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Friday, March 13, 2015

Different day, same Interoperababbleiciousness

In my email inbox, from TechTarget.
Single health IT standard not feasible, says Doug Fridsma
Doug Fridsma discusses the difficulties of uniting all providers under one health IT standard and talks about his move from ONC to AMIA.

SAN DIEGO -- This is the final part of an interview with outgoing ONC Chief Scientist Doug Fridsma, M.D.

Influential CIOs, such as Marc Probst of Intermountain, whom we saw at National Health IT Week a couple of weeks ago, are sounding calls for interoperability standards, either to have ONC mandate them, or if that doesn't happen, to call on Congress to pass legislation requiring the standards. His metaphor was to force a standard, just as government forced the railroad track gauge. How do you think health IT can get to uniform standards most quickly?

Doug Fridsma: The wonderful thing about health IT standards is there are so many to choose from. We've got a lot of different standards that are out there that we could potentially choose. There is this tension between saying we just need to use this standard, versus creating a consensus-driven approach where the industry says, 'We believe this standard will solve our problem, we believe the government should require that because it will help everyone.'

There is a tension between top-down, government-imposed standards and bottom-up, industry-adopted standards. Standards are standards because people use them. There's a whole host of standards out there that are standards but no one uses them and they don't really advance where we want to go. There's a real need for us as a country, and that means public and private participation, to identify both the challenges we have with the current standards, and to constrain them in ways that are really going to drive toward interoperability...
Well, there is in fact some legislative movement. From a new congressional "draft discussion bill."
(1) IN GENERAL.—Subtitle A of title XXX of the Public Health Service Act (42 U.S.C. 300jj–11 et seq.) is amended by adding at the end the following new section:
(a) INTEROPERABILITY.—In order for a qualified electronic health record to be considered interoperable, such record must satisfy the following criteria:
(1) OPEN ACCESS.—The record allows authorized users access to the entirety of a patient’s data from any and all qualified electronic health records without restriction.
(2) COMPLETE ACCESS TO HEALTH DATA.— The record allows authorized users access to the entirety of a patient’s data in one location, without the need for multiple interfaces (such as sign on systems).
(3) DOES NOT BLOCK ACCESS TO OTHER QUALIFIED ELECTRONIC HEALTH RECORDS.—The record does not prevent end users from interfacing with other qualified electronic health records.
(4) Other criteria?
(1) IN GENERAL.—The Secretary shall adopt, in accordance with this section—
(A) methods in which to measure if qualified electronic health records satisfy the criteria described in subsection (a); and
(B) modifications (including additions) to such methods, as appropriate.
INITIAL SUMMARY REPORT.—Not later than July 1, 2016, the Secretary, after consultation with relevant stakeholders, shall submit to Congress and provide for publication in the Federal Register and the posting on the Internet website of the Office of the National Coordinator for Health Information Technology of a report on the following:
(A) The initial set of methods adopted under this section.
(B) The strategies for achieving widespread interoperability.  
(C) An overview of the extent to which qualified electronic health records offered as of such date satisfy such initial set.
(D) Any barriers that are preventing widespread interoperability.
(E) The plan and milestones, including specific steps, to achieve widespread interoperability.
(2) FOLLOW-UP DETERMINATION AND REPORT ON WIDESPREAD INTEROPERABILITY.—Not later than December 31, 2017, the Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Office of the National Coordinator for Health Information Technology of the following:
(A) A determination by the Secretary whether the goal of widespread interoperability has been achieved.
(B) A list identifying the vendors of, or other entities offering, qualified electronic health records, which categorizes such entities, with respect to such records, as in compliance or not in compliance with the certification criteria described in section 3001(c)(5)(B)(ii) and with the requirements under clause (i) of section 3001(c)(5)(C) (including with the terms of the attestation and other requirements under such clause).
(C) Actions that may be taken by entities identified under subparagraph (B) as not being in compliance with such criteria and requirements in order for such entities to become in compliance with such criteria and requirements.
(D) Penalties described in section 3010A(b) to which entities, with respect to such qualified electronic health records, beginning January 1, 2019, are subject if such technology and entities are not in compliance with the certification criteria described in section 3001(c)(5)(B)(ii) and with the requirements under clause (i) of section 3001(c)(5)(C), respectively...
We'll see if this gets any traction. In any event, nothing substantive will likely happen anytime soon.

More in the news on "standards":
Turning the crimson tide of process inefficiency and waste
By Barlow, Rick Dana, Proquest LLC
When will healthcare universally implement supply data standards?

Ten years ago this May, a group of 13 pharmaceutical and medical device companies convened a kick-off meeting in Princeton, NJ, that concentrated on a critical but daunting array of goals. They wanted to prevent medical errors, authenticate products, track and trace those products throughout the supply chain and increase total supply chain efficiency.

That "first mover" group effectively laid the foundation and groundwork for the Healthcare User Group under the auspices of GS1 and its set of global standards for products in a variety of industries.

Outside of healthcare, most industries and their myriad participants have recognized and used the GS1 standards to improve their own financial and operational status.

Save for those manufacturers and distributors who move products to the consumer retail markets, inside of healthcare, many of its myriad participants can't seem to get past the idea of adopting and implementing standards...

HPN: Should federal requirements and/or payer reimbursement penalties be the final solution? Why?

Crowley: [This is] likely the only path forward. [It's a] chicken-and-egg argument - the only way to show benefit is for there to be actual use.

Skiba: In my opinion, federal requirements are a means to an end. They are that catalyst that's going to drive the healthcare marketplace to better standardization. For example, we anticipate additional guidance coming from the FDA, which will outline the provider side implementation of UDI. This will drive additional focus and market adoption.

Pettigrew: Unfortunately, this may be the only way standards adoption will find its way to the executive suite and will receive the proper attention and political clout to mobilize all parties in the supply chain. Regulatory pressure resulting reimbursement withholding would be the impetus to escalate this initiative on the list of organizational priorities. Otherwise, organizations will continue down the path of least residence.

LeMaster: As much as I hate the idea of government involvement I do wonder if we will be able to make this a high enough priority without it. I'd like to see incentives via meaningful use on the provider side. My concern is that if the government does get involved organizations will focus on compliance not the true benefits of standards...
Good article. A relatively long read, and a bit tangential, but relevant to the Health IT standardization issue nonetheless.

More. From the WestHealth Institute:
Nurses Say Medical Errors Could Be Reduced If Devices Were Connected, West Health Institute Survey Shows
Half of Nurses Surveyed Have Witnessed a Medical Error Because Medical Devices Were Not Coordinated, According to Survey

SAN DIEGO, CA and WASHINGTON, D.C. – March 12, 2015 – Nurses believe medical errors could be reduced if the medical devices hospitals rely on for testing, monitoring and treating patients could seamlessly share information, according to the newly released results of a national survey of more than 500 nurses conducted online by Harris Poll on behalf of the Gary and Mary West Health Institute.

Each year, it is estimated that more than 400,000 Americans die from preventable medical errors. This not only takes an enormous emotional toll on families and friends, but also places a heavy economic burden on the nation – an estimated trillion dollars or higher. As hospitals wage a war on error, there is growing appreciation that medical devices, while individually safe and effective at improving care and saving lives, can create risks for patients and challenges for clinicians when not seamlessly connected.

According to the survey, half of these nurses said they witnessed a medical error resulting from a lack of coordination among medical devices in a hospital setting. Devices include everything from infusion pumps, ventilators, pulse oximeters, blood pressure cuffs to electronic health records. The weighted survey was conducted online by Harris Poll from January 7-16, 2015 and included 526 nurses (credentialed at RN or higher and with an education of BSN or higher) who work full-time in a non-school setting.

Among these nurses, three in five (60 percent) said medical errors could be significantly reduced if medical devices were connected and shared data with each other automatically. This problem could be addressed by the widespread adoption of open communications standards that allow for the safe and secure exchange of data...
Standards. Not a profligate busywork "Standards Promulgation Industry," some actual (and few) standards.

Click here.
Again, maybe HL7® FHIR® will bring interop salvation.

And The Hits Just Keep On Comin...
Vendors Blocking Interoperability
By Christine Kern, Health IT Outcomes

One analyst argues that the feds should stop HITECH payments to lower vendor interop fees

The solution to lowering “outlandish” vendor interoperability fees is for the federal government to curtail HITECH incentive payments and stop trying to regulate how much EHR vendors charge providers for interoperability and focus on pay-for-performance efforts, according to Niam Yaraghi, a Brookings Institution policy analyst. “The best solution for the government is to do nothing,” Yaraghi wrote.

“The new pay for performance payment methods in which the medical providers are being paid a fixed amount for treating patients would drive them to become more efficient and increase their profit margin by seeking solutions such as health information exchange to cut costs. Because the market for new EHR products is now saturated, the only revenue source for EHR vendors is charges for data exchange. Currently, they can get away with outlandish charges because they know the incentives from the federal government allow doctors to cover their costs,” he asserts.

According to Health IT Outcomes, incentive payments under the HITECH Act have been unsuccessful in increasing EHR adoption, as revealed by a draft paper published by the National Bureau of Economic Research. And data from the ONC provided in December 2014 demonstrated that since the enactment of HITECH in 2009, 62 percent of physicians who adopted health IT tools identified financial incentives and penalties as a major influence on their decision to adopt, compared with only 23 percent of physicians who adopted before 2009.

But Yaraghi says regulating and incentivizing interoperability is not working, as iHealth Beat writes. He argues EHR vendors “have taken patient data hostage and are not willing to release it unless they receive a big ransom,” and notes, “They typically claim that technical problems limit the interoperability of their products” and charge significant fees to allow providers to exchange data...


Great LinkedIn article by Dave Chase.

Health Systems Spending Billions to Prepare for the Last Battle
A Forbes cover story reported on the billionaires at Cerner and Epic created by the HITECH Act. This was the $30 billion portion of the stimulus bill that is providing billions of subsidies for the adoption of electronic health records. When this kind of money is being spent, it begs the question whether health systems are making the best use of that investment in modernizing the U.S. healthcare system.

On the one hand, it’s hard to argue with modernizing the record-keeping in healthcare that isn’t far beyond how medicine was recorded in the time of Hippocrates. Many thousands of lives are saved as a result of this modernization (e.g., avoiding deadly prescription errors) and it is why there is strong support from the current and past administrations to modernize systems. On the other hand, most companies benefiting from the stimulus have two significant shortcomings that will need to be addressed for health systems to thrive in the new environment they are facing.
  1. The core design principle of these systems was optimizing the rapidly fading “do more, bill more” reimbursement model where the “patient” isn’t much more than a vessel for billing codes. For entirely logical reasons given the old reimbursement model, their success was measured by their ability to get as big of a bill as possible out as fast as possible. The shift to a value and outcome based model of reimbursement literally flips provider incentives on their head (e.g., hospitalizations are penalized rather than rewarded). For example, those successful in population health management recognize that the EHR is just one of several components that needs to be brought together into a view for nurses delivering proactive care.
  2. The legacy systems were designed for a healthcare system in stasis with a technology architecture not known for its nimbleness. For example, systems such as Epic are very customizable, however once customized, they are quite rigid. If there is one area of consensus about the future of the U.S. healthcare system, is that it’s destined to go through radical transformation. Nimble systems will be imperative to respond to a rapidly changing landscape...


My future?

Gotta love The New Yorker.

More to come...

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