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Simple Interoperability for HIE/EHR (idea promoted by Wes Rishel)

Last night, Wes Rishel (of McKinleyville, CA) posted a PPT on his blog (http://blogs.gartner.com/wes_rishel) on his views and ideas of simple interoperability. It is worth taking a look ().

I believe the concepts and ideas are interesting and pragmatic…the key being pragmatic. It appears that many HIE programs are seeking to do everything at one time (Wes describes as a "kerplunk" approach). When I worked with NHS Wales Informing Healthcare Programme, the model/approach we developed took a similarly simplistic/pragmatic approach because we needed to manage adoption, expectations, and costs. The central principle of interoperability we used was that sharing something/anything about the patient's health (e.g., meds, current condition, last clinician of care), even in text form, would be be 100% better than what has been shared previously, especially in emergency and out of hour situations. This is the approach that Wes is advocating and I agree it is an essential step in an incremental approach. One only needs to examine the NHS England approach (kerpluk) to see starting with complexity (e.g., HL7 v3) is hardly a cost effective means to rolling out a HIE/EHR.

In Wes' materials, he speaks to the need for a Health Internet Registrar (note: this is US healthcare based approach). I wonder if the Department of Health and Human Services National Plan and Provider Enumeration System (NPPES ) would be a good place to start for assigning responsibility for such a service. Thoughts?

Wes' also reviews a number of use cases for health information interoperability and sharing. One use case that I think we could introduce is the sharing between patients. Today people with like illness are sharing quite openly about their illness. They actually know a fair bit about their condition, their treatment protocols, and interest in other treatment protocols. It would seem to me that this is a patient population that needs simplistic interoperability and their use (which would be considerable) would drive more rapid adoption of interoperability in the clinical community (nothing drives progress like success). Thoughts?

The problem of health services sustainability ... how do we get much better at decommissioning services?

Guest Author: Professor Paul Corrigan
Former senior health policy adviser to Prime Minister Tony Blair; Former Director of Strategy and Commissioning at the London Strategic Health Authority

The funding problem for health services goes beyond the current financial crisis to the longer term. For 40 years health expenditure in developed countries has grown at 1.5% above the growth of GDP (2% in the USA). Unlike other industries health has begun to assume that resources automatically grow in line with increased demand. Other industries have learnt to meet a rising demand with step changes in their method of delivery.

Given that resources for health will not be able to automatically rise, every health care system believes that it will go bust for two consistent reasons. The first is the invention of new technology and the second is an aging population.

Both of these ‘problems’ are actually successes for the industry. It is partly the result of good health care that leads to an aging population and new technology can save lives and ease pain and distress.

In most other industries, new technology saves money by driving up productivity, but in health new technology is simply seen as a cost. The outcome of new technology is to keep people alive and therefore it must cost the health system more at the end of their life.

But the financial problems for health are not caused by end of life care but the rising cost of long term conditions. In England these cover 70% of NHS costs. The problem is not the new technology for Long Term Conditions but that health systems find it very difficult to get rid of old technologies.

In health systems the new fails to drive out the old because senior professionals have been using the old for some time. The battle between the old and the new in medical technology is for many doctors the struggle between habit and science. And persuading doctors to change their habits is one of the hardest things.

In England payors for health care are a set of locality based organisations called Primary Care Trusts that receive the finance to buy health care for their population directly from the central government. They commission health care and are aiming for the level of world class commissioning.

If the productivity problem for health is a failure to dispose of old technologies then the skills we need improve are not those that concern commissioning new health services. Our problem is much more world class decommissioning or how a health system stops doing inefficient things much more quickly than it has to date.

Happy New Year to all.

To start the year we'll begin with another report on the high cost of care in the US and the poor results of such spending.

http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.html

I would like to see a report that replays the analysis I heard several years ago. At that time a Canadian health economist discussing data similar to this. In his analysis of US healthcare cost, he subtracted care costs associated with the last few weeks/months (I don't remember exact period) of life and found that the US costs were more aligned with those of the rest of the world. Seems we have an eagerness to spend what it takes to prolong life when other countries may not be doing so. Without starting the "death panel" debate, there may be a need for a dose of better expectation management at the end of life.

Does anyone know of such a report?

EMR benefits, in theory and (Dutch) practice

Because of an increase in healthcare demand and a decline in available resources, the pressure on healthcare costs has increased throughout the years. This increased pressure of costs forces hospitals to deliver care in an efficient and cost-effective way. Electronic Medical Records (EMR) are often seen as a tool to realize the required cost reduction and efficiency improvements, even though recent research at the Harvard School of Public Health suggests otherwise. What types of benefits can be realized through EMR implementations? Are these benefits applicable to Dutch hospitals? To address these questions, we supported an MSc research project on this particular subject.

Interoperability made simple

With the increasing interest in Health Information Exchanges (HIEs), the debate on interoperability is becoming very complicated. Interoperability merely states that computer systems are able to exchange information and use that information in a meaningful way. That already sounds like the meaningful use discussion going on in the US around funding of EMR implementation by healthcare providers. And yes, it is just as complicated. In a very worthwhile contribution David McCallie takes a valiant first stab at simplifying interoperability. However, the ensuing discussion seems to focus on issues around patient-provider communication, where most countries are still struggling with the provider-provider communication. Here's a first go at simplifying provider access to patient health information.

Help in choosing a "good" Electronic Health Record

Healthcare professionals looking for a new software system to enable Electronic Health Records (EHRs) for their patients and their practice have powerful tools available to them. The EHR-System Functional Model, as developed over the last years by Health Level Seven, has been adopted by the international health informatics community as ISO standard 10781. The standard lists all the features one would expect from a mature EHR System (EHR-S). It has been used internationally to develop profiles for specific care settings (e.g. what functions are relevant for behavioral health, an emergency department, or clinical trials).

Focus on care quality and health outcomes

The leadership in the US is focussing on care quality and health outcomes when monitoring the effects of Health IT investments. The investment program made possible under ARRA has to contribute to the innovation of healthcare itself and not focus solely on the administrative and efficiency needs that are the consequence of healthcare reform. This has been the message of three keynote speeches during the Health Level 7 Plenary and Working Group Meeting in Atlanta this week. Speakers were John Tooker (American College of Physicians), Janet Corrigan (National Quality Forum) and David Blumenthal (Office of the National Coordinator for Health Information Technology). This message will focus the business cases that we develop for the Health Information Exchanges to be implemented in each of the states. Will this be realistic without a financial stimulus to provide high quality care and better health outcomes?

US Healthcare Transformation: Going Dutch?

Trends in healthcare reform across Europe show a likeness of German, Swiss, Austrian and Dutch initiatives. They also seem to have inspired the US Healthcare Transformation program. Given the European experience, there are a number of key issues that need to be solved in order to achieve the shared goals of healthcare reform. To my mind the most important issues are: universal coverage, definition of products and services, and creating a market with proper incentives. I want to share some of the key discussions to see whether we can contribute to the solution of a universal problem in developed countries: how to curb the growth of healthcare costs whilst increasing the quality of care delivered to the population at large.

Healthcare Quality Measurement & Reporting

The following report/blog was developed by Evelyn Gallego. (See extended entry for background.)
The HIT Standards Committee formed three subgroups to focus on the critical areas of: Clinical Operations, Clinical Quality (including quality reporting), and Privacy and Security. Of particular interest is the clinical quality group that is reviewing the endorsed quality measures and standardizing an implementable list to be be incorporated in HIT systems for quality measurement and public reporting.
In parallel, the NQF has already convened such a group—the Health Information Technology Expert Panel (HITEP). For the past two years, HITEP has actively reviewed the data types that need to be captured within electronic health records and the clinical workflow needed for effective and efficient quality measurement.
In light of all the work that I expect is happening behind the scenes a few thoughts come to mind:

The HIT Standards Committee did not provide further information on how the Clinical Quality subgroup would collaborate with or build on the work currently conducted by HITEP. This needs to be resolved.

Current quality measures tend to focus on patient-clinician interactions at the point of care not outcomes over an episode of care. With promise of HIT, it makes sense to add measures for a patients’ experience following an episode of care and capture data next appointment, patient entries to PHR, or via surveys on mobile phones. While it is important to measure EHR implementation & adoption, it is of greater value to the patient (or consumer) to see care quality information (experience and outcome).

While providing consumers comparative information about providers to enable more informed decision making should help to improve health care, successful adoption and use is equally important. Doing so requires addressing how consumers will be informed about these reports, how they will access them, how they will understand them, and how they will act upon the information provided to make better healthcare decisions...not a trivial undertaking.

Doctors thoughts about Obamacare

Members of the medical community has weighed in on the new health care plan being developed by the Obama Team:

The Allergists thought that it should be scratched,
and the Dermatologists advised not to make any rash moves.

The Gastroenterologists had a bad gut feeling about it,
while the Neurologists thought the Administration had a lot of nerve.

The Obstetricians felt Obama is laboring under a misconception.

Ophthalmologists considered the idea shortsighted.

Pathologists yelled, "Over my dead body!"
while the Pediatricians said, 'Oh, Grow up!'

The Psychiatrists thought the whole idea was madness,
while the Radiologists could see right through it.

Surgeons decided to wash their hands of the whole thing.

The Internists thought it was a bitter pill to swallow,
and the Plastic Surgeons said, "This puts a whole new face on the matter."

The Podiatrists thought it was a step forward,
but the Urologists were pissed off at the whole idea.

The Anesthesiologists thought the idea was a gas,
and the Cardiologists didn't have the heart to say no.

In the end, the Proctologists won out,
leaving the entire decision up to the a**holes in Washington!

About the authors

Simple Interoperability for HIE/EHR (idea promoted by Wes Rishel)

The problem of health services sustainability ... how do we get much better at decommissioning services?

EMR benefits, in theory and (Dutch) practice

Interoperability made simple

Help in choosing a "good" Electronic Health Record

Focus on care quality and health outcomes

US Healthcare Transformation: Going Dutch?

Healthcare Quality Measurement & Reporting

Doctors thoughts about Obamacare

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