Next up: the NYeC Annual Digital Health Conference in NYC

This should be great. The New York eHealth Collaborative (NYeC) is definitely on the progressive edge of Health IT thought and implementation. I'll be arriving early, on the 12th, to put on a surprise 90th birthday party on the 13th with my sister and niece for my ailing aunt, my late Ma's younger sister.

Registration link here. The Manhattan Hilton conference rooms block is sold out, but you can still buy at retail. Lots of great hotels in the immediate area, too.

Conference agenda here. A packed two days. I'll be wearing my REC blogger and KHIT hats, and will, of course, be shlepping my camera gear. Many thanks to NYeC for the press pass.

A video from the 2012 event:

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DECEMBER ON THE CONFERENCE TOUR

IHI graciously extended to me a media pass as well for their December Conference. Agenda here. Speakers include the beloved/hated Don Berwick.

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MEANINGFUL USE INCENTIVE PAYMENTS UPDATE

Through September.

$16.6 billion and counting. Notice, as I predicted, how the federal shutdown and HealthCare.gov woes have blotted out any substantive criticism of the Meaningful Use program expenditures (though MU may well be placed back on the chopping block during the next federal shutdown dance in early January).

Stage Two Year One starts in 53 days (for those on the calendar year schedule), btw.
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"INTEROPERABILITY"

I hate that word. It's a misnomer. Nonetheless, the mainstream complaints regarding it remain pretty much where they've been for quite some time.

EHR Interoperability Remains Elusive
John Commins, for  ,HealthLeaders Media, November 8, 2013

A lack of standards, privacy concerns, and proprietary and competition issues are just a few of the hurdles hampering the interoperability of EHR data among participants in health information exchanges.

EHR Interoperability Remains Elusive

John Commins, for HealthLeaders Media , November 8, 2013

A lack of standards, privacy concerns, and proprietary and competition issues are just a few of the hurdles hampering the interoperability of EHR data among participants in health information exchanges.

Healthcare providers have made solid progress over the last decade building in-house electronic health records systems to share patient data within their networks. However, interoperability with outside providers and payers remains a significant barrier, according to eHealth Initiative's 10th annual survey of health information exchanges.

Three-quarters of the nearly 200 eHI survey respondents said they've had to build numerous time-consuming and expensive interfaces between different systems to facilitate information sharing, including 68 organizations that said they had to build 10 or more interfaces with different systems. More than 140 respondents cited interoperability as a pressing concern.

Jennifer Covich Bordenick, CEO of the nonprofit, independent eHI, says the results of the survey are "mixed," but adds that it would be a mistake to say that no progress is being made.

"If you look back five years you can see huge leaps in progress, but when you are looking year-to-year it is very slow. It is hard to look at these things in such a small period of time," she says. "The type of problems we are having now is a sign of moving in the right direction. These issues wouldn't have arisen five years ago because we didn't have enough knowledge or we weren't connected enough. Now we're having connection issues, which is a good thing, whereas before we were just trying to convince people that they should do this."

Bordenick says the hurdles in front of interoperability aren't necessarily technical.

"There are proprietary and competition issues where people don't want to share data with other organizations," she says. "While we are all focused on the patient there are a lot of concerns that competitors are going to use their data to their advantage. So competition is one barrier and the other is standards."...

I again repeat what I posted on September 19th (itself a repeat).

One.Single.Core.Comphrehensive.
Data.Dictionary.Standard

One. Then stand back and watch the Market Work Its Magic in terms of features, functionality, and usability. Let a Thousand RDBMS Schema and Workflow Logic Paths Bloom. Let a Thousand Certified Health IT Systems compete to survive. You need not specify by federal regulation any additional substantive "regulation" of the "means" for achieving the ends that we all agree are desirable and necessary. There are, after all, only three fundamental data types at issue: text (structured, e.g., ICD9, and unstructured, e,g., open-ended SOAP note narrative), numbers (integer and floating-point decimal), and images. All things above that are mere "representations" of the basic data (e.g., text lengths, datetime formats, logical, .tiffs, .jpegs etc). You can't tell me that a world that can live with, e.g., 10,000 ICD-9 codes (going up soon by a factor of 5 or so with the migration to ICD-10) would melt into a puddle on the floor at the prospect of a standard data dictionary comprised of perhaps a similar number of metadata-standardized data elements spanning the gamut of administrative and clinical data definitions cutting across ambulatory and inpatient settings and the numerous medical specialties. We're probably already a good bit of the way there given the certain overlap across systems, just not in any organized fashion.

Think about it.

Why don't we do this? Well, no one wants to have to "re-map" their myriad proprietary RDBMS schema to link back to a single data hub dictionary standard. And, apparently the IT industry doesn't come equipped with any lessons-learned rear view mirrors.

That's pretty understandable, I have to admit. In the parlance, it goes to opaque data silos, “vendor lock,” etc. But, such is fundamentally anathema to efficient and accurate data interchange (the "interoperability" misnomer).

Yet, the alternative to a data dictionary standard is our old-news, frustratingly entrenched, Clunkitude-on-Steroids Nibble-Endlessly-Around-the-Edges Outside-In workaround -- albeit one that keeps armies of Health IT geeks employed starting and putting out fires.

Money better spent on actual clinical care.

I'm still awaiting substantive pushback. There are conceptually really only two alternatives: [1] n-dimensional point-to-point data mapping, from EHR 1 to EHRs 2-n, or [2] a central data mapping/routing "hub," into which EHRs 1-n send their data for translation for the receiving EHR.

The complications arising from these two alternative scenarios ought to be obvious.

Of course, we also need a no-dupes, no-nuls unique patient identifier in such a dictionary, one that The Big Brother Bogeyman keeps at bay.
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More to come...