post by Abbas Dhilawala, CTO of Galen Data.

The medical industry in the United States and around the world faces unprecedented challenges in 2019. An aging population, growing costs throughout the system, and frequent regulatory changes are just a few reasons why healthcare providers are increasingly adopting new technologies that can reduce costs and drive operational efficiency throughout the healthcare industry.

To that end, a growing number of connected medical devices are using the internet of things (IoT) to collect, analyze and transmit health data or images to internal hospital servers or cloud-based storage. While these innovative devices are slowly changing the paradigm of patient care and lowering costs throughout the system, med tech companies are still facing major barriers in the widespread adoption of connected medical devices.

Here are a few challenges associated with connected medical device platforms and the IoT, and how med tech companies can work to overcome those difficulties in the near future.

Improving Interoperability Between Connected Medical Devices

The technology companies that are building connected medical devices envision a future where wearable medical devices will instantly collect, analyze and transmit patient data to a central data repository where it can be used to update electronic health records and provide physicians with real-time information about patient wellness. One of the major obstacles here is interoperability – such a system would require a standard format for data and a common communication protocol that would allow all of these connected devices to transmit data to a single system.

Health plans, health care providers and medical technology vendors must work together to develop a consensus for interoperability standards that will facilitate more open exchange of data between authorized parties.

Address Growing Concerns over Cybersecurity

As connected medical devices proliferate through our world, it is becoming clear that medical technology companies need to take bigger steps to secure these devices and the data they collect against data breaches and malicious software attacks. Research from the Ponemon institute found that 70 percent of medical device manufacturers believe an attack on their medical devices is likely, but just 17% have taken significant steps to protect against this kind of attack.

We can look at data from recent years to estimate the results of poor security oversight in the world of connected medical devices. McAfee reports that the healthcare industry saw a 211% increase in cybersecurity incidents in 2017 compared to 2016. In the same year, 65% of all healthcare-related ransomware attacks were conducted by exploiting software vulnerabilities in connected imaging devices. However you measure it, the connected medical devices produced today aren’t sufficiently secure to be used in modern healthcare settings without the risk of compromising patient data.

Medical technology companies need to reduce the security risk posed by their devices by investing in improved security measures that reduce or eliminate software vulnerabilities. Medical technology companies should adopt a secure-by-design approach, even if it means adding hardware that increases the power consumption or cost of the product. Healthcare providers and patients need to trust that connected medical devices provide adequate protections for sensitive data.

Work to Fully Understand User Needs

The market for connected medical devices is expected to triple between 2018 and 2023, reaching a value in excess of $60 billion globally. As healthcare plans and providers move towards value-based payment models, the companies that build connected medical devices will have to demonstrate that their devices improve patient outcomes when compared to the alternative.

Manufacturers of medical devices must develop stronger ties to clinicians and patients that use their products and invest more resources in collecting evidence about the efficacy of their devices in improving outcomes for patients. In an outcome-based model, health plans will only want to pay for connected medical devices that create genuine value in the marketplace, and preference will likely be shown for devices that lead the way in software security.

Focus on Actualizing Real Benefits

As IoT medical devices become increasingly common in the marketplace, med tech companies must develop use cases that highlight the benefits they can deliver to early adopters. This includes efficiencies like the ability to transmit data wirelessly to health care providers, the potential to automatically update patient health records using data from wearables, easier access to data for physicians and health plans, and overall lowered costs of medical care.

Medical technology companies are working towards building the systems and functions that will usher in a more data-driven and patient-focused approach to health care. The most successful manufacturers will be the ones that gain industry support by delivering reduced costs and enhancing patient outcomes through repeatable use cases.

Summary

Connected medical devices stand to revolutionize the global healthcare industry, but there are still many challenges to overcome before IoT medical devices take over. Manufacturers of IoT medical devices must improve interoperability between systems to promote data sharing, address growing concerns over device security and generate evidence that their devices can meet user requirements and improve patient outcomes. Med tech companies that focus on creating real, demonstrable benefits for their customers will have the best opportunities to succeed as the healthcare IoT expands in size over the next five years.

About Abbas Dhilawala
Abbas has over 13 years of experience developing enterprise grade software for the medical device industry. He is well versed with technology and industry standards regulating security and privacy of data. His expertise lies in programming, cloud, cyber security, data storage and regulated medical device software.

Nationwide Healthcare Interoperability Isn’t Happening

Posted on August 8, 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.

I’ve got interoperability on the mind today. I think it’s probably because of all the tweets that are coming out on the #InteropForum hashtag from the ONC Interoperability Forum in DC. I would have liked to attend, but I’m grateful that so many people are sharing what’s happening. That said, I must admit that I’m tired of a lot of the tweets that aren’t grounded in reality and that call for things that are never going to happen or tweets that propose goals that aren’t meaningful (yes, I had to use that word).

The first reality that’s become clear to me is that nationwide interoperability of healthcare data isn’t going to happen.

It’s just not going to happen and in most cases it shouldn’t happen when you consider the costs and benefits. Sure, we are all traveling a lot more, but there are 45 or so states in the US where no healthcare organization has need for my health information. If they do, then there are ways they can get it, but they are rare. Even if I have a crazy medical incident in an unusual state, those care providers know how to take care of me even without all my health records. Doctors are always treating patients with limited information. If I’m a chronic patient where certain information would be important for me if I’m treated out of state by a doctor that doesn’t know me, there are hundreds of options for me to carry that information on my phone.

My point here is that there aren’t any massive economic incentives for there to nationwide sharing of health data. Don’t be confused though. I’m not saying that sharing health data is not beneficial. What I’m saying is that we don’t need to build a national framework of health data sharing. When people suggest we should make that a reality, they’re essentially dooming interoperability. Talk about biting off more than you can chew. It’s become quite clear to me that Nationwide Interoperability of health data isn’t going to happen.

I love this excerpt from Brian Mack’s blog post on the Great Lakes Health Connect (an HIE) blog:

The Trusted Exchange Framework and Common Agreement (TEFCA) released by the Office of the National Coordinator last January, was (it was thought) intended to bring clarity and define a path forward for national interoperability, but has instead just added more uncertainty and the promise of additional layers of bureaucracy.

Discussions around national healthcare interoperability just bring more uncertainty and more layers of bureaucracy. It’s a failed approach.

With that said, it’s also very clear that smaller scale interoperability is not only possible but a valuable thing for most in healthcare. This was highlighted by interoperability expert, Greg Meyer, when he tweeted:

It’s really great that Greg is trying to figure out how we can generalize these point to point interoperability solutions. That’s a smart approach. However, buried in this tweet in a way that most will miss is the fact that there are a lot of unique scenarios and solutions where healthcare interoperability has been successful. Healthcare interoperability is possible and many organizations are doing it. Just not on a national scale.

To continue Greg’s analogy, we need more of these interoperability “snowflakes” and we need those creating the snowflakes to share their successes. A blizzard of snowflakes is a powerful thing even though the individual snowflakes are small. As it stands today, a national approach to interoperability is more like spending millions and billions of dollars on a snow making machine and then never turning it on. I’d rather have a million snowflakes than a billion dollar machine that doesn’t produce any snow. </ end snowflake analogy>

Another example of healthcare interoperability in action was shared at the Healthcare IT Expo this year. Don Lee offered a great summary of UPMC’s success with interoperability and the parts of interoperability they have solved. There’s always still more work to do, but if every hospital was able to accomplish what UPMC has accomplished in regards to healthcare interoperability, then we could have a very different discussion around healthcare data sharing.

The only solution I see to healthcare interoperability is for healthcare organizations to make it a priority. As I said back in 2013, Interoperability Needs Action, Not Talk. The more small interoperability connections we make, the more we’ll understand our data, how to connect, and build relationships between organizations. All of that will be key to even starting to thinking about nationwide healthcare interoperability. Until then, let’s table the nationwide healthcare interoperability discussions.

Overcoming Data Silos Within The Health Care Ecosystem

Posted on May 30, 2018 I Written By

The following is a guest blog post by Dave Corbin, CEO of HULFT.

While there’s a barely an industry or sector that hasn’t been heavily influenced or redefined by the onslaught of data, in healthcare the impact is especially acute. Health care industry players are now having to negotiate a delicate balance between exploiting the opportunities that come with the deeper insights and actionable intelligence, with managing the growing technical complexities that arise.

Let’s face it – the health care sector is renowned for the depth of its silos. It’s a significant and wide-ranging challenge. It starts in the closed world of drug R&D to a generation of providers still using fax machines (remember those?) to share patient medical records. In theory, we’d all agree that improved health data exchange is a win-win for everyone involved (providers, policymakers, patients, etc.) In reality, before we can even begin to leverage the vast troves of data from electronic medical records (EMRs), we need to overcome two key issues.

The first is data security. According to the 2018 HIMSS Cybersecurity survey, the majority of respondents, 75 percent, experienced a significant security incident in the last 12 months. The threat landscape has grown in complexity and volume and it’s critical for health care organizations to invest in privacy-by-design defense mechanisms such as encryption, security analytics, and multi-factor authentication to protect valuable patient data. For seamless data sharing to become the norm, everyone in the ecosystem must be vigilant about data protection and online privacy.

The second is interoperability – the extent to which different IT systems, software applications, and devices can exchange data and interpret that shared data. Or, to be more specific, making EMRs more “portable” so they follow a patient’s journey. After all, care is happening at multiple venues – it’s happening in hospitals, rehab facilities, long term care facilities, hospices, and more.

My own knee surgery started with the orthopaedic surgeon, who referred me to external providers that would supply me with MRIs, blood tests, and EKGs. The day of surgery included not just the surgeon, but an outside surgery center and an anaesthesiologist, all requiring separate contracts. The net result was that my medical information for a relatively routine surgery was spread over five locations and many data types.

Without an enforced standard of interoperability, data exchanges can get complicated and time-consuming, which then hinders not just the flow of information but patient care. We can do better by reducing data complexity for the patient, doctor and service providers.

Speed, security, and accessibility when it comes to health data management and sharing don’t have to elude us. A holistic approach to health data security and ecosystem interoperability can be achieved in partnership with an intuitive data logistics platform that scales to evolving data complexities and cuts development time. This can help lead your organization to transcend healthcare’s many silos often without the need for a major overhaul of existing IT system. And that’s a powerful prescription.

Dave Corbin is CEO of HULFT, a comprehensive data logistics platform that provides both the secure back-end data transfer and integration technologies to help health care organizations form a foundation for an overall enterprise data strategy that makes data more accessible and useful. HULFT is a proud sponsor of Health IT Expo, a practical innovation conference organized by Healthcare Scene. Learn more here: hulftinc.com.    

Insights from Alan Portela on Healthcare IT Barriers and Opportunities

Posted on April 5, 2017 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.

I’ve interviewed hundreds and maybe even thousands of healthcare IT professionals. I learn a little bit from each of them. However, some people I interview offer me a view of healthcare IT that I haven’t thought about before. That’s what it was like for me when I first interviewed Alan Portela, CEO of AirStrip, 4-5 years ago.

Ever since then, I’ve never turned down a chance to interview Alan Portela. Plus, he’s so insightful that I usually ask him if it’s ok if we turn the cameras on so that everyone can learn from him. That’s what happened at HIMSS when I had a chance to interview Alan.

The focus of my interview with Alan was around the changing world of healthcare IT. I wanted to hear what challenges Alan and his team at AirStrip were facing and also what opportunities he saw for healthcare IT’s future. Like usual, Alan brought out some great insights that will benefit anyone working in healthcare IT.

Watch my full video interview with Alan Portela below:

Find more great Healthcare Scene interviews on YouTube.

When Healthcare Faxing Goes Wrong

Posted on January 11, 2017 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.

I recently wrote a tongue in cheek post about The Perfect Interoperability Solution. Go and read it and you’ll see what I mean. We’ll be here when you get back.

For those of you too lazy to click over and read the post, the punchline is that I was talking about all the beautiful parts of faxes in healthcare. Faxes have a lot of really redeeming qualities. That’s why they’ve survived so long in healthcare. However, we should learn from their great qualities and take interoperability to the next level.

In the comments on that post, regular reader R Troy offered this tragic story about why we should do better than faxing in healthcare:

At best, fax should be a method of nearly last resort, voice calls being the only thing that is worse (highly prone to miscommunication). Sure, there are solutions such as Brian noted, and I’m not suggesting that it go away because it does help to make the best of a poor method of communication. It’s just that in real life fax’s are often partially or completely unreadable, can’t get through, don’t reach the right person or entity, or even something as stupid as someone forgetting to press SEND or OK. Of course, if the fax came from an EHR, quality would likely be fine – but typically, someone fills in something on a photocopied form – perhaps legibly, and then that sheet is put into a fax machine and maybe even gets both sent and received.

Real life scenario; doctor sends a patient to the ER for an emergency transfusion, to be followed up by related infusions (which were going to be done on an outpatient basis the next day until the situation worsened). The doctor writes up the orders to have someone fax to the ER, but along the way, something unknown happens and the ER never gets the fax. Patient arrives, ER has no clue what to due, figuring the orders will eventually arrive. One nurse figures that the problem is with the pharmacy. The patient’s family pushes hard and finally – 6 hours later, discovers that no orders have arrived; doctor is phoned, and 10 minutes later the ER has the instructions.

What should have happened? In very plain terms, the doctor should have logged into the EHR (albeit a different system than the hospital uses), put in orders, and those orders should have gone straight to the ER’s EHR (I gather via Direct Messaging) so that when the patient arrived the ER would know what to do. OR – the doctor should have logged into the hospital’s EHR remotely and entered the orders. But that’s not what happened, and the patient waited many hours for badly needed blood, and a valuable ER bed was occupied for those same hours with no treatment being done.

Fax does have its uses – but IMO they should be limited to situations where there is no other choice, not be ‘how we do things’.

BTW, the scenario above actually happened. Oh, and the ER in question is now being expanded, an expansion that might not be needed if 1. it had decent communications with doctors feeding it patients, 2. it’s EHR was fully connected to that used by the rest of the hospital, 3. It had a viable and efficient work flow revolving around the EHR. Instead, patients are stacked up in the hallways and waiting room waiting for treatment, for techs to come, for orders to hopefully show up. The hospital is spending 10’s of millions to expand but not addressing the root causes of their problems, the biggest of which is poor communication based primarily on phones and fax machines.

The sad part is these miscommunications happen all day, every day in healthcare. Stories like this is why we can and need to do better than fax for healthcare interoperability.

Patients Frustrated By Lack Of Health Data Access

Posted on January 3, 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.

A new survey by Surescripts has concluded that patients are unhappy with their access to their healthcare data, and that they’d like to see the way in which their data is stored and shared change substantially.  Due to Surescripts’ focus on medication information management, many of the questions focus on meds, but the responses clearly reflect broader trends in health data sharing.

According to the 2016 Connected Care and the Patient Experience report, which drew on a survey of 1,000 Americans, most patients believe that their medical information should be stored electronically and shared in one central location. This, of course, flies in the face of current industry interoperability models, which largely focus on uniting countless distributed information sources.

Ninety-eight percent of respondents said that they felt that someone should have complete access to their medical records, though they don’t seem to have specified whom they’d prefer to play this role. They’re so concerned about having a complete medical record that 58% have attempted to compile their own medical history, Surescripts found.

Part of the reason they’re eager to see someone have full access to their health records is that it would make their care more efficient. For example, 93% said they felt doctors would save time if their patients’ medication history was in one location.

They’re also sick of retelling stories that could be found easily in a complete medical record, which is not too surprising given that they spend an average of 8 minutes on paperwork plus 8 minutes verbally sharing their medical history per doctor’s visit. To put this in perspective, 54% said that that renewing a driver’s license takes less work, 37% said opening a bank account was easier, and 32% said applying for a marriage license was simpler.

The respondents seemed very aware that improved data access would protect them, as well. Nine out of ten patients felt that their doctor would be less likely to prescribe the wrong medication if they had a more complete set of information. In fact, 90% of respondents said that they felt their lives could be endangered if their doctors don’t have access to their complete medication history.

Meanwhile, patients also seem more willing than ever to share their medical history. Researchers found that 77% will share physical information, 69% will share insurance information and 51% mental health information. I don’t have a comparable set of numbers to back this up, but my guess is that these are much higher levels than we’ve seen in the past.

On a separate note, the study noted that 52% of patients expect doctors to offer remote visits, and 36% believe that most doctor’s appointments will be remote in the next 10 years. Clearly, patients are demanding not just data access, but convenience.

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.

The Perfect Option for Healthcare Interoperability

Posted on December 15, 2016 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.

I’ve come up with the perfect option to take care of healthcare interoperability. I realize that this is a major problem and solving that problem would improve care, lower costs, and make healthcare great again (sorry, I couldn’t help it).

This approach is unique because every healthcare organization out there already supports it. In fact, I don’t know any healthcare organization that would need to spend more money to implement this solution. In fact, the standard this option would use is already out there and everyone has already adopted the standard.

Furthermore, every provider and hospital already have a unique credential and their identity is shared with most of the people that need to share information with them in healthcare. In most cases the information to make the health data sharing between offices and hospitals is already on their website. Plus, this option is something that is easily learned by everyone involved. Most people in healthcare already know how to use it well.

The healthcare interoperability solution I’m describing is: The Fax.

Yeah. It’s shocking I know. That long list of benefits that I describe already exist in the fax. In fact, healthcare data sharing has been happening with faxes for a long time. Why then isn’t fax enough to make healthcare interoperability a reality?

While Fax has plenty of upside (there’s a reason it’s stuck around so long in healthcare), faxes also have a lot of downsides. First is that faxes still have to be sorted and assigned to a patient. This doesn’t happen automatically. It’s still a manual process. Second, faxes are often low quality and readability can really be a problem. Certainly, they’ve gotten better as we’ve started faxing printed reports, but faxes can still be very hard to read.

If you’ve ever worked in medical records, you know how hard it can be to make sure you’re attaching a fax to the right patient. It can be a real challenge. Plus, it’s not surprising that faxes often get attached to the wrong patient.

Another problem with faxes is that they can use up a lot of paper. There are definitely fax servers and other forms of secure electronic fax out there, but it’s shocking how many practices still print regular faxes and then scan and attach them into their EMR. Plus, is the fax really that secure? They can be, but in many cases they’re not. No one is tracking who looks at the faxes that are received. There aren’t restricted permissions on who can and can’t look at the faxes. It’s just an open stack of faxes that anyone can look at and read.

Another big problem with faxes is that they don’t provide any granular data. This is why it’s often hard to identify the correct patient for the fax. However, it’s also a problem as we start wanting to do more predictive analytics and population health efforts that require granular health data on a patient. Sure, you could use OCR (Optical Character Recognition) and NLP (Natural Language Processing) to pull out the details from these unstructured faxes, but that’s not as good as granular data that’s more precise.

Of course, we all love the way the fax produces a Blarrrrrring NOISE!!

While this post is somewhat tongue in cheek, I think it’s important to look back at these “legacy” technologies that have been so popular. Understanding why they have been so popular and in many ways still are so popular can help us understand what the solutions of the future need as a baseline to be a successful replacement. Healthcare Interoperability efforts can certainly learn a lot from the success of faxes in healthcare.

Creating Healthcare Interoperability Bundles

Posted on October 25, 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.

At this point in the evolution of healthcare data, you’d think it would be easy to at least define interoperability, even if we can’t make it happen. But the truth is that despite the critical importance of the term, we still aren’t as clear as we should be on how to define it. In fact, the range of possible solutions that can be called “interoperable” is all over the map.

For example, a TechTarget site defines interoperability as “the ability of a system or a product to work with other systems or products without special effort on the part of the customer.” When defined down to its most basic elements, even passive methods of pushing data from one to another count is interoperability, even if that data doesn’t get used in clinical care.

Meanwhile, an analysis by research firm KLAS breaks interoperability down into four levels of usefulness, ranked from information being available, to providers having the ability to locate records, to the availability of clinical view to this data having an impact on patient care.

According to a recent survey by the firm, 20% of respondents had access to patient information, 13% could easily locate the data, 8% could access the data via a clinical view and just 6% had interoperable data in hand that could impact patient care.

Clearly, there’s a big gap between these two definitions, and that’s a problem. Why? Because the way we define baseline interoperability will have concrete consequences on how data is organized, transmitted and stored. So I’d argue that until we have a better idea of what true, full interoperability looks like, maybe we should map out interoperability “bundles” that suit a given clinical situation.

A Variety of Interoperabilities

For example, if you’re an ACO addressing population health issues, it would make sense to define a specific level of interoperability needed to support patient self-management and behavioral change. And that would include not only sharing between EMR databases, but also remote monitoring information and even fitness tracking data. After all, there is little value to trying to, say, address chronic health concerns without addressing some data collected outside of clinic or hospital.

On the other hand, when caring for a nursing home-bound patient, coordination of care across hospitals, rehab centers, nurses, pharmacists and other caregivers is vital. So full-fledged interoperability in this setting must be effective horizontally, i.e. between institutions. Without a richly-detailed history of care, it can be quite difficult to help a dependent patient with a low level of physical or mental functioning effectively. (For more background on nursing home data sharing click here.)

Then, consider the case of a healthy married couple with two healthy children. Getting together the right data on these patients may simply be a matter of seeing to it that urgent care visit data is shared with a primary care physician, and that the occasional specialist is looped in as needed. To serve this population, in other words, you don’t need too many bells and whistles interoperability-wise.

Of course, it would be great if we could throw the floodgates open and share data with everyone everywhere the way, say, cellular networks do already. But given that such in event won’t happen anytime in the near future, it probably makes sense to limit our expectations and build some data sharing models that work today.

Is Interoperability Worth Paying For?

Posted on August 18, 2016 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.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager 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, a role he recently repeated for a Council member.

A member of our extended family is a nurse practitioner. Recently, we talked about her practice providing care for several homebound, older patients. She tracks their health with her employer’s proprietary EHR, which she quickly compared to a half-dozen others she’s used. If you want a good, quick EHR eval, ask a nurse.

What concerned her most, beyond usability, etc., was piecing together their medical records. She didn’t have an interoperability problem, she had several of them. Most of her patients had moved from their old home to Florida leaving a mixed trail of practioners, hospitals, and clinics, etc. She has to plow through paper and electronic files to put together a working record. She worries about being blindsided by important omissions or doctors who hold onto records for fear of losing patients.

Interop Problems: Not Just Your Doc and Hospital

She is not alone. Our remarkably decentralized healthcare system generates these glitches, omissions, ironies and hang ups with amazing speed. However, when we talk about interoperability, we focus on mainly on hospital to hospital or PCP to PCP relations. Doing so, doesn’t fully cover the subject. For example, others who provide care include:

  • College Health Systems
  • Pharmacy and Lab Systems
  • Public Health Clinics
  • Travel and other Specialty Clinics
  • Urgent Care Clinics
  • Visiting Nurses
  • Walk in Clinics, etc., etc.

They may or may not pass their records back to a main provider, if there is one. When they do it’s usually by FAX making the recipient key in the data. None of this is particularly a new story. Indeed, the AHA did a study of interoperability that nails interoperability’s barriers:

Hospitals have tried to overcome interoperability barriers through the use of interfaces and HIEs but they are, at best, costly workarounds and, at worst, mechanisms that will never get the country to true interoperability. While standards are part of the solution, they are still not specified enough to make them truly work. Clearly, much work remains, including steps by the federal government to support advances in interoperability. Until that happens, patients across the country will be shortchanged from the benefits of truly connected care.

We’ve Tried Standards, We’ve Tried Matching, Now, Let’s Try Money

So, what do we do? Do we hope for some technical panacea that makes these problems seem like dial-up modems? Perhaps. We could also put our hopes in the industry suddenly adopting an interop standard. Again, Perhaps.

I think the answer lies not in technology or standards, but by paying for interop successes. For a long time, I’ve mulled over a conversation I had with Chandresh Shah at John’s first conference. I’d lamented to him that buying a Coke at a Las Vegas CVS, brought up my DC buying record. Why couldn’t we have EHR systems like that? Chandresh instantly answered that CVS had an economic incentive to follow me, but my medical records didn’t. He was right. There’s no money to follow, as it were.

That leads to this question, why not redirect some MU funds and pay for interoperability? Would providers make interop, that is data exchange, CCDs, etc., work if they were paid? For example, what if we paid them $50 for their first 500 transfers and $25 for their first 500 receptions? This, of course, would need rules. I’m well aware of the human ability to game just about anything from soda machines to state lotteries.

If pay incentives were tried, they’d have to start slowly and in several different settings, but start they should. Progress, such as it is, is far too slow and isn’t getting us much of anywhere. My nurse practitioner’s patients can’t wait forever.