A Stand Up Double
By Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA
Last Friday ONC (the Office of the National Coordinator for Health IT) released a long-awaited Report On Health Information Blocking. The ONC blog capsulizes the report:
Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Our report examines the known extent of information blocking, provides criteria for identifying and distinguishing it from other barriers to interoperability, and describes steps the federal government and the private sector can take to deter this conduct.
We were struck with two major reactions to the ONC Info Blocking Report:
- It’s a solid double: it does a credible job of recognizing that the major problems of interoperability and blocking are not technical or due to a lack of standards, but rather due to business practices and business models. The report also proposes a baseline of potential solutions.
- It’s not a home run: the report misses the opportunity to describe a comprehensive approach to combat information blocking.
In turn, we offer seven recommendations to strengthen the report:
- Place Greater Weight on Patient Safety and Public Policy Concerns
- Lower the Burden of Proof For Information Blocking
- Put Criminal Penalties On the Table
- Broaden the Scope of Tactics for Addressing Information Blocking
- Emphasize Federal Purchasing Power — Not Regulatory Power — to Address Information Blocking
- Place Less Weight on the Interests of EHR vendors
- Name Names, Shine the Light
If one more person describes Epic’s new API as being “open”, I’m going to turn purple. Don’t let the URL fool you: http://open.epic.com/
Last week EHR vendor Epic unveiled it’s new API (application programming interface) targeted at developers — more specifically at remote patient monitoring companies and health/wellness apps or portals. Epic seems to have had second thoughts about the site since only remnants of the landing page are still there as of today.
Not to worry. As a public service, I kept a copy and have reproduced the text below — with personal annotations/translations added.
What’s Wrong With Epic’s API?
What’s wrong with Epic’s API from a developers POV? Data goes in. It doesn’t come out. If you are a developer, this is a great way to disintermediate yourself — you create all the value, Epic captures all the value.
Would you bank at an institution that allows you to make deposits, but not withdrawals?
Despite the chatty language that was on Epic’s website, their API is a continuing extension of Epic’s ethos of control rather than collaboration. It’s downright condescending.
What part of health information exchange do they not get over at Epic?
Enough banter. Let’s get to the meat of it.
Yesterday’s announcement of “Standard Health Data Connectivity Specifications” by the EHR|HIE Interoperability Workgroup (EHR|HIE WG) is potentially earth-shattering.
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.
(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.
My guess is you’ve probably never asked yourself this question. A quick preview:
- Technical barriers aren’t the limiting factors to Facebook becoming a care coordination platform.
- Facebook’s company DNA won’t play well in health care.
- 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.
On March 31, CMS released the long-awaited “Medicare Shared Savings Program: Accountable Care Organizations” document (ACO Rule). Read the details here (strong suggestion: unless you’re working on your PhD in ACOs, start with the fact sheets).
There are many surprises. Here are eight first impressions on this 429 page tome:
- The bar has been set high…very high. Tire kickers need not apply.
- Don’t expect to see many or any small ACOs.
- Patients will be confused by ACOs.
- Concerns over maintaining competition and avoiding antitrust are being taken seriously.
- CMS scores points for coordinating the ACO Rule across Federal agencies.
- CMS loses points for micromanagement and a controlling mindset.
- Possible losers — hospitals, ACO vendors.
- Possible winners — physicians, health plans.
The details follow.
iMedicalApps recently published its list of Top 20 Free iPhone Medical Apps for Healthcare Professionals.
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:
- New England Journal of Medicine
- 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.
After attending the largest annual health IT conference of the year — HIMSS 11 – John Moore reported that “nearly every EHR vendor has an iPad App for the EHR [electronic health record], or will be releasing such this year.”
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.
By Rich Elmore and Arien Malec. Rich Elmore is the Direct Project Communication Workgroup leader and Vice President, Strategic Initiatives at Allscripts. Arien Malec is ONC’s Coordinator, Direct Project and Coordinator, S&I Framework.
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.
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.
Friday, February 4, 2011
11:30 am Eastern Time
10:30 am Central Time
9:30 am Mountain Time
8:30 am Pacific Time
Vince Kuraitis JD, MBA
Better Health Technologies, LLC
Garry Carneal, JD, MA
Schooner Healthcare Services
More Information and Registration: Click here.