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Saturday, June 15, 2013

" It's not one-size-fits-all"

The interoperability standards in the meaningful use rules have come under fire in recent months for being too weak. But representatives from The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) are defending what they call strong provisions to move the industry forward.

Speaking in a June 6 webinar, "CMS and ONC eHealth provider webinar on advancing interoperability," Steve Posnack, director of the ONC's Federal Policy Division, said the stage 2 rules may not deliver full, industry-wide interoperability immediately. Policymakers have to take into account limitations inherent in the regulatory process, as well as provider and vendor readiness to adopt standards.

Posnack compared criticism of the lack of interoperability in the stage 2 rules to people faulting the government for there being no cars on the road that are ready to meet higher gas-mileage standards. There isn't a lot regulatory agencies can do if the industry doesn't produce products that comply with stiffer requirements.

We are making a lot of progress, and we're moving in an incremental and deliberate fashion.
Still, he said progress is being made, and this progress will be more apparent as providers start transitioning to stage 2 of meaningful use.

"It's best to remember it's not one-size-fits-all," Posnack said. "It's not one solvable problem. We're about to get there; it's coming and you're going to see it very soon. We are making a lot of progress, and we're moving in an incremental and deliberate fashion."

The webinar responded to criticism that has been leveled at the meaningful use program in recent months for not doing enough to advance interoperability standards.

In May, a group of six Republican senators sent a letter and white paper to Department of Health and Human Services Secretary Kathleen Sebelius asking the agency to address what the senators see as insufficient policies for supporting interoperability...
"It's best to remember it's not one-size-fits-all," Posnack said. "It's not one solvable problem."

Well, I disagree, with respect to the Big Picture, the national goal. It should be.

One master RDBMS data dictionary standard specifying the precise name, data type, data length, and cardinality (inclusive of no-dupes/no nuls requirements). Yes, of course, incorporate work already done, e.g., ICD-9, ICD-10, CPT, RxNorm, SNOMED-CT, LOINC, and CVX.

Yes, it would necessarily be a large dictionary table. So what? It wouldn't be that large, and it would certainly be manageable. Yes, like any standard, it would be open to revision and appending over time by the Standards Body. No, not every HIT vendor would have to use every data element, only those relevant to the product customer target (beyond those common to all medical disciplines and those required by Meaningful Use and its eventual successor).

"Interoperability"/"data mapping" problem solved. Let all vendors compete on features, functionality, speed, "look and feel" (UX) usability (also UX), price, support, etc.

Instead of the despised opacity of "Vendor Lock" data siloing.

See my August 29th, 2012 post Single source of Truth.

UX improvement props just underwent a facelift.

Nice. Improved readability.


“There are no plans for any more extensions,” he told attendees, repeating it twice, for emphasis.

The current extension, from Oct. 1, 2013 to Oct. 1, 2014 was partly due to looking at the incremental changes needed in reforming healthcare, and realizing that “sometimes, extensions are needed," Mostashari said. It was also to allow for a crosswalk to be made between ICD-10 and (Systematized Nomenclature Of Medicine Clinical Terms) SNOMED, a more physician friendly systematically organized computer-processable collection of medical terms used for diagnoses...
Yeah. He better hope that the pending national HIX rollouts go smoothly. If they turn out to be the Cluster[bleep] many are predicting (and which the GOP in particular is salivating over), hordes of status quo interests will descend on The Hill to try to scuttle the ICD-10 move.
States running out of time on health insurance exchanges
By Amanda White,  Washington Post, June 16

With the deadline for states to implement Affordable Care Act-mandated health insurance exchanges less than four months away, state governments will need to move fast.

States are having to reevaluate their existing health insurance infrastructures to meet the act’s requirements. They have already received nearly $4 billion in funding for the effort thus far — and can access more dollars through 2014...

The endless,. mindless "interoperability" debate just goes on and on and on...

Despite progress on health IT interoperability, tough questions remain
June 17, 2013 | By Susan D. Hall
Data-sharing in healthcare remains difficult, and despite assertions that the industry is on the cusp of a breakthrough, many are impatient with the slow pace of progress.

Those attending the Digital Healthcare Conference in Madison, Wis., last week addressed some of the biggest questions about the sad state of interoperability, according to InformationWeek. Among them:

Shouldn't data standards allow easier sharing across vendor systems? Epic CEO and founder Judy Faulkner (pictured) said that data standards describe only "a very, very small subset of the data that's really there," according to the article. Intermountain Healthcare CIO Marc Probst has told FierceHealthIT that lack of standards has his team redesigning interfaces over and over. At the conference, Jamie Ferguson, vice president of health IT strategy and policy for Kaiser Permanente, however, said that existing standards are "perfectly good" for close to two-thirds of needed records, but that electronic health records tend not to be implemented well based on the standards...


Gotta love 'em.


Mostashari: ICD-10, Meaningful Use can be synergistic
June 20, 2013 | By Dan Bowman

Contrary to what many in the health IT industry think, National Coordinator for Health IT Farzad Mostashari said he does not see the transition to ICD-10 as disruptive to the Meaningful Use process.

Instead, Mostashari said in a recent interview with Healthcare IT News, he believes that ICD-10 can serve as a motivation of sorts for providers moving forward with EHR implementation.

"If anything, I'm seeing that if we can get the synergy going … people seeing if I have a Meaningful Use certified EHR, if I have clinical documentation, then it's easier for me to get to ICD-10, then that's another reason for me to move forward on the clinical side," he said.

Still, Mostashari said he thinks there's "money to be made" by vendors who can help ease the ICD-10 transition for frustrated providers. He said that he envisions companies creating tools that can help providers avoid having to remember thousands of codes by instead suggesting a handful of codes to use, depending on a given scenario.

"Anything that eases the burden on frontline clinicians for documentation and coding," Mostashari said. "Those are the kinds of tools I'm thinking of and I'm sure the market will think of many more."

Mostashari's belief that the ICD-10 and Meaningful Use efforts can be synergistic differs from opinions expressed last month by the College of Healthcare Information Executives, which called for a one-year extension of Meaningful Use Stage 2. CHIME CEO Russell Branzell, in a phone conversation with FierceHealthIT, cited ICD-10 as one of several factors in its request...
Another vendor opportunity? Well, we'll see. Who's gonna pay for all of this?

I know: "Asked and Answered."

More to come...

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