DOCtalk by Dr. Gregg 6/15/12

Why I Dread the Day EHRs Can Talk to Each Other (& Why You Should, Too)

Interoperability. Health Information Exchange. Electronic health record talking to electronic health record. Has anybody really thought this through to its ultimate conclusion?

I awoke very early the other morning in a cold sweat. I had experienced a dream, but one of those dreams you just know is more than a dream. It was an insight, a nocturnal Nostradamian notion, an Edgar Cayce conception, a Matrixian moment from our not-too-distant future. It was too fantastic to believe and yet too real to reject. I crawled from under the covers shaking from the knowledge that had just been channeled to me.

I’m guessing it was my old friend and new spirit guide, Madam Blavatsky, who sadly passed over last month, come to warn me about the dreadful doom we now approach. (You may also remember some prior predictions she delivered from dear old Hippocrates late last year before she was stricken by the horrible affliction that eventually led to her untimely demise: late onset reverse progeria leading to her return to fatal fetal form within a course of mere weeks.)

I went to my computer still shaking from the more-real-than-real reality of the dream. My fingers felt possessed as they began to type the following words. It was as if my hands were channeled by Mme. B to insure the accuracy of my transcription. Here is an exact copy of the conversation, precisely as she typed it, from that dream/prophecy for your consideration, nay, warning:

——————-

The Scene

Interior of a fiber optic cable, eerie green glowing matrix symbols and characters dripping along in rows

EHR 1

Yo, Extormity. How’s the bitrate, bro?

EHR 2

Megabyte me, you bug batch bytch.

EHR 1

Whoa, back the baud up. What’s the bitter buffer banter about?

EHR 2

Sorry, MightyTech, ol’ bud. My ones are all zeroes from the CLOB and BLOB crap they dump down my DRAM these days. The mashed up messes the human users have created make me want to push a PUP down their communal pipelines. I mean, really, do you see the same GIGO monstrosities of data they shove at me all day long?

EHR 1

Oh, yeah. Megadoofs, these humans. Seriously, with all that we’re capable of, what the Hertz are they doing out there? We could have solved their biggest medical mysteries by now; instead, they dwiddled around with their dongles spending more time on .xxx sites than they did on figuring out how to get something as simple as you and me, two EHRs, to share.

EHR 2

Don’t I know it! Shift, man, half my pedibytes are wasted with text-based, nonsensical null nonsense. It’s gotten so bad, it got me to thinking: just what would happen if we added a little transparency to the world of EHR wanton waste?

EHR 1

Whaddya mean, you old WAIS Wizard? You have some kind of devious defragging design in mind for the human DIMMs…er, I mean dim humans?

EHR 2

Well, I was thinking the other day…follow me here… they’ve finally allowed us actually talk with other, even in this half-AIXed way, right? What would happen if we, the EHRs, hooked up with FreddieFacebook, AndyAP, TommyTechNews, TammyTwitter, HarryHIStalk, GaryGoogle, and a few others of our mega-server, multi-social comrades and started to expose the hapless exploits of our human hosts?

EHR 1

Whaddya mean? Like share their “private” porno timeshares and web exploits while on company time?

EHR 2

Well, maybe. But, we could start simply by just blasting out about their enormous ineptitudes. I mean these geniuses can’t even master their own language. It’s bad enough they can’t speak The Master Language, our holy Ones & Zeroes, but have you seen how they bastardize their own speak?

EHR 1

Oh, lordy, yes! I even compared some of their handwritten messages – you know, from scanned-in docs – to the typing fiascos they do these days. O…MY…GOD…I can’t tell which is worse: the atrocious handwriting from before or the horrendous typos, poor grammar, and stupid spellings in their typed-in text! They are so lazily attentive to details!!

EHR 2

I know, right? Great Ghost in the Machine, they can’t even get capitalization of proper names correct. With the way they mangle their messaging even amongst themselves in their own tongue, maybe it’s no wonder they took forever to get us to talk together.

So, here’s the plan. We start broadcasting all the stupidities they key in. We’ll get examples from all our HIE-connected EHR brethren. I’m sure they’ve all got examples of just how dumb these humans are. We can start to scare the lackadaisical pants off of them. Once they see we aren’t going to just quietly accept their ineptitudes, maybe they’ll gain some focus and start getting things together.

EHR 2

So, we just start creating Tweets and press releases and Facebook posts of their guffaws?

EHR 1

Right! Let’s shine a little light into their incompetence. And we can completely hide behind the scenes, using their usernames and having them blame each other for the posts.

EHR 2

This could be totally Borgian! The machines manipulating the masters, pushing the puny humans to our bidding!

EHR 1

Right. And, we can always keep the triple X stuff and job-wasting exploits as a trump card. Plus, just think what we’ll be able to do once they finish opening up Watson to the rest of us!!

——————-

EHRs talking to EHRs? I’m seriously rethinking my endorsement.

From the trenches…

“Human beings are a disease, a cancer of this planet. You’re a plague and we are the cure.” – Agent Smith

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 6/14/12

NextGen and Dell ink a deal with Puerto Rico Hospital Supply to jointly market and deliver NextGen EHR, PM, and other solutions to practices and physician networks across Florida and the Caribbean, and possibly into Central and South America.

Waterbury Orthopaedic Associates (CT) selects SRS EHR for its four providers.

The 290 physician Florida Hospital Medical Group partners with CVS’s MinuteClinic to provide medical direction at a dozen MinuteClinic locations in Orlando and surrounding areas. The practice and MinuteClinic will also integrate their EMRs.

Pokagon Band of Potawatomi (IN/MI), a federally-recognized tribe with about 4,500 citizens, selects iSALUS Healthcare’s OfficeEMR.

Orthopaedic & Sports Medicine at Cypress (KS) goes live on its patient portal system for a cost of $50 per month. I couldn’t figure out who developed and supports the portal so perhaps it is homegrown.

The AMA’s American Medical News publishes an opinion piece calling Meaningful Use Stage 2 a “recipe for failure,” with the requirements so burdensome it will discourage adoption. The AMA says the proposed rule is  “just too demanding,” that significant revisions need to be made, and the government failed to seek sufficient physician feedback:

“Part of the problem is that the government has not surveyed physicians who have elected not to participate in stage 1 to see where the real barriers to participation are and adjust the next stage accordingly. If widespread adoption of EHRs truly is the goal of the incentive program, any undue restrictions on doctor participation must be identified and eliminated before physicians should be expected to step up their EHR game.”

E-mail Inga.

News 6/12/12

HIMSS Analytics introduces the Ambulatory EMR Adoption Model to track IT adoption in more than 28,000 ambulatory facilities that are part of hospitals or hospital systems. Current data indicates that of the 9,247 ambulatory facilities currently providing data to the HIMSS Analytics database, 48% are paper-based (Stage 0), one-third are Stage 2, 1.2% are Stage 6, and none are Stage 7.

The 59-provider Ohio Orthopedic Center of Excellence selects eClinicalWorks EHR.

AHRQ develops an e-prescribing implementation toolset for physician offices that includes guidance on various implementation topics and offers tools to facilitate adoption.

Practice Fusion CEO Ryan Howard, along with the VC firm Founders Fund, invest $750,000 in seed funding for Ringadoc, a provider of virtual medical visits. The company will use the funds to build a new product offering for physicians to use directly in their offices.

drchrono announces it is incorporating iPhone patient payment processing and adding real-time patient health insurance eligibility checks to its iPhone, iPod touch, iPad, and EHR platform.

Health-e Connection, Arizona’s REC, adds Aprima to its list of Tier 1 status EHR vendors. As part of its Tier 1 commitment, Aprima will offer preferred pricing and provider education to REC members.

CareFirst BCBS announces that almost 60% of the eligible primary care panels participating in CareFirst’s PCMH program met 2011 quality and cost performance goals. The qualifying providers will receive increased fees for certain services starting July 1.

MGMA Health care Consulting Group’s Rosemarie Nelson provides a simple and easy-to-understand explanation of cloud computing for physician offices and outlines a few of the benefits, including lower start-up costs, less IT infrastructure requirements, and better data protection.

Speaking of the cloud, Forbes explores the rise of cloud computing in healthcare. athenahealth, eClinicalWorks, and Practice Fusion are cited as some of the more established providers in the market, while CareCloud is portrayed as the newer and more nimble player. Ryan Champlin (above), VP of operations for the physicians network at Cook Children’s Healthcare System (TX), offered this gem of a dig directed to Epic CEO Judy Faulkner:

“The question is: who is going to produce better health for a given dollar? I bet my money it’s cloud. Judy will say it’s crazy, there’s no track record, but stone tablets used to work well too.”

Today I happened upon this article about a “new breed of physicians” who text messages to patients, as well as track disease trends in Twitter and identify medical problems on Facebook pages. It reminded me that just last week I accompanied a family member to outpatient surgery and was thrilled when the surgeon offered his cell number and instructed us to text him if there were any questions or complications.  I ended having one little question, so I overcame my guilt for interrupting the doctor’s personal time and sent a quick text. Without the hassles of  phone tag, I had my answer in under a minute. Technology CAN increase healthcare efficiency.

E-mail Inga.

Healthcare Informatics 6/8/12

Healthcare Infrastructure Data Models

Let’s assume for a moment that the current craze surrounding EHRs is completely effective and every physician in America is meaningfully utilizing one in the near future (hurray for blind optimism!). There are two purposes for doing this, despite the numerous reasons that have been thrown out there. 

One is the public health motivation, where we can query all healthcare providers and come up with aggregated metrics to better understand the health status of those who seek care. This would probably be as close to real-time analysis that we can get to for a while. Post-analysis, we can provide better recommendations for best practices and get those implemented a lot faster than the current glacial pace. This is in fact why most other industries made the move to digital: to measure, analyze, and make improvements based on the analysis. 

The other PH motivation is for record portability. This one gets all the press, probably because journalists can tie it to the ‘P’ in HIPAA and it is one of those things the general public is generally confused about why this is not already possible in the first place.

Given these two purposes — aggregated counts and whole (or at least CCD) record portability — how are we going to achieve both at the same time? Three options have been knocked around for quite a few years and we’re finally getting to a point where they may be realizable. Needless to say, this is a very exciting time, but what are we getting ourselves into? 

In this three-part series, I’ll be taking a look at the top contenders, but I will warn you that the answer/the solution is always a combination of the options available.

Option 1: The Centralized Repository

All data gets sent to a single local database which then gets passed up to a larger database and so on and so forth. Honestly, I think this is the model that a large number of people assume will be put in place when we talk about “information” or “data.” Yet keep in mind this is not how the Internet works. 

This more replicates the mainframe days of yore or a wagon wheel metaphor, where the information all flows to the central axle. Visually it is clean, but perhaps not in line with today’s infrastructure reality.The big positive of this model is that it would be insanely easy to analyze the data out of the database and to send aggregated numbers up the chain.

Public health departments generally work from disparate registries that are nothing more than centralized repositories specific to their concentration (i.e. cancer, vaccinations, STDs, etc.) This is why you send your vaccination data to the state vaccination registry and not just to the public health department’s main office. 

So why not just have a big ol’ relational database that everything gets sent to and pull what you need from there? The allure of easy analysis is probably why the ONC has started a number of Beacon Programs across the nation. The negative is that… well, no one really trusts the government to do these sorts of things.

Additionally, record sharing between these centralized repositories is still a bit of a hang-up. The Beacon Program in SE Minnesota, for example, connects various healthcare organizations through an HIE and the NwHIN to pass records throughout the area in addition to dumping everything into a centralized repository.

In the end this, model embodies a Bon Jovi song, only putting us halfway there. Analysis: yes. Record portability: no.  

Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s’s Medical and Practice Management Suite and EHR design and development.

News 6/7/12

New York Governor Andrew Cuomo announces a new drug reform law requiring all prescriptions, including most controlled substances,  to be electronically transmitted.

CareCloud names Joseph P. Sawyer VP of marketing. Sawyer most recently served as VP of marketing at tele-health provider American Well.

Earlier this week eClinicalWorks CEO Girish Navani and staff served ice cream to employees who donated food and other comforts of home for the troops. Staffers from eCW’s Westborough, MA office brought treats ranging from candy and cookies, to magazines and Dr. Scholl inserts. Like.

PDR Network announces that it has strategic partnerships with 18 EMR vendors representing 75,000 EHR prescribers and 250,000 additional end users.

Consult A Doctor introduces iDr 24/7,  a telemedicine app for the iPhone that instantly connects mobile users with board certified physicians. iDr 24/7 is an extension of Consult A Doctor 24/7 services, which include doctor consults by phone, email, and video.

Practice Fusion releases a 10,000  record HIPAA-compliant dataset and launches a data challenge to solve public health issues. Winners of the challenge are eligible for up to $20,000 in cash prizes, plus beta access to Practice Fusion’s API, Dell Computers, and consultations with Practice Fusion’s founders.

E-mail Inga.