In 2007, Apple iOS and (Google) Android had a collective market share of 0%.

Today they have a collective market share of 77%.

That’s inefficient, ineffective, and just plain wrong. 

But we’re seeing light at the end of the tunnel — the proposed Stage 2 Meaningful Use (MU) rules reinforce new, evolving accountable care payment approaches. The rules support moving competition in healthcare to the right bases — sharing and adding value to patient health record data.

Today: Competition Based on Hoarding Patient Data

Health care providers today have incentive to hoard patient health record information. They might phrase it as:

I don’t get paid to share data with other doctors and hospitals — I get paid to do procedures, tests, surgeries, admissions….

HIPAA has severe penalties for sharing data inappropriately. I could spend time in jail for violating privacy/security regs for sharing patient data when I shouldn’t. Better to be safe than sorry.

Why would I want to share data with other doctors or hospitals? They are competitors. Patient data is MY competitive asset. Would I like to have access to their data? Of course…but no way will I share my data.

Would I want to provide other care providers with information to help keep a patient shared care plan current? What’s a shared care plan?

Competition Based on Hoarding: Wrong!

(more…)

Implications of a Shifting National HIE Architecture

My colleague Shahid Shah and I are glad to make available to you a copy of the slides from our upcoming presentation “The Future of Platforms in Healthcare.”  This presentation takes place at the eCollaboration Forum as part of HIMSS12 on Thursday, February 23.

You can access the slides here.

While the eCollaboration Forum in Las Vegas is sold out, you can still sign up for the live webinar all day Thursday, February 23: http://eCollab12.eventbrite.com

Here’s a brief summary of our presentation “The Future of Platforms in Healthcare”.

I. NECESSARY: Platforms are a “Must Have”, Not Just A “Nice to Have”

Today’s EMR (electronic medical record) products cannot enable accountable care. Here’s what you would have to believe to think that closed, proprietary products can get us to accountable care:

1. That one company can develop all needed functionality, and
2. That health IT will become a winner-take-all market (either through single-payer or all care providers in a market voluntarily choosing to buy the identical “product”), or
3. That optimal collaboration across products can be achieved by phone, paper, fax

Our conclusion is: interoperable platforms are a “Must Have”.

II. COMPLEX: Many Key Characteristics of Platforms (more…)

The inaugural eCollaboration Forum taking place at HIMSS12 on Thursday, February 23, 2012 in Las Vegas is SOLD OUT!

A webinar is available to those who will not be in Las Vegas: http://eCollab12.eventbrite.com

Theme — Collaborative Platforms and Applications in Health Care

This is the Health IT industry’s first-ever event focusing on collaborative health platforms and applications! We take an expansive view of platforms and will be exploring the required technologies, business ecosystems, and clinical care delivery needed to achieve accountable care.

It is also the first event ever that HIMSS has partnered with an outside organization to produce a “conference-within-a-conference”, as well as the first event of it’s kind focused on collaborative platforms and how they enable new models of care delivery and new business models for health care!

Full agenda:

(more…)

A recent article by Andreas Constantinou in Vision Mobile blog provides guidance. The article lists a Dead Platform Graveyard from the past 10 years — you will probably recognize some of the names: Meego (Nokia/Intel), Palm 5/6, Symbian OS (Nokia) WebOS (HP), Windows Mobile (Microsoft). Blackberry RIM is a candidate to make next year’s list.

Software platforms have failed for a combination of reasons:

• Cost of ownership
• Conflicting revenue model
• Lack of network effects
• High adoption barriers

The author also provides great lessons and guidance as to what DOES work:

(more…)

Brian Ahier sparked a feud with his Google+ post commenting on a recent JAMIA article entitled Shift in the Architecture of the Nationwide Health Information Network. We’re at 60+ comments and going strong. The discussion has also been picked up on in Modern Healthcare.

The JAMIA article was written by Leslie Lenert and colleagues, and Lenert joins in heartily in the Google+ discussion. From the abstract, here are 3 key points they make:

1) …a significant change in the architecture of the NwHIN is taking place. Prior to 2010, the focus of information exchange in the NwHIN was the Regional Health Information Organization (RHIO). Since 2010, the Office of the National Coordinator (ONC) has been sponsoring policies that promote an internetlike architecture that encourages point to-point information exchange and private health information exchange networks.

2) The net effect of these activities is to undercut the limited business model for RHIOs, decreasing the likelihood of their success…

3) These changes may impact the health of patients and communities. Independent, scientifically focused debate is needed on the wisdom of ONC’s proposed changes in its strategy for the NwHIN.

What does the Family Feud survey audience think of these points?

While I’ll acknowledge that one could draw many inferences from the discussion, here’s my interpretation, synthesis and commentary of the main points in the Lenert, et. al. article.

1) A Shift in NwHIN Architecture is Occurring

(more…)

The headline in yesterday’s LA Times declares:

‘App Economy’ credited with creating 446,000 jobs.

What’s the App Economy?

(more…)

Eric Schmidt, Chairman (and former President) of Google, coined the term “Gang of Four” in referring to the similar platform/application technical architecture and business models of these companies. In the case of Apple iOS and Google Android OS, much of the value is created by the 500K+ applications built on these platforms, not just by the platform themselves.

So four of the largest, most successful companies in the world are built on platforms — what does this imply for health care? Are “platforms” in health care a “Nice to Have” or a “Must Have”?

(more…)

Please consider attending the inaugural eCollaboration Forum taking place at HIMSS12 on Thursday, February 23, 2012 in Las Vegas at the Venetian Sands Expo Center.

Theme — Collaborative Platforms and Applications in Health Care

This is the Health IT industry’s first-ever event focusing on collaborative health platforms and applications! We take an expansive view of platforms and will be exploring the required technologies, business ecosystems, and clinical care delivery needed to achieve accountable care.

Speakers

Sponsored by HIMSS and Collaborative Health Consortium (formerly the Clinical Groupware Collaborative), the inaugural eCollaboration Forum has scheduled the following speakers [updated as of 2/3/12]:

• Farzad Mostashari, MD, ScM – National Coordinator for Health Information Technology
• Esther Dyson – Principal, EDventure Holdings
• John Mattison, MD – Assistant Medical Director and CMIO of Kaiser Permanente, SCAL
• Jinesh Varia, Technology Evangelist, Amazon Web Services
• Mark Blatt, MD, MBA – Worldwide Medical Director, Intel, “Collaborative Care: An Economic Imperative for Care Delivery Systems”
• David Whitlinger – Executive Director, NY eHealth Collaborative “Supporting New Models of Care Through Collaboration with States & Vendors”
• Steve Adams – President and Chairman, Collaborative Health Consortium; EVP Collaborative Care, Alere
• David Kibbe, MD, MBA – The Kibbe Group and American Academy of Family Physicians “Developing Trust in the Health Internet as a Platform”
• Vince Kuraitis – Principal, Better Health Technologies “The Future of Collaborative Health Platforms”
• Shahid N. Shah – CEO, Netspective and Blogger at HealthcareGuy.com “The Future of Collaborative Health Platforms”
• Brian Ahier – Health IT Evangelist, Mid-Columbia Medical Center
• Joshua Newman, MD, MSHS – Director of Product Management and Health Strategy, Salesforce.com
• West Shell III – Chairman and CEO, Healthline
• Scott Rea – Vice President GOV/EDU Relations and Senior PKI Architect, DigiCert
• Joe Miller – Director of eBusiness, AmeriHealth Mercy
• Richard Migliore, MD, EVP Health Services, United Health Group
• Jordan Shlain, MD – CEO, HealthLoop
• Joseph Miller, Director, eBusiness, AmeriHealth Mercy
• Bettina Experton, MD, MPH, President and CEO, Humetrix
• Josh Mandel, MD, Lead Architect, SMART, Harvard Medical School
• Brian Prestwich, MD, Assistant Professor of Family Medicine, Keck School of Medicine USC
• Rushika Fernandopulle, MD, President, Iora Health
• Jonathan Hare, Chairman, Reslient Networks
• Richard Migliori, MD, Executive Vice President, Business Initiatives & Clinical Affairs, Chief Healthcare Officer, UnitedHealth Group Alliances
• Dave DeBronkart, @ePatientDave
• Robert M. Kolodner, MD, Chief Health Informatics Officer, Open Health Tools
• Scott Barclay, Chief Strategy Officer, SureScripts
• Jinesh Varia, Technology Evangelist, Amazon Web Services

For the latest up-to-the-minute list of speakers, click here.

(more…)

What are acceptable bases of competition in health care?

My sense is that the distinctions here are not well understood and often go undiscussed, so I’ll quickly get to the point:

It’s OK for care providers to compete on the bases of quality, price, patient satisfaction, and many other factors

It’s NOT OK for care providers to compete on the basis of controlling or limiting access to patient health information. It’s just not right.

Today’s US healthcare system embraces market competition. For-profit and non-profit health care systems and care providers compete against one another. While we might or might not like this, all I’m asking you to do here is to recognize it.

Hospital based delivery systems work hard to keep patients within their network (walled garden) of providers. That’s understandable. But we need to probe deeper and examine how they are doing this — again, what are the bases of competition.

In many industries we accept the idea of creating proprietary, non-interoperable technology as a means of competitive differentiation. For example, the Apple iTunes system is not interoperable with MP3 players. This is an explicit and intentional part of Apple’s business strategy. I have no problem with this type of competition in digital entertainment.

Health care is different.

(more…)

My mom would not know what I mean by “Standard Health Data Connectivity Specifications,” so I’ll try to write this in plain English.

Who Are These Guys? The EHR|HIE Interoperability Workgroup

The workgroup consists of HIEs (Health Information Exchanges) representing seven of the largest states, eight EHR vendors, and three HIE software/services vendors. (more…)

.

. 

.

by Nate DiNiro

HealthCamp Oregon is organizing 2 events during the 3rd week of October in Portland, Oregon. The events will focus on Healthcare, Health IT, the ePatient & Participatory Medicine movement and all-things Healthcare Transformation!

The first event, a panel that will focus on the impact of social media in healthcare, is scheduled for Thursday 10/20. We’re also helping to promote the annual Kaiser Center for Health Research Saward Lecture, scheduled for Friday 10/21. More information on that event can be found below. The second event we’re planning is a HealthCamp unconference, scheduled on Saturday 10/22 and to be held at the offices of Urban Airship. If you’re unfamiliar with either of the previous terms “HealthCamp” or “unconference”, please read on and we’ll fill you in below.

(more…)

It’s a different issue whether closed or walled garden HIT is an acceptable means toward that end.

Outside of healthcare, we understand and can accept that businesses used closed, proprietary IT as part of their business model. Apple has designed their iPod with an eye toward incompatibility and high hassle factor in not being plug-and-play with other music players and systems.

IMHO, however, healthcare is different. Keep your proprietary business model away from my body and gimme my damn data.

Google+ v. Facebook on Data Portability

We are witnessing an important dynamic begin to play out between FB and Google+. I note a significant difference in mindset and policies toward data portability. (more…)

Readers and commenters (on e-CareManagement and The Health Care Blog) quickly grasped that a social networking platform could play a very useful role in coordinating our health care, yet also agreed with the conclusion that Facebook wasn’t  “it”.

So let’s ask the question again: Could Google+ be your platform for care coordination? This post will

• Describe Google+ and Circles
• Discuss how Google+ gets past some of Facebook’s limitations as a care coordination platform
• Comment on Google+ as a care coordination platform (promising, but too early to tell) (more…)

Healthcare needs positive role models for innovation…and we have a real-time mentor in Netflix.

If you have a Netflix subscription, you probably identify with the company as providing a convenient DVD rental service — order on the web, the DVD arrives by mail, send it back in the handy pre-paid envelope when you’re done.

Today’s ReadWriteWeb describes Netflix’ latest letter to shareholders and explains how the company is preparing for the demise of DVDs:

(more…)

Let’s take a minute to consider the mechanics of how this will occur. You’ve received a prescription, and it directs the pharmacist to tailor the medicine to YOUR genetic profile.

Consider two possible scenarios of how this transaction might happen. You’re on the phone with your pharmacist:

1) “OK, you need my DNA sequence. I keep my genetic profile in my mattress…let me get it and I’ll read it out loud to you.  C, A, T, G, G, A, T… no,  that was actually a G…let me start over.  C, A, T, G, G, A, T… (19 hours later) … T, and G. Can you read that back to me to make sure you got it right?”

2) “You have permission to access my DNA sequence at my health URL (or maybe a health record bank, or perhaps hand her a flash drive, or ??).

Still think you’ll never use a PHR?

In my mind, the issue isn’t WHETHER, but WHEN.

Yes, I know that adoption has lagged and that surveys suggest 7% or less of the U.S. population has used a PHR.

Stay with me on this one for a minute. You’d have to have two underlying beliefs to conclude that PHR systems won’t eventually emerge:

• That health record data will persist in non-electronic formats, i.e., paper
• That people won’t have interest in accessing or using their health record data (more…)

(click on the graphics to link to original sources)

Regular readers know that I find Professor Clay Christensen’s theory of disruptive innovation to be a useful lens to explain industry evolution. Let’s look at two recent health IT initiatives and see why one is working and the other is stalled.

(more…)

1. Technical barriers aren’t the limiting factors to Facebook becoming a care coordination platform.
2. Facebook’s company DNA won’t play well in health care.
3. Could Facebook become the care coordination platform of the future? If not Facebook, then what?

1) Technical barriers aren’t the limiting factors to Facebook as a care coordination platform.

Can you imagine Facebook as a care coordination platform? I don’t think it’s much of a stretch. Facebook already has 650 million people on its network with a myriad of tools that allow for one-to-one or group interactions.

What would it take to make Facebook a viable care coordination platform?

• More servers to handle the volume — not a problem
• Specialized applications suited for health care conditions — not a problem
• Privacy settings that made people comfortable — more on this later
• A mechanism to identify and connect the members of YOUR care team — really tough, BUT this is NOT a technological problem, but a health system one

Suppose you are a 55–year-old woman who is a brittle diabetic. Your care team might include a family physician, an endocrinologist, a registered dietitian, a diabetic nurse, a ophthalmologist, a podiatrist, a psychologist, and others. Ideally you’d have one care plan that coordinates the care among members of the team, including you.

What’s the reality of today’s health care non-system?

• There is no formal designation of “your team.”
• There is no mechanism to designate one “plan” that coordinates the plays among your team members.
• It’s possible that multiple quarterbacks are calling the plays for your care.
• It’s possible that members of your team have no knowledge THAT you are being treated by others and HOW you are being treated by others.

Care coordination today is in the stone ages — there is no system for care coordination.

Supplying a modern Facebook-type technology platform doesn’t change this. The major limiting factors in Facebook’s becoming a care coordination platform aren’t technological.

Let’s look a bit deeper.

(more…)

1. Administrative Mandates (Compliance HIPAA 5010, ICD-10, etc.).
2. Care Management, Data Analytics, and Informatics.
3. Health Insurance Exchanges and Individual Markets.
4. New Provider Payment & Delivery Systems (ACOs, PCMHs, etc.).
5. Bend the Cost Trend.
6. Medicare and Medicaid.
7. Health Information Exchanges and EMRs.
8. Consumer’s Role in the Modernization of Healthcare.
9. Reform Uncertainties.
10. Payer/Provider Interoperability.

Dear health plan colleagues,

Wake up! The order of this list is totally out of whack.

#2: Care Management, Data Analytics, Informatics. Good…sounds about right.

However,

#2 can’t happen before you address:

#7: HIEs and EMRs

#10: Payer/Provider Interoperability

Health plans can’t analyze the data and assist in care management unless they first have access to it. Payers need access to clinical data, and they are at risk of being cut out of the loop.

P.S.

Please also take a look at priority #1: Administrative Mandates (Compliance HIPAA 5010, ICD-10, etc.). This is completely reactive!

In these times of great change, is this how health plans want to posture themselves in the community?

Having been a debater in high school and then trained as a lawyer, my default mode of thinking is to be critical:

“Hey, Vince, how ya doin’? Great day isn’t it?”

“Well, …err…maybe, maybe not…actually, here’s 14 reasons why not.”

My wife and friends kindly tell me that this personal quality can be insufferable, and if you’ve ever met a lawyer you know what I’m talking about. My internal defense mechanism against my inner-critical brain is simply to turn it off — just go along for the ride and live in the moment.

To the extent that you can connect with what I’m saying, I suggest that before reading this report that you turn off the critical part of your brain.

If you’re a regular reader, chances are you’ve read individual white papers on these topics:

• PCMH — the Patient Centered Medical Home
• Care Coordination
• Access to care for the un and underinsured
• HIT — health information technology and the HITECH Act
• Payment reform, especially as it’s been discussed around ACOs (accountable care organizations).

“Better to Best” transcends all these topics — it weaves them together, displays the interrelationships, and describes specific components of what a truly integrated health system could look like. (more…)

Click here.

The whitepaper is a great overview of accountable care and ACOs (Accountable Care Organizations). It’s a quick and easily digestible read.

However, there is one key point articulated in the paper that I’d like to emphasize here:

accountable care is not synonymous with ACOs.

(more…)

“If banks can exchange funds electronically through the ATM system, why can’t my doctor and hospital exchange information electronically?”

Keith Boone’s concise article “A Doctor is Not a Bank” explains why this conclusion about healthcare interoperability is overly-simplistic.

…and Keith’s article reminded me of an even deeper explanation presented in the National Academies’ Frontiers of Engineering series — Why Health Information Technology Doesn’t Work, by Elmer Bernstam and Todd Johnson. The table below summarizes the differences between health data and banking data.

  (more…)

What struck me about the list is that the state-of-the-art is stand alone applications — I didn’t see any that had any connection to an EHR (electronic health record).  Here’s the top 5 to give you a flavor of what’s on the list:

1. Medscape
2. Micromedex
3. New England Journal of Medicine
4. Epocrates
5. Free Medical Calculators

I expect that this list will begin to look very different in coming years as EHRs continue to open their platforms to outside developers…and applications will increasingly be integrated into direct patient care.

Doctors love iPads…not surprising? But, how might you explain this?

There are at least two different possibilities:

• Coincidence Theory
• Conspiracy Theory

The Coincidence Theory

So doctors want to access EHR software through the iPad…what’s the big deal?

Apple has built a great new hardware platform with the iPad. There’s nothing else like it in the marketplace.  While other companies are building competing tablets, Apple’s has been the only viable option in the market for over a year.

(more…)

At that time, the Direct Project was still being incubated and was not widely known or understood. Since then, it’s gone from being an idea to a project in full-speed implementation.

The simplest conceptualization of the Direct Project has been as a secure email alternative to medically-related transactions that today typically occur by fax, e.g., Dr. A faxes a medical record to Dr. B.

The functionality of the Direct Project has been described as “push-only”. Fred notes that

Push-only means that A can send messages to B, but B cannot automatically get data  from A (that would be pulling). Email and Faxes are push models. Web pages are pull models (i.e. sent to you when your browser asks for them).

“Push-only” misses the innovative potential of how the Direct-Project could be used. Let me try to make a simple conceptual leap that hopefully will open your eyes to The Power of Push.

With a little creativity and jury rigging, push transactions can easily become pull transactions.  For example, what if I were to call you on the phone (or send you an email, a fax, a carrier pigeon, a smoke signal) simply asking you to send (push) me some information.

Voila. Push is turned into push and pull.

Fred describes examples of  higher level functionality enabled when you get creative with push:

(more…)

A patient’s health records are no longer confined to a doctor’s office, shelved inside a dusty file cabinet. With the advent of the Nationwide Health Information Network, a framework of standards, services and policies that allow health practitioners to securely exchange health data, medical records digitized to be easily shared between doctor’s offices, hospitals, benefit providers, government agencies and other health organizations, all across America.

This health information exchange is dramatically enhanced by the Direct Project. Launched in March 2010, the Direct Project was created to enable a simple, direct, secure and scalable way for participants to send authenticated, encrypted health information to known, trusted recipients over the Internet in support of Stage 1 Meaningful Use requirements. The Direct Project has more than 200 participants from over 60 different organizations. These participants include EHR and PHR vendors, medical organizations, systems integrators, integrated delivery networks, federal organizations, state and regional health information organizations, organizations that provide health information exchange capabilities, and health information technology vendors. (more…)

Click here for more information about subscribing to Accountable Care News.

Webinar Title: An Impending Marriage: Electronic Health Records (EHRs) and Care Management Software

The presentation will be geared at practicing clinical case managers in health plans, hospitals, disease management companies, and similar organizations:

• Describe market forces driving integration of EHRs and care management software. 
• Review care management software survey data and stimulus funding for EHR adoption. 
• Describe a 3 stage framework for the evolution of EHRs and care management software. 
• Characterize benefits to patients and impacts on care manager responsibilities.

The event is sponsored by HealthSciences Institute and the PartnersinImprovement Alliance.

When:

Friday, February 4, 2011
11:30 am Eastern Time
10:30 am Central Time
9:30 am Mountain Time
8:30 am Pacific Time

Your Presenters:

Vince Kuraitis JD, MBA
Better Health Technologies, LLC

Garry Carneal, JD, MA
Schooner Healthcare Services

More Information and Registration:  Click here.

The Health 2.0 movement has seen incredible growth recently, with new tools and services continuously being released. Of course, Health 2.0 developers face a number of challenges when it comes to getting providers and patients to adopt new tools, including integrating into a health system that is still mostly paper-based. Another serious obstacle facing developers is how to interpret and, where appropriate, comply with the HIPAA privacy and security regulations. 

Questions abound when it comes to Health 2.0 and HIPAA, and it’s vital we get them answered, both for the sake of protecting users’ privacy and to ensure people are able to experience the full benefits of innovative Health 2.0 tools. We can’t afford to see the public’s trust in new health information technology put at risk, nor can we afford to have innovation stifled.

To help solve this problem, the Center for Democracy & Technology (CDT) has launched a crowdsourcing project to determine the most vexing Health 2.0/HIPAA questions.

This is where you come in: (more…)

Early Feedback on PCAST 

• Limited. The first commentaries were primarily by technical and/or clinical bloggers. The mainstream HIT world had remarkably little initial reaction to the Report. 
• Respectful of the imprimatur of “The President’s” Report and noting some of the big names associated with the report (e.g., Google’s Eric Schmidt and Microsoft’s Craig Mundie.)
• Focused on technical and/or clinical perspectives around two broad themes.
  • The vision is on target:  “extraordinary”, “breathtakingly innovative”.
  • These guys didn’t do all their technical homework. The range varies, but the message is consistent. 

Today’s POV on PCAST 

What  a difference a six weeks makes.  (more…)

I’ll share a couple of particularly useful and well written analyses and commentaries by colleagues.

Health IT guru and thought leader Dr. John Halamka writes about The Proposed Stage 2 and 3 Meaningful Use Recommendations in his blog.

This is a great article to get a thumbnail overview of all the proposed recommendations. John lists 38 criteria and provides a quick commentary on how challenging he sees each of them. (Keep in mind that he’s CIO at one of the most HIT-advanced health systems in the country — your definition of “easy” and his might not be alike.)

(more…)

A full list of objectives for Stages 1, 2 & 3 is available in the PowerPoint presented to HITPC.

The proposed objectives contain a mix of items that are:

• Unchanged from Stage 1
• Similar MU criteria with higher implementation goals, e.g.,
  • Stage 1: CPOE for Rx orders 30%
  • Stage 2: CPOE for 60% of Rx, lab and radiology orders entered by licensed professionals
• Clarifications or more detailed specifications
• Discretionary objectives moved to core set
• New items

Here’s a list of proposed new objectives for Stage 2 MU: (more…)

The reviews are filtering in and I’m seeing two major themes: 

1. The vision is on target:  “extraordinary”, “breathtakingly innovative”.
2. These guys didn’t do all their technical homework. The range varies, but the message is consistent. 

Here are some early critiques of the PCAST report. Let the debate continue! (more…)

Remember the penguin problem described by economists?

No one moves unless everyone moves, so no one moves. 

Overcoming the penguin problem has a lot to do with creating expectations. A recent writing by Dr. James O’Connor in Physician Practice expresses a voice from the physician community that I’ve never heard before.  His essay is entitled “Meaningful Use — Doctors Have No Choice”.

(more…)

vs.

The debate is highly controversial and nuanced. There are “experts” on both sides.

My point today is not to take sides (although I’ll admit my canine partiality to the open web), but rather:

• to point out that the debate is occurring 
• to explain what the discussions are about
• to suggest that competition between walled gardens vs. the open web is creating healthy competition and providing consumers with great choices (e.g., Apple iPhone as a walled garden vs. Google Android OS as a more open approach)
• to point out that health care has not had much to say in this debate…until very recently.

A while back I started writing a series “Healthcare Crosses the Chasm to the Network Economy” . This essay continues that series. (more…)

• Extended Network Connectivity – As a network of networks, Surescripts will support and enable the exchange of all types of clinical messages between EHRs, HIEs and health systems that, today, are not connected with each other.
• Net2Net Connect – Allows health systems and technology vendors that already support clinical information sharing within their network to connect to Surescripts in order to receive and send clinical information outside their network (December 2010).
• Message Stream – Secure messaging tools for health systems and technology vendors to enable their physicians to electronically exchange clinical information (December 2010).
• Clinical Message Portal – Simple connectivity tools intended for providers that, today, do not have an EHR system to send and receive clinical messages. (January 2011).

Many others have recapped the new Surescripts network, so I’ll simply point you to a few of these resources:

• Surescripts press release
• Surescripts website — Clinical Interoperability Services
• “Surescripts, a Defacto NHIN”,  John Moore, Chilmark Research
• “Surescripts goes beyond e-prescribing” John Halamka, Life As A Healthcare CIO
• “Surescripts launching online health-care records network”, Washington Post
• ”Push for better ways to share e-health records”, Washington Post

Here are my 6 first-take reactions. (more…)

This is a short story about Blood Pressure Chart – a web-based tool used to manage, analyze and share blood pressure records. The old saying, “necessity is a mother of invention”, is almost applicable here. Almost, because coming up with an idea to store whatever records in a web app is hardly inventive. Certainly not in 2010. Strangely, a moderate set of requirements could not be satisfied by any preexisting solution.

For at least the past decade, I’ve been hearing about my country’s health care going digital. Millions (billions?) of taxpayers’ dollars later, I was given a paper notepad to record my blood pressure.

Having seen a doctor using a typewriter recently, I wasn’t really surprised, but simply had to find a better way. Few hours of googling and checking out a few desktop apps and one web app made me realize that nobody has taken it seriously so far. “I could make something much better in a week”, I thought to myself… but ideas for new functionality kept on coming and around a month later the site was ready.

When you create pretty much anything, it’s good to start by asking yourself a few questions before you touch any tools. Who is going to use it? What do they want to use it for? What are strengths and weaknesses of competing solutions? What non-standard functionality can we offer to enhance user experience?

First and foremost, I’m competing with a simple paper notebook. (more…)

Federally supported “Beacon Communities” are at work now defining how health information technology will support accountable, evidence-based care in communities – especially for care of chronic conditions. Backed by $235 million in federal grants, 15 communities across the country are serving as Beacon Community pilots for eventual wide-scale, performance-based use of technology to improve our health care delivery system.

The goal of the webinar is to address

• The fundamental nature and vision of the Beacon Community Program
• How the Beacon Program will influence nationwide delivery system reform and be a guide-path toward developing community infrastructures
• Other implications for the future of healthcare delivery

Why You Need to Know About Beacon Communities (more…)

Mike Miliard did a great job in capturing highlights and key points of my presentation at the Mobile Health Expo conference earlier this week. You can read his story here.

Please write me at vincek@bhtinfo.com in you’d like a copy of the PowerPoint presentation.

Update:  Neil Versel of FierceEMR also wrote up the presentation.  Here’s a link to his concise, on-target article ”HIE, mobility, open platforms start to knock down ‘walled gardens’ of proprietary EMRs.”

“Track who is on a care team — and share info with the patient.”

That’s just one of the summary recommendations coming from expert testimony given in a recent public hearing on how to improve care coordination through the use of health information technology. The Meaningful Use workgroup and Quality Measures workgroups are now wrestling with how to translate this recommendation into meaningful use criteria for HITECH Stages 2 and 3.

Seems like a good idea — simple, straightforward — perhaps even obvious. The EHR (electronic health record) could be a great tool for keeping care team members in the loop and on the same page about a patient’s care.

But then I thought about this for a few minutes, and the complexities started dawning. This seemingly simple recommendation — “Track who is on a care team and share info with the patient” — is the proverbial can of worms.

(more…)

When a major, multinational company does a complete turnaround on its operating and business model, it’s worth noting and examining the reasons behind the switch.

Wireless Week reported on a presentation made at the CTIA conference this week by Verizon COO, Lowell McAdam:

In a nod to the future, McAdam also said Verizon Wireless will scratch its “walled garden” approach because “in a 4G world, we need to turn that guarded model inside out.” The operator will transform its business model, he said, because it realizes that innovation in applications and use will come from outside the company.  Verizon will open its network, applications and location technologies to outside developers…[emphasis added].

Ars Technica reported further on McAdam’s commentary: 

I think collaboration and openness will be the operating platform for the future if we’re to bring the full promise of what 4G LTE brings. That’s really the new paradigm, the new model for operating in the entire wireless industry.

“Now I know that some of you in the audience are saying, ‘C’mon Lowell, you guys are the poster child for walled garden.’ What I’d say is that for the first 25 years that garden approach of closed systems served the industry pretty well. But in a 4G I think we need to turn that garden model inside out.”

How big a deal is this? Here’s an imaginary comparable statement that might be made by Judy Faulkner, CEO of Epic:

(more…)

Care management software is intended to help patients make critical connections across the health care delivery system.  Today it’s used primarily by 3rd party care managers who are typically either employed directed or indirectly by payers. While not surprising, the state-of-the-art of care management software is that it continues to function as disconnected islands of information.

The  2010 Health Information Technology Survey (available at no charge) provides an insightful yet sobering snapshot of care management software. The study was sponsored by TCS Healthcare Technologies, the Case Management Society of America, and the American Board of Quality Assurance and Utilization Review Physicians.

The study consists of answers from 670 respondents who chose to fill out to a web based survey; most respondents are direct care managers. 

The results are further broken down by subcategories of care management:  case management, disease management, utilization management, nurse triage, independent review organization, pharmacy benefits management, and behavioral health.  Variability among these subcategories should be considered directional given that the respondents are self-selected. The study doesn’t portend to be methodological rigorous, yet it’s a tremendously useful glimpse into the realities of care managers and the software they use.

Here are some key conclusions (mine) based on findings shown in Table 5A.  The numbers reflect the percentage of care manager respondents who indicated that their software provided specific capabilities.

(more…)

OK, let me be the first to admit that today’s “just-the-facts-ma’am” post might be a little dry…but trust me, its really important stuff to know in understanding the process of how the Health IT Policy Committee (HITPC) and its workgroups are approaching formulating recommendations for HITECH Stages 2 and 3.

At this point at least two different workgroups are involved in developing recommendations for HITECH Stages 2 and 3.

• A newly formed Quality Measures Workgroup. This group will “produce initial recommendations on quality measure prioritization and the quality measure convergence process pertaining to measure gaps and opportunities for Stage 2 Meaningful Use”. The group is chaired by Dr. David Blumenthal and held its first meeting on September 10.
• The Meaningful Use (MU) Workgroup. Most recently, the MU Workgroup solicited expert testimony on Care Coordination (August 5) and Population Health (July 29).

Important recent HITPC and Workgroup activities are summarized below.

(more…)

Who has the most comprehensive data about YOUR clinical conditions?

For most people, the answer today is “your health plan”, but it’s not at all clear that health plans will continue to have this role in the future.

As physicians and hospitals adopt EHRs, it’s foreseeable that clinical data about patients will be far more available and accessible.

Will patient data become:

• A jockeying point for control and business advantage between health plans and care providers,
• A collaborative opportunity to optimize clinical care and care coordination, or
• Both? (more…)

We’ve spent the past year creating the MU (meaningful use) requirements for Stage 1 of the HITECH act.  As shown by the diagram above, Stage 1 focuses on Data Capture and Sharing. Now it’s time to begin to focus on Stage 2 (Advanced Clinical Processes) and Stage 3 (Improved Outcomes).

The current generation of EMRs (electronic medical records) were designed primarily to assist care providers with clinical documentation, billing, and maximizing revenues. They were not designed to enable care coordination and optimize population health.  

This essay is the first in a new, ongoing series that will highlight:

• Design and metrics for Stages 2 and 3 of the HITECH act
• Companies and care providers developing and using applications targeting Stage 2 and 3 MU objectives

This first essay will provide an overview of what we’ve seen in Stage 1 and what we might expect in Stages 2 and 3. (more…)

The Twitter hashtag for the event is #HCU10.

Pop quiz: Among early-stage companies that are successful, what percentage are successful with the initial business model with which they started (Plan A) vs. a secondary business model (Plan B)?

Harvard Business School Professor Clay Christensen studied this issue.  He found that among successful companies, only 7% succeeded with their initial business model, while 93% evolved into a different business model.

So let’s take this finding and reexamine our human nature. In light of these statistics, what makes more sense:

• Defending Plan A to your dying breath?
• Assuming Plan A is probably flawed, and anticipating the need for Plan B without getting defensive?

We question many of the assumptions underlying HITECH Plan A. We also want to talk about the need and content for Plan B in a constructive way.

In this essay we’ll discuss:

1) The Need for HITECH Plan B

2) Questioning Assumptions — Issues to Reconsider in Plan B

a) Rewarding Incremental Progress
b) Addressing Root Causes for Non-adoption of EHR Technology
c) Questioning Health Information Exchanges (HIEs) as Building Blocks for the Nationwide Health Information Network (NHIN)
d) Catalyzing Movement Toward Modular EHR Technology
e) Focusing Incentives on High Leverage Physicians
f) Recalibrating Expectations for EHR Technology Adoption
g) Getting Bang-for-the-Buck in Achieving Meaningful Use Objectives
h) Comprehensively Revamping Privacy/Security Laws vs. Tweaking HIPAA
i) Maximizing Sync Between HITECH and PPACA
j) Leveraging Potential for Patient-Driven Disruptive Innovation
k) Promoting EHR Adoption Beyond Hospitals and Physicians, e.g., long-term care, home health, behavioral health, etc.
l) Dumping Certification

3) Summing Up

(more…)

.

….or to be more specific, HITECH is synergistic with payment reform that could come from the recently passed national health care reform legislation — the Patient Protection and Affordable Care Act (PPACA).

We’ll keep this post fairly short and try to avoid many of the more divisive aspects of this topic. The need for healthcare payment reform is well understood on both sides of the aisle:

Realizing the full potential of health IT depends in no small measure on changing the health care system’s overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide. Only then will they be motivated to take full advantage of the power of electronic health records. Dr. David Blumenthal,  New England Journal of Medicine, April 9, 2009

(more…)

by Dave deBronkart (e-PatientDave), Vince Kuraitis, and David C. Kibbe

So far this series has looked at HITECH participation by hospitals (grumbling but in the game) and physicians (wary, on the sidelines), kudos for ONC’s three major policy points, and how HITECH is already moving the needle on the vendor side. Today we’re going to look at the reason the whole system exists: patients.

It’s possible to look at the patients issue from a moral or ethical perspective, or from a business planner’s ecosystem perspective. In this post we’ll simply look at it pragmatically: is our approach going to work? It’s our thesis that although you won’t see it written anywhere, the stage is being set for a kind of disruption that’s in no healthcare book: patient-driven disruptive innovation.

We’ll assert that in all our good thinking, we’ve shined the flashlight at the wrong place. Sure, we all read the book (or parts), and we talk about disruption – within a dysfunctional system.

If you believe a complex system’s actual built-in goals are revealed by its actual behavior, then it’s clear the consumer’s not at the core of healthcare’s feedback loops. What if they were?

We assert that to disrupt within a non-working system is to bark up a pointless tree: even if you win, you haven’t altered what matters. Business planners and policy people who do this will miss the mark. Here’s what we see when we step back and look anew from the consumer’s view:

1. We’ve been disrupting on the wrong channel.
2. It’s about the consumer’s appetite.
3. Patient as platform:
   • Doc Searls was right
   • Lean says data should travel with the “job.”
   • “Nothing about me without me.”
4. Raw Data Now: Give us the information and the game changes.
5. HITECH begins to enable patient-driven disruptive innovation.
6. Let’s see patient-driven disruption. Our data will be the fuel.

(more…)

Most of the press coverage and attention to HITECH has been to the “buy” side of the market:  The central question here has been: “Will doctors and hospitals buy and use EHR technology?”

Meanwhile — and much more quietly — the sell (vendor) side of the EHR market is already dramatically different than it was a year ago. We observe change occurring at at least three levels:

1. HITECH as Policy Change
2. HITECH as Mindset Change
3. HITECH as Technology/Business Model Change

(more…)

While this might sound like a criticism of the way HITECH has been implemented, it’s not intended that way — it’s a commentary on 1) the complexity and scope of change that will be required to make HITECH successful, and 2) the level of protective entrenchment existing American health care today.

Rather, we believe that the Office of the National Coordinator (ONC) for Health IT – Dr. David Blumenthal and his staff — have done a superb job in interpreting and defining key aspects of HITECH legislation. We’re big fans.

For those of you who have been following our writings over the past 18 months, think of this post as a summary and status report on the extensive incumbent (cat) vs. innovator (dog) dialogue:

1. A Recap  — The Stagnant Electronic Medical Record (EMR) Market Before 2009
2. ONC Gets It Right In Three Major Interpretations and Definitions of HITECH

a) Meaningful Use (MU) Emphasizes “Meaningful”, Not “Use”

b) Vendors Get a Level Playing Field With Certification

c) Lightweight, Open Standards Promote EHR Interoperability and Modularity

(more…)

(click on any of the above graphics to be linked to the orginal source)

by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA

In the previous post in this series on “Is HITECH Working?”, we straightforwardly noted that hospitals are playing in the HITECH game. The issue of whether physicians will play is MUCH thornier.

As the headlines above succinctly convey — we conclude that for now there is too much fear, uncertainty, and doubt (FUD) to expect significantly increased EHR technology adoption by most physicians from the HITECH incentives and penalties.

Here are topics we’ll cover today:

• Fear, Uncertainty, Doubt
• Little Risk by Waiting a Year or Two
• A More Granular View — Segmenting Physicians
• Is There Another Side to the Story?
• How Important is Physician Adoption to the Success of HITECH?

(more…)

by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA 

The rationale for hospitals having to play in the HITECH game is straightforward: the financial carrots through 2015 are helpful, and the financial sticks after 2015 will be very painful.

We’ll discuss:

• Financial Impacts on Hospitals
• Survey Data Showing Hospitals Will Play
• Why Success is Not Guaranteed

Financial Impacts on Hospitals

Even prior to HITECH, most hospital executives already had passed the threshold decision and concluded that they need to implement EHR technology. Thus, the issue for most hospitals isn’t “whether” to implement EHR technology, but “when”, “at what cost”, and “how”. (more…)

by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA

If you’re like many folks we talk with, you understand the importance of the HITECH Act legislation — yet feel overwhelmed by the complexity and details.

This series of blog posts is for you. We address the question “Is HITECH working?” with seven straightforward observations. We’ve worked hard to boil down the complexity and make it understandable to the casual industry observer.

Is HITECH Working? Summarizing the Seven Observations

Our 7 Observations are:

(more…)

More information and registration here.

I’m honored to be a guest presenter, along with collaborators Lyle Berkowitz MD, Brian Klepper PhD, and Matthew Holt.

Certification Programs NPRM (Notice of Proposed Rulemaking)

Health IT, U. S. Department of Health and Human Services; March 2, 2010

Certification NPRM

Facts-At-A-Glance

FAQ

Bookmarked version of Certification NPRM (much easier to navigate)

U. S. Department of Health and Human Services; March 2, 2010

Via OCCAM Practice Management blog, March 3, 2010

Commentary and Analysis

Proposed EHR Certification Rule Changes Game

HDM Breaking News; March 2, 2010

“The rule mentions the Certification Commission for Health Information Technology, but does not grant it any grandfather status…. So, while CCHIT appears to be able to continue its operations under the proposed temporary certification program, its future isn’t clear in the proposed permanent program.”

Certification NPRM: A Statement from Alisa Ray, Executive Director, Certification Commission for Health Information Technology (CCHIT)

EHR Decisions; March 3, 2010

“…we feel confident about our prospects of becoming accredited…. We feel confident about the future, and we look forward to the opportunity to continue playing a role in accelerating the adoption of health IT.

 Why Rush Vendor Certification of EHR Technologies?

The Health Care Blog; March 08, 2010

“David Blumenthal and his staff have unveiled two separate plans to test and certify EHR technology products and services. We don’t think this is a good idea…this recently-announced two-stage EHR technology certification plan bears all the marks of a hastily drawn up blueprint that, if rushed into production, could easily collapse of its own bureaucratic weight.”

HIT Leaders React to Proposed EHR Testing and Compliance Rule

HealthLeaders Media; March 4, 2010

• “They got it exactly right.” Simeon Schwartz, MD, president and CEO of WestMed Medical Group.
• “It’s going to be interesting to see how much the vendors got out ahead of this and how much they’ve hedged their bets” Eric Saff, CIO of John Muir Health
• “…no matter where you are in the chain of this market, you can in fact certify those modules as opposed to waiting until you meet complete meaningful use to be certified. So I think that’s great. I think that’s really considerate of the ONC.” Luigi Leblanc of Solink

(more…)

However…I can’t help but comment on John’s misleading story “CCD Standard Gaining Traction, CCR Fading” in The Health Care Blog. He writes:

In a number of interviews with leading HIE [Health Information Exchange] vendors, it is becoming clear that the clinical standard, Continuity of Care Document (CCD) will be the dominant standard in the future.  The leading competing standard, Continuity of Care Record (CCR) appears to be fading with one vendor stating that virtually no client is asking for CCR today.

I have four beefs with John’s essay:

1. It’s no news that HIEs prefer CCD.
2. HIEs are not representative of the broader health IT market.
3. The narrow findings don’t justify the broad conclusion.
4. The CCD and CCR standards are more complementary than competitive

Let’s look at these one at a time.

(more…)

I’d describe the app as Garmin-like but running on the iPhone. You type in the address at which you’re going to start your drive and then you type in the address of the location where you want to drive to. The iPhone displays a map and step-by-step directions. Want to zoom in on a section of the map? …just put your fingers on the screen, spread them, and instantly you see the map in greater detail. The app uses the GPS built into the iPhone to display your current location and progress on the map.

A few years ago you would have had to purchase a separate Garmin or Garmin-like appliance to get this type of functionality. Is this iPhone app as good as the Garmin? For many people, the answer might well be “No”, but that’s not the point.  For many people the iPhone app WILL be good enough — and having that choice is what creates a vibrant marketplace.

So what does this have to do with health care? A lot.

To date, health care has not had an iPhone like platform on which to run multiple high value applications. If you wanted specific functionality, you had to buy an independent appliance. For more on the appliance vs. platform distinction, start reading at Chapter 2 of Harvard Law Prof. Jonathan Zittrain’s excellent (and freely available) book, The Future of the Internet and How to Avoid It.

If you rethink health care, just about ANY technology or service can be reconceptualized as an app that COULD run on a common platform. Mull this over for a while…

(more…)

Descriptive Summaries and Documents

 *Dissecting the Meaningful Use Proposed Rule PowerPoint

eHealth Initiative Policy Webinar; January 8, 2010

*What You Need to Know About the Meaningful Use Proposed Rule, Standards and Implementation Specification, and Interim Final Rule Certification Criteria PowerPoint

HIMSS Webinar; January 6, 2010

*Meaningful Use, Certification Criteria and Standards, and HHS Certification Process

HIMSS, frequently updated material, some members-only

Source Documents (Bookmarked)

Notice of Proposed Rulemaking (NPRM), Medicare and Medicaid Programs; Electronic Health Record Incentive Program; December 30, 2009

Warning: 536 pages of barely intelligible gobbledygook; stay away from this unless you are a lawyer, accountant, actuary, consultant, geek or wanna-be thereof 

Interim Federal Rule (IFR), HIT: Initial Set of Standards, Implementation Specifications, and Certification Criteria For EHR Technology; December 30, 2009

NPRM and IFR Tables in Spreadsheet Format

Healthcare Standards; January 9, 2009

Centers for Medicare & Medicaid Services (CMS) Website, Fact Sheets, Links

Updates on Meaningful Use, Certified EHR Technology and the Stimulus Bill

Software Advice; January 10, 2010

Analyses

*Urgently Needed: Useful Meaning of Meaningful Use

The Health Care Blog; January 9, 2009

*Now Reading: Proposed CMS Rule for EHR Incentives (from a patient access perspective)

Ted Eytan MD; January 10, 2010

(more…)

Dr. John Halamka — Vice Chair of the HIT Standards Committee of the ONC and one of the most vocal and influential figures in health IT — writes a blog post this morning entitled “The Genius of AND”. Halamka reasonably summarizes the essence of the debate about standards and interoperability as being between “the healthcare informatics crowd” (cats) and the “Internet crowd” (dogs):

He notes that the debate shouldn’t be about one or the other POV prevailing (“either/or”), but about integrating both points of view (“and”):

..we need to embrace both approaches – the right tool for the right job depending on what you want to achieve.

For provider to provider communication which requires the exchange of documents with non-repudiation as the medico-legal record for direct clinical care, the CDA/CCD has great metadata and the ability to support structured data as well as free text discharge summaries/operative notes/history&physicals.

For a summary record that represents a snapshot in time of problems, medications, and labs for transmission between EHRs and PHRs, the CCR and other formats such as Google’s CCRg or PDF can do the job.

I’m absolutely stunned…and speechless.

(more…)

The letter is directed at 10 EMR (electronic medical record) vendors, and asks very pointed questions about whether the vendors have been negligent in not addressing patient safety issues in their technologies.

Senator Grassley, you have the scent and you’re on the trail.  There are several other questions you should be asking these vendors: (more…)

BrightTALK is sponsoring a complimentary Electronic Health Record Summit this Tuesday, October 20, 2009.

David C. Kibbe MD, MBA and I will be presenting “Introduction to Clinical Groupware and the Clinical Groupware Collaborative”

Clinical groupware is a new and evolving model for the development and deployment of health information technology (HIT) platforms and applications having the following characteristics:

• Use of the Internet and the web for EHR technology.
• Explicit design for information sharing and online communication among providers and patients/consumers.
• A modular or component architecture upon which applications can be aggregated to meet specific clinical and workflow tasks.
• Patient/consumer engagement tools that facilitate ongoing health management and care coordination.
• Interface and data exchange standards for information sharing that emerge in a market-driven manner.

The Clinical Groupware Collaborative is in a formative stage organization. To date, representatives from over 50 companies have expressed interest. We are working to be formally incorporated in November 2009.

To register, attend live, or view afterward on-demand, click the following link:  http://www.brighttalk.com/webcasts/6114/attend  

Here’s a full listing of the other Electronic Health Record Summit presentations:   

Kaiser Permanente’s Journey and Ultimate Success with Health IT, Andrew M. Wiesenthal, The Permanente Federation

Prescribing the Best Security for Your EHR System, Andrew Klein, Product Management at SonicWALL

Business Associates Now and Then: HIPAA, EHRs and the HITECH Act, Susan Miller, Security & Privacy Workgroup Chair, WEDI

Fraud & Abuse in the EHR, Jean Bishop, J Bishop Consulting

New HIPAA Rules and EHRs: ARRA & Breach Notification, Raj Goel, Brainlink International; Jim Sheldon-Dean, Lewis Creek Systems

Three Forcing Factors of Electronic Healthcare Records, Kim Singletary, McAfee

How Great EHRs Empower Participatory Medicine, e-Patient Dave deBronkart, Society for Participatory Medicine co-chair

How big a network will the Health Internet (aka National Health Information Network) be?

My BOTE (back-of-the-envelope) calculation is that this network could consist of about 301 million nodes.  Here’s my math (pls. clarify or amplify):

• 300 million individuals in U.S.
• 700 K doctors
• 5 K hospitals
• 295 K — other B2B healthcare entities

Very rough…but I hope you get the point.

So let’s put into perspective press releases from Google or Microsoft announcing that they have developed new “partnerships” (i.e.nodes in the network) for Google Health or Microsoft HealthVault. As an example, today Google announced partnerships with APWU Health Plan and Harvard Pilgrim Health Plan.

(more…)

Here’s a copy of our PowerPoint slides…

and here’s DMAA’s writeup:

Helping physicians and hospitals meet the “meaningful use” criteria for federal support for health information technology under recently passed legislation represents a keen opportunity for the population health management industry, presenters at this session said yesterday.

Vince Kuraitis, JD, MBA, of Better Health Technologies, LLC, and Don Storey, MD, of RMD Networks, presented a look at the evolution of HIT and the electronic medical records systems from a strongly proprietary model with little interoperability to new model of integrated, modular applications from various vendors sharing common languages and platforms.

(more…)

I’m writing to extend a warm personal invitation to learn more about the Clinical Groupware Collaborative (CGC).  To-date, purely through word-of-mouth over 40 companies have expressed interest in the CGC, and we expect that you’ll be hearing a lot more about us over the coming months.

Our meeting will take place next Tuesday, September 22, 6 PM in conjunction with The Forum 09, the annual meeting of DMAA: The Care Continuum Alliance.  More details are provided at the bottom of this post.

I’ll address a few questions that might be on your mind.

Q. What is Clinical Groupware? 

(more…)

The Federation of American Hospitals (FAH) sent a letter to Dr. David Blumenthal (National Coordinator for Health IT) arguing that “Meaningful Use” funding should not be tied to achievement of quality measures.  The FAH is the trade association for for-profit hospitals; the letter is dated August 26 and a copy is available on the HealthHombre website, with a deserved hat tip.

First, let me concede that they make a reasonable point on p. 3 when they say “Under it’s framework, the Policy Committee has recommended that HHS should adopt a measure for 2013 requiring a 10 percent reduction in preventable admissions from 2012 to qualify as a meaningful EHR user.”  This measure deserves discussion.

Here’s the implicit threat of a lawsuit — the nuclear bomb: (more…)

This post is a foundational overview of characteristics of network industries.  Much of the terminology will deserve deeper discussion, but we have to start somewhere.

In his book The Economics of Network Industries, Professor Oz Shy lists four characteristics of network industries.

The main characteristics of these markets which distinguish them from the market for grain, dairy products, apples, and treasury bonds are:

1. Complementarity, compatibility and standards
2. Consumption externalities [network effects]
3. Switching costs and lock-in
4. Significant economies of scale in production

In this essay, I’ll quote from Dr. Shy in explaining each of these characteristics.  I’ll also offer a few thoughts as to how these characteristics apply to healthcare. More specifically, I’ll discuss physician adoption of EHRs (electronic health records) and patient adoption of PHRSs (personal health record systems).  

Why a PHRS instead of a plain old PHR?  Think of a PHRS as a PHR data repository platform bundled with multiple high-value applications. For a more detailed explanation, read here.   

Let’s look at the characteristics of network industries one at a time.

(more…)