The HIMSS12 Conference in Las Vegas last week had the highest attendance ever. Even the large convention facility seemed crowded and at times claustrophobic. Nevertheless, I'd say it was a very successful meeting. I came away with a lot of ideas for future posts. For now I'll just discuss first impressions of what I thought were major themes I identified, as filtered through my one of 35,000 minds that attended this year's meeting.
Data mining was a very hot topic. Secondary use of data will be facilitated through the expected increase in health information exchange. Vendors, government agencies, researchers are looking forward to a 21st century gold rush of clinical data-not only to improve the quality and efficiency of health care but also for anticipated financial gain in some cases. The drive for health data is almost alarmingly commercialized. This recent report, unrelated to HIMSS12, epitomizes what I mean.
Clinical decision support (CDS) also got a lot of play. Clinical decision support systems are ubiquitous for checking for drug-drug interactions and allergy checks and even to promote guideline adherence. Order sets are a good way to implement CDS rules. But the safety and efficacy of CDS are still questioned. The challenge of decision support is to deliver information the clinician or patient needs at the time the information is needed with actionable choices in a manner that harmonizes with workflow. Strides in the development of artificial intelligence to filter data, generate information, and offer timely suggestions should be expected.
In the last paragraph I mentioned patient safety. The intention to deliver safe care is never far from a clinician's thoughts while practicing medicine. In fact, improvement in patient safety is one of the characteristics used to promote EHR adoption. Published reports on the use of EHRs to improve the safe delivery of care however are contradictory. Several speakers mentioned the Institute of Medicine's report published late last year on EHR safety. An article in Health Affairs was also mentioned several times.
I think these publications point the way toward enhanced scrutiny of the safety of HIT systems, better studies of the current state of the industry, and easier, more efficient, and systematic methods of collecting data on the safety risks of EHR technology.
Health information exchange was a popular topic of discussion. ONC representatives and others touted the successes of the Direct Project, NwHIN Exchange and Connect activities, State HIE grant programs, and health information exchange pilots in the Beacon and SHARP communities. There are a lot of stakeholders in this area with different viewpoints and different criteria for success. I don't think many are fully satisfied with the amount of health information exchange taking place today in the U.S. Vendor preparedness, provider acceptance, and infrastructure are barriers to "push" transactions such as Direct. Federal policy, local governance issues, consumer consent issues, vendor readiness, and infrastructure inhibit robust exchange. Progress is being made in incremental steps but much more needs to be accomplished to reach the full potential of HIT. This leads to the next topic-consumer empowerment.
More and more, patients want facile access to their health information. The "Blue Button" initiative of the VA
is leading the way to opening up the flow of data to patients. There should be easy ways to upload information to a personal health record or to a file on a home computer for patients to use to communicate with their multiple physicians and to enhance their ability to participate in promotion of their health. The ONC has made consumer engagement one of its strategic priorities and has developed a new web site to disseminate information to patients and families.
Last but not least, mobile health was a ubiquitous theme. Mobile health applications are being developed to empower providers and patients alike. The use of mobile technology to facilitate the use of patient care devices, both external and implanted, to facilitate patient care was particularly noteworthy. This technology is advancing like a tidal wave. This field offers perhaps the greatest opportunities for innovators today. Issues with FDA regulation of medical devices are a potential risk. Even the definition of a medical device seems to be in flux. We will have to be nimble to keep up with all the developments in this realm of health IT. Here is a good HIMSS resource.I haven't even touched upon the NPRMs released during the week. I will wait for the dust to settle a bit before I offer my thoughts. The coming months should be interesting for health IT participants.
Saturday, February 25, 2012
Thursday, February 9, 2012
Is the view only option for HIE worthwhile?
I watched the NeHC University online presentation- an introduction to the HIE Landscape early this month. The results of a survey of active HIEs were presented. Findings were that about half of the responders plan to offer the view only data option while just a quarter plan to support document sharing. In a similar vein, AZ HIMSS offered a state of the state update for HIT in Arizona at the end of January. It turns out that largest HIE in Arizona also plans on providing view only access to data. As a physician as well as a strong proponent of electronic information exchange, I am disappointed that more robust ways of freeing up patient information flow is not the goal of most HIE programs around the country.
The "view only" option for HIE has numerous limitations. If the user wants to retain the information in a more permanent format, there is no convenient way to do this. The receiver must re-enter the data in their own EHR, PHR, or other information system. This relies on memory and human typing skills, both of which are subject to error. The process is time consuming and does not fit well with the workflow of busy clinicians and patients. I suppose screen shots could be saved but the data is still basically constrained in a silo. Worse yet, for those with information privacy concerns, it would be hard to keep an accurate audit trail for this method of copying patient information. Also, it would be difficult to support the creation and maintenance of a longitudinal health record for the patient. Furthermore, the data would be in a format that would not allow ready use of clinical decision support tools to improve the quality of patient care.
For the last four years I have served as a volunteer monitor at the IHE North American Connectathon. Most of the profiles I have tested belong in the Patient Care Coordination domain. To make a long story short, we test the ability of different vendors to conform to various clinical document summary specifications (medical summaries, ER referrals, Labor and delivery records, and ED physician notes to name a few. For further information see this site) and exchange those documents with information trading partners. The testing plan offers options of: view only, document import, section import, and discrete data import. The view only option allows one vendor to view another vendor's summary document on their computer screen, like pulling up a web page. As discussed above, this information is not in an easy to use format. The document import option allows the vendor to import the entire document and attach it to a patient's medical record. The workflow is similar to filing outside records received by mail or fax in a patient's paper chart, as many clinicians do today. Section import allows attachment of a section of a summary document to the patient's chart-for example the allergy section, problem list, medication list, demographic data, etc. This capability only has limited uses currently but could be used as a data source to drive a medication or problem list reconciliation engine. Discrete data import has the greatest potential to change how we do medicine. As the name implies, information at the data element level can be imported and inserted in the patient's chart. This information could then be used support CDS, prepare graphical representations of patient data, and for reconciliation activities such as reconciling a medication list. Unfortunately, the bar to pass the tests at the Connectathon has been set too low. Vendors only need to be able to support the view option. I have had conversations with fellow monitors and others and many agree it would be a valuable step forward to require vendors to support the discrete data import option. It is my belief that this is the most useful way to drive innovation and improve information exchange capabilities among different EHRs. There could be other incentives as well.
The federal government made a commitment to encouraging HIE through the State HIE Grant program. Federal policy has a considerable influence on the strategies the states are adopting. For example, it was made clear that The Direct Project specification should be adopted and implemented. I wish the ONC would put greater pressure on the state grantees to adopt options for data import as opposed to view only health information exchange. One only needs to look to the popularity of the VA sponsored "Blue Button" initiative to see that download technology is desired and used by patients and other stakeholders in the health care marketplace.
The "view only" option for HIE has numerous limitations. If the user wants to retain the information in a more permanent format, there is no convenient way to do this. The receiver must re-enter the data in their own EHR, PHR, or other information system. This relies on memory and human typing skills, both of which are subject to error. The process is time consuming and does not fit well with the workflow of busy clinicians and patients. I suppose screen shots could be saved but the data is still basically constrained in a silo. Worse yet, for those with information privacy concerns, it would be hard to keep an accurate audit trail for this method of copying patient information. Also, it would be difficult to support the creation and maintenance of a longitudinal health record for the patient. Furthermore, the data would be in a format that would not allow ready use of clinical decision support tools to improve the quality of patient care.
For the last four years I have served as a volunteer monitor at the IHE North American Connectathon. Most of the profiles I have tested belong in the Patient Care Coordination domain. To make a long story short, we test the ability of different vendors to conform to various clinical document summary specifications (medical summaries, ER referrals, Labor and delivery records, and ED physician notes to name a few. For further information see this site) and exchange those documents with information trading partners. The testing plan offers options of: view only, document import, section import, and discrete data import. The view only option allows one vendor to view another vendor's summary document on their computer screen, like pulling up a web page. As discussed above, this information is not in an easy to use format. The document import option allows the vendor to import the entire document and attach it to a patient's medical record. The workflow is similar to filing outside records received by mail or fax in a patient's paper chart, as many clinicians do today. Section import allows attachment of a section of a summary document to the patient's chart-for example the allergy section, problem list, medication list, demographic data, etc. This capability only has limited uses currently but could be used as a data source to drive a medication or problem list reconciliation engine. Discrete data import has the greatest potential to change how we do medicine. As the name implies, information at the data element level can be imported and inserted in the patient's chart. This information could then be used support CDS, prepare graphical representations of patient data, and for reconciliation activities such as reconciling a medication list. Unfortunately, the bar to pass the tests at the Connectathon has been set too low. Vendors only need to be able to support the view option. I have had conversations with fellow monitors and others and many agree it would be a valuable step forward to require vendors to support the discrete data import option. It is my belief that this is the most useful way to drive innovation and improve information exchange capabilities among different EHRs. There could be other incentives as well.
The federal government made a commitment to encouraging HIE through the State HIE Grant program. Federal policy has a considerable influence on the strategies the states are adopting. For example, it was made clear that The Direct Project specification should be adopted and implemented. I wish the ONC would put greater pressure on the state grantees to adopt options for data import as opposed to view only health information exchange. One only needs to look to the popularity of the VA sponsored "Blue Button" initiative to see that download technology is desired and used by patients and other stakeholders in the health care marketplace.
Thursday, February 2, 2012
Cumulative Index through December 2011
I have prepared a cumulative index to posts for this blog from its beginning.
A Commercial Web-based HIE Offering from Verizon July 20, 2010
A Peeve: The auto-log off in HIT Dec. 27, 2011
Breach Notification-Part 1 Oct. 15, 2009
Breach Notification-Part 2 Oct. 26, 2009
Certification July 29, 2009
Certification Follow-up Aug. 19, 2009
Clinical Decision Support Systems Mar. 23, 2011
Clinician Workflow April 11, 2010
Consumer Preferences Nov. 2, 2009
Digital Certificates-uses in HIE June 15, 2011
Dr. Blumenthal--An Inspirational Keynote Address at HIMSS10 Mar. 7, 2010
EHR's for Surgeons/specialists Nov. 19, 2010
EHR Safety Feb. 21, 2010
EMR Certification Revisited Nov. 17, 2009
EMR Usability Nov. 22, 2009
Future Role for HITSP? Dec. 2, 2009
Handheld Devices-the Mobile Clinician Jan. 9, 2010
Health Information Exchange Aug. 18, 2009
Health IT Ontologies of the Future Jan. 12, 2011
Health IT Workforce Training Dec. 27, 2009
HIMSS 11 ARRA Usability Symposium Mar. 2, 2011
HIMSS Virtual Conf. 2011:
Closing keynote-an exceptional presentation June 14, 2011
HIT Outlook for 2012: a crystal ball Dec. 2, 2011
HIT Workforce Training Dec. 14, 2009
Imaging and Meaningful Use Debate Jan. 27, 2011
Information Exchange Patterns May 28, 2010
IFR on Standards and NPRM on Meaningful Use Feb. 16, 2010
Introduction July 17, 2009
Introduction to electronic signatures and digital certificates June 9, 2011
It's all about workflow Mar. 31, 2010
Looking forward to 2012 Nov. 27, 2011
Meaningful Use and Incentives to adopt HIT July 21, 2009
Messages vs. Documents June 16, 2010
More Thoughts on Documents Sept. 6, 2010
My Favorite Day at HIMSS 11 Mar. 3, 2011
NA Connectathon 2011 Jan. 22, 2011
Online Education Sept.10, 2009
Online Graduate Degrees-My Experience Nov. 18, 2009
Optionality and Interoperability in Health Care Software Dec. 6, 2010
Outlook for New Workforce Trainees July 25, 2010
Patient Portals Mar. 30, 2011
PCAST Report Thoughts Feb. 11, 2011
Planning for HIMSS11 Dec. 1, 2010
Provider Directories Mar. 31, 2011
Quality Reporting Sept. 30, 2009
Reasons Specialists should consider Regional Extension Centers May 8, 2011
Recommendations for HIMSS 2012 Dec. 12, 2011
Reconciliation-an unmet challenge Sept. 14, 2009
State Grants for Health Information Exchange June 18, 2010
Summary of the HIT Policy Committee Workgroup hearing on EHR Safety Mar. 15, 2010
The Direct Project Goes Live Mar. 1, 2011
The Perfect Storm Barometer:what are the greatest HIT risks for clinicians June 20, 2011
Thought on the NHIN Mar. 18, 2010
Trusted Identities May 25, 2011
Where are the HIT Experts? Aug. 26, 2011
A Commercial Web-based HIE Offering from Verizon July 20, 2010
A Peeve: The auto-log off in HIT Dec. 27, 2011
Breach Notification-Part 1 Oct. 15, 2009
Breach Notification-Part 2 Oct. 26, 2009
Certification July 29, 2009
Certification Follow-up Aug. 19, 2009
Clinical Decision Support Systems Mar. 23, 2011
Clinician Workflow April 11, 2010
Consumer Preferences Nov. 2, 2009
Digital Certificates-uses in HIE June 15, 2011
Dr. Blumenthal--An Inspirational Keynote Address at HIMSS10 Mar. 7, 2010
EHR's for Surgeons/specialists Nov. 19, 2010
EHR Safety Feb. 21, 2010
EMR Certification Revisited Nov. 17, 2009
EMR Usability Nov. 22, 2009
Future Role for HITSP? Dec. 2, 2009
Handheld Devices-the Mobile Clinician Jan. 9, 2010
Health Information Exchange Aug. 18, 2009
Health IT Ontologies of the Future Jan. 12, 2011
Health IT Workforce Training Dec. 27, 2009
HIMSS 11 ARRA Usability Symposium Mar. 2, 2011
HIMSS Virtual Conf. 2011:
Closing keynote-an exceptional presentation June 14, 2011
HIT Outlook for 2012: a crystal ball Dec. 2, 2011
HIT Workforce Training Dec. 14, 2009
Imaging and Meaningful Use Debate Jan. 27, 2011
Information Exchange Patterns May 28, 2010
IFR on Standards and NPRM on Meaningful Use Feb. 16, 2010
Introduction July 17, 2009
Introduction to electronic signatures and digital certificates June 9, 2011
It's all about workflow Mar. 31, 2010
Looking forward to 2012 Nov. 27, 2011
Meaningful Use and Incentives to adopt HIT July 21, 2009
Messages vs. Documents June 16, 2010
More Thoughts on Documents Sept. 6, 2010
My Favorite Day at HIMSS 11 Mar. 3, 2011
NA Connectathon 2011 Jan. 22, 2011
Online Education Sept.10, 2009
Online Graduate Degrees-My Experience Nov. 18, 2009
Optionality and Interoperability in Health Care Software Dec. 6, 2010
Outlook for New Workforce Trainees July 25, 2010
Patient Portals Mar. 30, 2011
PCAST Report Thoughts Feb. 11, 2011
Planning for HIMSS11 Dec. 1, 2010
Provider Directories Mar. 31, 2011
Quality Reporting Sept. 30, 2009
Reasons Specialists should consider Regional Extension Centers May 8, 2011
Recommendations for HIMSS 2012 Dec. 12, 2011
Reconciliation-an unmet challenge Sept. 14, 2009
State Grants for Health Information Exchange June 18, 2010
Summary of the HIT Policy Committee Workgroup hearing on EHR Safety Mar. 15, 2010
The Direct Project Goes Live Mar. 1, 2011
The Perfect Storm Barometer:what are the greatest HIT risks for clinicians June 20, 2011
Thought on the NHIN Mar. 18, 2010
Trusted Identities May 25, 2011
Where are the HIT Experts? Aug. 26, 2011
Quarterly Index Update 2011 With Links-1st Quarter Dr. Bob's HIT Thoughts
A Commercial Web-based HIE Offering from Verizon July 20, 2010
Breach Notification-Part 1 Oct. 15, 2009
Breach Notification-Part 2 Oct. 26, 2009
Certification July 29, 2009
Certification Follow-up Aug. 19, 2009
Clinical Decision Support Systems Mar. 23, 2011
Clinician Workflow April 11, 2010
Consumer Preferences Nov. 2, 2009
Dr. Blumenthal--An Inspirational Keynote Address at HIMSS10 Mar. 7, 2010
EHR's for Surgeons/specialists Nov. 19, 2010
EHR Safety Feb. 21, 2010
EMR Certification Revisited Nov. 17, 2009
EMR Usability Nov. 22, 2009
Future Role for HITSP? Dec. 2, 2009
Handheld Devices-the Mobile Clinician Jan. 9, 2010
Health Information Exchange Aug. 18, 2009
Health IT Ontologies of the Future Jan. 12, 2011
Health IT Workforce Training Dec. 27, 2009
HIMSS 11 ARRA Usability Symposium Mar. 2, 2011
HIT Workforce Training Dec. 14, 2009
Imaging and Meaningful Use Debate Jan. 27, 2011
Information Exchange Patterns May 28, 2010
IFR on Standards and NPRM on Meaningful Use Feb. 16, 2010
Introduction July 17, 2009
It's all about workflow Mar. 31, 2010
Meaningful Use and Incentives to adopt HIT July 21, 2009
Messages vs. Documents June 16, 2010
More Thoughts on Documents Sept. 6, 2010
My Favorite Day at HIMSS 11 Mar. 3, 2011
NA Connectathon 2011 Jan. 22, 2011
Online Education Sept.10, 2009
Online Graduate Degrees-My Experience Nov. 18, 2009
Optionality and Interoperability in Health Care Software Dec. 6, 2010
Outlook for New Workforce Trainees July 25, 2010
Patient Portals Mar. 30, 2011
PCAST Report Thoughts Feb. 11, 2011
Planning for HIMSS11 Dec. 1, 2010
Provider Directories Mar. 31, 2011
Quality Reporting Sept. 30, 2009
Reconciliation-an unmet Challenge Sept. 14, 2009
State Grants for Health Information Exchange June 18, 2010
Summary of the HIT Policy Committee Workgroup hearing Mar. 15, 2010
on EHR Safety
The Direct Project Goes Live Mar. 1, 2011
Thought on the NHIN Mar. 18, 2010
A Commercial Web-based HIE Offering from Verizon July 20, 2010
Breach Notification-Part 1 Oct. 15, 2009
Breach Notification-Part 2 Oct. 26, 2009
Certification July 29, 2009
Certification Follow-up Aug. 19, 2009
Clinical Decision Support Systems Mar. 23, 2011
Clinician Workflow April 11, 2010
Consumer Preferences Nov. 2, 2009
Dr. Blumenthal--An Inspirational Keynote Address at HIMSS10 Mar. 7, 2010
EHR's for Surgeons/specialists Nov. 19, 2010
EHR Safety Feb. 21, 2010
EMR Certification Revisited Nov. 17, 2009
EMR Usability Nov. 22, 2009
Future Role for HITSP? Dec. 2, 2009
Handheld Devices-the Mobile Clinician Jan. 9, 2010
Health Information Exchange Aug. 18, 2009
Health IT Ontologies of the Future Jan. 12, 2011
Health IT Workforce Training Dec. 27, 2009
HIMSS 11 ARRA Usability Symposium Mar. 2, 2011
HIT Workforce Training Dec. 14, 2009
Imaging and Meaningful Use Debate Jan. 27, 2011
Information Exchange Patterns May 28, 2010
IFR on Standards and NPRM on Meaningful Use Feb. 16, 2010
Introduction July 17, 2009
It's all about workflow Mar. 31, 2010
Meaningful Use and Incentives to adopt HIT July 21, 2009
Messages vs. Documents June 16, 2010
More Thoughts on Documents Sept. 6, 2010
My Favorite Day at HIMSS 11 Mar. 3, 2011
NA Connectathon 2011 Jan. 22, 2011
Online Education Sept.10, 2009
Online Graduate Degrees-My Experience Nov. 18, 2009
Optionality and Interoperability in Health Care Software Dec. 6, 2010
Outlook for New Workforce Trainees July 25, 2010
Patient Portals Mar. 30, 2011
PCAST Report Thoughts Feb. 11, 2011
Planning for HIMSS11 Dec. 1, 2010
Provider Directories Mar. 31, 2011
Quality Reporting Sept. 30, 2009
Reconciliation-an unmet Challenge Sept. 14, 2009
State Grants for Health Information Exchange June 18, 2010
Summary of the HIT Policy Committee Workgroup hearing Mar. 15, 2010
on EHR Safety
The Direct Project Goes Live Mar. 1, 2011
Thought on the NHIN Mar. 18, 2010
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