The KHIT Blog: Defining "Interoperability" down, an update

Thursday, September 14, 2017

Defining "Interoperability" down, an update

Pretty interesting Modern Healthcare article arrived in my inbox this morning.

Epic takes a step towards interoperability with Share Everywhere
By Rachel Z. Arndt

Epic Systems Corp. is making headway in the quest for interoperability and potentially fulfilling meaningful use requirements with a new way for patients to send their medical records to their providers.

The new product, called Share Everywhere and unveiled Wednesday, allows patients to give doctors access to their medical records through an internet browser. That means doctors don't have to have their own electronic health record systems and the information can be shared despite not having EHRs that can communicate.

"This is really patient-driven interoperability," said Sean Bina, Epic's vice president of access applications. "This makes it so the patient can direct their existing record to the clinician of their choice," he said, regardless of whether that patient is one of the 64% of Americans who have records in Epic EHRs or whether that doctor is one of the 57.8% of ambulatory physicians who use Epic.

The receiving doctors need only have a computer and an internet connection—a requirement that might have been helpful in the recent hurricanes…

As I've noted before, my world of late has been "all Epic all the time," mostly in my role as next-of-kin caregiver, as well as an episodic chronic care F/up patient. Kaiser Permanente? Epic. Muir? Epic. UCSF? Epic. Stanford Medical Center? Epic. (I think Sutter Health is also on Epic, but I'm not certain.)

They pretty much rule the Bay Area (which is a pretty good thing for us, net). Their national footprint is huge as well.

More from Rachel's article:

"Where we are now is we're looking at how do we get the data into the workflow of the clinician so it's not something else they have to do, it's just there," said Charles Christian, vice president of technology and engagement for the Indiana Health Information Exchange. "There is a massive amount of data that's being shared for a variety of reasons. The question is, how much of it is actually being used to have an impact on the outcomes?"

Interesting. Goes to my long irascible (pedantic?) beef regarding the misnomer "interoperability," which I've called "interoperababble." To recap: no amount of calling point-to-point interfaced data exchange "interoperability" will make it so -- should you take the IEEE definition seriously.

As do I.

"How do we get the data into the workflow so it's not something else they have to do, it's just there?"

Indeed. That is in fact the heart of the IEEE definition. To the extent that Epic's "Share Everywhere" service facilitates that "seamlessness" workflow goal, it may in fact be a substantive step in the right direction.

Though, it does appear to be "read-only." Minimally, the recipient provider would have to "screen-scrape" the data into her own EHR (or otherwise save them "to file") for "write" updating in the wake of acting upon the data. Chain-of-custody/last record update concerns, anyone?

We'll see. From Epic's press release:

Epic Announces Worldwide Interoperability with Share Everywhere
Patients can authorize any provider to view their record in Epic and to send progress notes back

Verona, Wis. – Epic, creator of the most widely used electronic health record, today announced Share Everywhere, a big leap forward in interoperability. Share Everywhere will allow patients to grant access to their data to any providers who have internet access, even if they don’t have EHRs. In addition, using Share Everywhere, a provider granted access can send a progress note back to the patient’s healthcare organization for improved continuity of care…

"Send a progress note back?" Perhaps that might suffice to allay "last update" concerns. Perhaps. A fundamental issue in QA broadly is that of "document version control."

ERRATUM

Have you registered for the Oct 1st-4th Santa Clara Health 2.0 Annual Conference yet? Hope to see you there.
____________

More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Thursday, September 14, 2017

Defining "Interoperability" down, an update

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