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Thursday, March 3, 2016

#HIMSS16 Day 3

BREAKING!  In my email inbox today!

Lucky me! I may have to leave the conference early! (Love the "tommorrow" spelling.)

But, first, a bit of snark.

I searched "Uber" on the Conference website. No match. Thank you.

Attended the #HITsm panel / interactive discussion. Excellent.

Mandi Bishop moderating

The panelist on the right is Drew DeFord. He brought up "Lean." BobbyG was all smiles. Color me an Evangelistic Believer. See my coverage of last year's Lean Healthcare Transformation Summit in Dallas. The 2016 Summit will be in Miami this June. A tremendous value. Highly recommend you go if you can. Interact with the leaders in progressive, science-based health care process QI.

In response to a question asked of the panel and audience regarding "what you you think will be the innovation that will have the most significant impact of the health care industry going forward?" my response was "that of 'AI' or 'IA' (artificial intelligence / intelligence augmentation)." See my prior posts on the topic.

It's somewhat of a close call, But, overall, with respect to the "health care industry" writ large, that would be my view.

Below, at #HITsm, Chuck Workflow Man Webster, commenting while doing a Periscope live stream.


Shlepped down to the rear of Level 1 to area 11954.

Sequoia Project presentation.
"In 2012, The Sequoia Project, previously Healtheway, was chartered as a non-profit 501(c)(3) to advance the implementation of secure, interoperable nationwide health information exchange.  The Office of the National Coordinator for Health Information Technology, part of the US Department of Health and Human Services, transitioned management of its eHealth Exchange to The Sequoia Project for maintenance.  Since 2012, the Exchange has grown to become the largest health information exchange network in the country.  In 2014, we began to support additional interoperability initiatives beginning with Carequality.

We have assembled, through these initiatives, and our engagement with government and industry, experts who can identify the barriers to interoperability and pioneer processes to make health information exchange work on a national level. We are a neutral body, inclusive of diverse participants, which allows us to create practical solutions to data exchange problems. As a nonprofit operating in the public interest, our governance process insures transparent oversight of this work.

Our vision is to make the right health information accessible at the right place and time to improve the health and welfare of all Americans."
Yeah. Good a time as any to review some of Fred Trotter's 2011 book "Hacking Healthcare."
Chapter 11. Interoperability

The first thing to keep in mind when thinking about interoperability is not a particular standard or technology, but motivations for instituting data exchange. Widescale interoperability has been technically possible for more than 20 years, and major hospitals have had data worth exchanging for at least that long. But as with EHRs, exchanging health data has stalled due to conflicting and backward incentives. 

Historically (with a few notable exceptions) most healthcare institutions have found little motivation for interoperability. There is a lot of motivation to profess interest in healthcare interoperability, which costs nothing. This creates confusion among those outside the healthcare industry. For example, if the hospital CEO says that interoperability is “critical,” why is there no health data being exchanged? 

For most clinics and hospitals, making patient data portable makes the patient portable. Why would anyone invest in a technology that makes it easier for patients to migrate to competitors? For any healthcare provider, a patient represents a financial asset that is expensive to replace. And the easy exchange of records lowers one of the main barriers to patients leaving— information about their medical histories. For centuries, a doctor-patient relationship was something very difficult to replicate. Patients understood that their current doctor was familiar with their health story, and moving would mean losing that familiarity. In a world without portable healthcare records, that relationship is priceless to the patient and difficult to rebuild. Changing doctors will still be hard, even when the health record is movable, but it will become a tractable problem. 

Similarly, health IT vendors lack motivation to properly support interoperability standards. If the data for a single patient can easily be exported from an EHR, then the data for every patient can also be exported easily. True interoperability means that it is much simpler for one EHR to replace another, and therefore one EHR vendor to be replaced by another. As it stands, without widespread interoperability, it is almost impossible to migrate from one EHR to another. Again, interoperability will not make migration between EHR systems easy, but it will make it possible. EHR vendors know this, and have a similarly mixed motivation regarding interoperability. Most EHR vendors claim that they are interoperable because they provide tools to migrate data into their EHR system. Generally, the motivation for interoperability drops for vendors substantially when they see that it creates a path away from the vendor. 

Many EHR vendors charge extra for modules designed to export data, and this fee often becomes a kind of “severance pay” for EHR vendors. When purchasing an EHR, it is critical to request that any modules required for data exchange be included in up-front pricing. Neglecting this often ensures that you have to pay your vendor for the privilege of firing them...

Trotter, Fred; Uhlman, David (2011-10-07). Hacking Healthcare (pp. 167-168). OReilly Media - A. Kindle Edition.
That was five years ago. (I first reviewed Fred's book in March 2012). Are we still stuck largely with "Free Beer Tomorrow?" "Interoperababble?" (See all of my "Interoperababble" rants here.)

Or, are we on the cusp of a beneficent, "transformative" exponential Hockey Stick Function interop uptick?

One hopes.


OK, quick analogy (of sorts). Say you're some penny-ante geezer who comes to Vegas in flip-up shades, Hawaiian shirt, cargo shorts, sandals, and black knee socks. You play the penny slots, and maybe bet a penny on an NBA game with your friend (absurd; bear with me). Your strategy? Double your bet if you lose to get your money back.

What would be the consequence of a 24-game losing streak? I quickly drop some stuff into an Excel sheet to illustrate.

After 12 losses you're only out about 41 bucks. No biggie. But, as you can see, the upslope really gets going thereafter. Hockey Stick neck really cranes up around loss #19. Hard to believe that final number. Don't take my word for it, screen-scrape and paste this exponential expression into Google: ".01*2^24="

Consider that the longest NBA team losing streak is 28 games (76'ers). Longest NFL losing streak, 26 games (Tampa Bay). Consider had you started out wagering not with a penny, but $100.


I used to play street hoops in Vegas at a NW side city park with these low-life degenerate sports book gambler dudes (the ones who weren't in iterative jail repose at the time). This guy "Doc" explained his "double-down" M.O. to me. I thought, "yeah, bro', that's why you're habitually on the verge of being homeless."

So (flipping the analogy from losses to wins), in terms of significant interop progress, maybe we're getting close to the Hockey Stick neck.

One hopes.

More to come...

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