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Wednesday, May 6, 2015

HELP: "Failing Electronic Health Records Program May Stand in Way of Precision Medicine"

Interoperababble Update:

Senators blast EHR program
Poorly designed EHRs could put precision medicine initiative at risk
WASHINGTON | May 6, 2015

Until physicians have EHRs that can talk with one another, the Precision Medicine Initiative introduced by President Barack Obama could be in jeopardy, Sen. Lamar Alexander said Tuesday.

"We've got to get these records to a place where the systems can talk to one another – that's called interoperability – and also where more doctors, particularly the smaller physicians' offices, want to adopt these systems, can afford the cost and can be confident that their investment will be of value," Alexander said...
Yeah. Let's review some fundamentals.

Consider the automobile analogy. A gasoline-powered car is "interoperable" in two senses.
  1. You can gas up anywhere in the nation "without special effort." Consider the fuel to be the car's standard "input data";
  2. The car's literal instrument "dashboard" (displaying operating parameters "output data") and physical manipulation tools (all comprising your "interface" and driving "UX") are essentially 'interchangeable" and consequently produce "interoperability" -- notwithstanding the wide variability of ancillary "features" depending on make and model (most of them pertaining to comfort and convenience).
The foregoing are fully consistent with the above-cited core IEEE definitions.

No such equivalent exists for EHRs. A "standard data dictionary" would go precisely to analogy point #1 above (and, implicitly, to point #2).

I know, I know; not gonna happen. The barriers, though, are incumbent-deferential political, not technical. What I fear is that policymakers are simply going to "punt," and "define interoperability down," effectively striking the "without special effort" part. Additional workflow burden (along with "dirty data" propagation) may well become the norm, all the current swooning over FHIR® notwithstanding.

Chronic Health IT (misnomer) "interoperability" concerns aside, is the "EHR program" really "failing"?

apropos of that concern, last week, this hardcopy came in my mail:

The featured article title and subtitle read
The new politics of meaningful use
As the federal program moves toward its final stage, some politicians are loudly questioning just what it's accomplished after five years and nearly $30 billion -- and many providers are voicing big concerns about what all these rules are really good for
This issue is not available online (I've searched high and low for this article). I guess it was a HIMSS15 frisbee tabloid. The article, by Neil Versel, is simply excellent: candid, thorough, and fair. In fact, the entire issue is packed with great content.

My tweets to the Senate HELP committee leadership.


More to come...

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