Friday, December 10, 2010


The Healthcare IT world is abuzz with the report by the President's Council of Advisors on Science and Technology (PCAST) on realizing the full potential from HIT. Here is a link to the full report:

In John Halamka's review of the PCAST report, he writes:
"In the spirit of my recent blog about The Glass Half Full, I believe the PCAST report is a positive set of recommendations that builds on the Meaningful Use Stage 1 effort to date.   ONC should be congratulated for creating a foundation that is so consistent with the PCAST vision for the future"
Do you agree that the work on HIT thus far (via ONCHIT, Meaningful Use, etc) is consistent with the PCAST recommendations?

Thursday, October 14, 2010

Privacy safeguards

For the past few months, the Wall Street Journal has run a great series on the use of electronic personal information by commercial entities. The series is titled "What They Know." While the emphasis of this series has mostly been on the tracking of web browsing behavior, the latest article in this series discusses the "scraping" of personal data from a patient support network called PatientsLikeMe.

This is a troubling development.

Like the electronic commerce IT revolution before it, the anticipated healthcare IT revolution depends upon the proper security (and associated trust) of private data. I have covered Privacy in healthcare before (see this, for example) and my summary conclusion remains that this topic will receive a disproportionate amount of attention in the coming months.

I don't agree with alarmists like Deb Peel who advocate against use of any patient data (and consequently put a number of patients at risk). The right answer is to put well understood safeguards in place and use de-identified data in a manner that promotes innovation in outcomes based treatment. This is an opportunity for companies to innovate in this space.

What products/innovations do you think we need?

Friday, October 8, 2010

The Art of Product Management

As a product manager, I think a lot about how I can better understand my customers. A funny incident made me realize that one can't ever assume to know customers well enough: it's always a work in progress.

During the last week of September, I joined several other colleagues at the annual AHIMA conference in Orlando, Florida. The conference is a gathering of Health Information Management (HIM) professionals. Topics cover transcription, coding, release of information (or as the healthcare industry calls it, simply, 'ROI'), audits, and compliance. My company's booth was organized around our themes of connecting the patient record, EMR enablement, and compliance.

Emily, our Manager of Experiential Marketing, had developed a booth activity around building a bracelet as a metaphor for what we do: link the discrete elements in the physical and digital worlds and create a complete, valuable, patient record. For each bracelet that visitors made, we would donate money to a good cause. To obtain charms needed to build this bracelet, visitors would have to visit various stations and learn about our solutions. I didn't think this was a practical idea because I wasn't sure our customers would want to build bracelets at a conference. I thought an Apple iPad giveaway might have been more appealing.

It turned out--I was totally wrong and our booth visitors LOVED the activity! Emily knew this audience a lot better than I did. We ended up oversubscribed (mobbed?) and many customers told me that this was one of the most active booths at the show. Mission accomplished! Well done Emily and the team!

Tuesday, September 21, 2010

Ingenix acquires coding company

HISTalk reports that Ingenix is acquiring A-Life Medical. I have speculated on the grand strategy behind Ingenix's acquisition spree (see for example, this, this, this, or this) and it's getting more clear now: Ingenix wants to have a presence in multiple touchpoints in the healthcare IT value chain. They are assembling data collection and analytical components that used together will provide a powerful analytics-driven (outcomes driven?) healthcare delivery model.

This has been a busy week at work with our planning projects in full swing. I'm looking forward to AHIMA later this week and I plan to resuming a more predictable posting schedule after that. Much to report on based on what I've learnt in these past few weeks!

Friday, September 17, 2010

Blumenthal Vs. O'Neil

ONCHIT chief David Blumenthal and former Treasury Secretary, Paul O'Neill debated EMRs and national standards: see related story from Mass Device.

I'm back from several field visits this week to hospitals in North Carolina. I'll summarize observations in a future post; and then from Sept 26 through Sept 29th, I'm back on the road for AHIMA. I look forward to further conversations with healthcare executives and I'll report findings soon thereafter.

Monday, September 13, 2010

Meaningful Use for 90% hospitals in the next two years

The Wall Street Journal today reports that 28% hospitals expect to qualify for incentives in 2011 and 62% in 2012. This is consistent with my expectation from a few weeks ago that Meaningful Use will be item #1 on the agenda for healthcare IT. The Gold Rush is about to begin, even though questions remain on whether true adoption can be achieved in this time frame.

I'm visiting a number of hospital CIOs this week (and posting will be light as a result) but I'll report back on first-hand impressions from the field.

Tuesday, September 7, 2010

Eric Dishman on taking health care off the mainframe

Eric Dishman has a wonderful TED Talk on moving our healthcare system "off the mainframe." This talk was part of TED MED 2009. Mr. Dishman makes a compelling case for why we need a shift in mentality away from crisis-driven (or event-driven) institutional healthcare model to a more proactive personal-driven model of care.

Don't miss it! (you may need to click the direct link above: RSS readers may not show the video below)

Friday, September 3, 2010

Healthcare Costs and the American Dream

The New America Blog has a story on rising healthcare costs: Good news: increases are more modest compared to previous years; bad news: cost increases are now almost entirely being passed on to consumers.

I was speaking to a friend recently who works for a major life insurance company. That company has recently moved to a high-deductible plan, meaning employees are now responsible for several thousand dollars of medical expenses before any insurance kicks in. For younger healthier people, skipping healthcare is an option but for young families or older employees this is effectively a 5%+ pay cut.

I'm not one to argue against patients taking more responsibility, and consequently more costs, for their health and well being. However, the issue here is less about individual responsibility and more about the social contract we have with our employers. The contract that if we do our jobs well and if we work hard there are certain measures of security that accrue. See this article from the Financial Times from a few weeks ago on the crisis in Middle America.

How does one reverse this decline?

Tuesday, August 31, 2010

How Long Will It Take to Adopt EMRs?

One story that got a lot of press last week was Prof. Aashish Jha's research update on the adoption of Electronic Medical Records. Prof. Jha has observed that only about 12% of US hospitals have a fully operational EMR at the end of 2009 and only 2% would have complied with Meaningful Use guidelines release this July that determine whether Providers can receive Federal incentives starting next year. 

Common sense suggests that electronic medical records should have much wider adoption, particularly since most sides agree that a properly implemented EMR improves patient care. After all, as one advertisement by United Healthcare recently noted, "your Pizza delivery guy stores your orders electronically. Why can't your doctor do the same?" The reality is that EMRs have not been widely adopted because there are many counter forces:
  • Medical information like health status is not as determininistic as, say, financial data. There is no unique score, or set of scores that can uniquely pin point the state of your health in a way that two reasonable, independent observers would always agree. In banking, there is no ambiguity on your bank balance when it is viewed by two separate observers. Similarly, your Pizza preferences are, in general, mostly deterministic and can be described in a way that is interpreted in the same way. I buy this argument, but it doesn't explain it all.
  • Some commentators have suggested that medicine is viewed as an art by an older generation of physicians and as long as that group makes decisions for the medical community, EMRs and other metrics-driven tools are likely to remain on the backburner. This is an artful argument, but again, it cannot explain the widespread inability of Providers to adopt EMRs. Some (more cynical?) observers have even claimed that the Providers don't want EMRs because it allows them to preserve inefficiencies and make more money.
  • The most compelling reason for the lack of adoption is simply that the benefits of EMR accure to those that don't pay for it. Put in other words, those that have to pay for EMRs aren't the ones that benefit the most. So, cash strapped hospitals are not very likely to want to make a huge IT investment if they don't see direct returns of some form. The Federal goverment has recognized this misalignment of incentives and much of the HITECH funding through Meaningful Use attempts to address this deficiency.
So, if you believe this logic, it would stand to reason that EMRs will see a much more rapid pace of adoption as Federal incentives kick in. Prof. Jha's paper seems to make a similar conclusion.
For more on the topic, Prof. Eric Ford and others published a bass diffusion analysis applied to EMRs. This study was published in 2006 and concluded that EMR adoption would take a decade longer than the 2014 target set by the Bush Administration as part of E.O. 13335 that established the ONCHIT. I have yet to see an update on this study, post Meaningful Use incentive payments, but the paper is still worth a read for its analysis of buying behavior in the medical community. Specifically, the paper examines the similarity in buysing behavior between healthcare IT and consumer goods, given that both are influenced by the coefficient of imitation (doing what key opinion leaders do) than coefficient of innovation (buying the latest and greatest). Heady stuff.

Tuesday, August 24, 2010

Ingenix...yet again

In several recent posts, I have tried to determine the grand strategy behind Ingenix's recent acquisition spree.

For a much more comprehensive analysis, see today's HISTalk Investor's Chair briefing.

So, what's your take on the real story behind all this momentum? What is Ingenix (and United Healthcare by extension) trying to do?

Monday, August 23, 2010

Using Crowdsourcing Principles for CDS

One of the emerging challenges for Clinical Decision Support systems is the problem of how to describe the data that is input into the rules engine. For a detailed description of this problem, see Keith Boone's Standards Activity Around Clinical Decision Support.

Of course, with Meaningful Use still in Stage 1, the emphasis is currently on data capture rather than clinical decision support. Healthcare IT has an article on how Google's IP from its failed Wave product may be of help in digitizing hard-to-read physician notes.  Most providers today perform some form of scanning of physical files; the approach proposed in the article essentially involves principles of "crowdsourcing" where a complex translation is farmed out to a large number of people that work on tiny bits of the problem, usually only for a few seconds each.

When the focus shifts towards CDS in Stage 2 of Meaningful Use, a similar crowdsourced approach could be used to create CDS rules databases. Hosted EMR vendors like athenahealth are most likely to be in a position to mine their databases for such an effort.

Thursday, August 19, 2010

Best Care Anywhere Reviewed by Andy Oram

For those of you that read my review of Best Care Anywhere, please see Andy Oram's comprehensive and insightful read: The Software Behind the VA's health care transformation.

Andy ends the post with a call for help:
If you'd like to learn more about VistA, help to add features so it can become the nation's electronic health record system, or just meet the fascinating people who work with it, check out the WorldVistA community..... doctors are moving quickly to install electronic record systems ..... To play in this space, VistA needs both more promotion and.... changes to simplify deployment and configuration.

Monday, August 16, 2010

Ingenix Continued

I've reported on this blog that Ingenix bought Executive Health Resources not too long after picking up Picis. Well, they've done it again: Ingenix announced yet another acquisition at close of business today: Axolotl, an HIE Services providerIngenix was rumored to be entering the HIE space and HISTalk reaffirmed it this morning. This acquisition confirms it.

With a string of recent acquisitions, UnitedHealthcare is inching closer to its vision of becoming a Kaiser-like end-to-end provider with a focus on outcomes. This also appears to be a pragmatic shift away from some of the more fancy predictive modeling approaches that hold promise but do not deliver near-term results.

Organizational Models Behind Healthcare Delivery

In a review of the China Study, I wrote about how Healthcare discussions often revolve around insurance, treatments, technology, operational excellence, etc. but not as often on driving factors like lifestyles, choices, etc. As a product manager, I'm often confronted by similar questions on strategy; for example, can organizational culture be a source of sustainable advantage? Are we overly focused on business models, technology leadership, incumbency  when we should also think about how are teams operate and how members relate with each other?

Today's HISTalk mentions how Epic, the leader of the EMR vendor market if you measure momentum, focuses not on hiring candidates with the best experience but instead selects those with the right traits, qualities, and skills. HISTalk states:
"Epic emphasizes that many hospitals can staff their projects internally, choosing people who know the organization. However, they emphasize choosing the best and brightest, not those with time to spare. Epic advocates the same approach it takes in its own hiring: don’t worry about relevant experience, choose people with the right traits, qualities, and skills, they say."
Top-tier management consulting firms like BCG, Bain, and McKinsey have always known this. As a result, these firms test candidates on scenarios (or "cases") to evaluate how a candidate would think in a particular situation rather than evaluating the candidate on behavioral questions (that can generally be memorized). Other companies in other industries are catching on. Netflix famously released it's Freedom and Responsibility Culture reference guide that emphasizes context over control.

How much time do you spend on your organization's team dynamics? What methods do you use to select candidates?

Wednesday, August 11, 2010

Data Classification

John Moehrke has a comprehensive post on Data Classification. As privacy and security considerations are codified within electronic medical records, standards are essential. There are three areas that I see these standards playing a transformative role, but I'm sure there are others:

  1. HIE Consent Management: There are seven services needed for the creation of HIEs. Many are still under development but the least developed area amongst these is most likely patient consent. See Private Access--one of the potential technology providers in this space.
  2. Release of Information: Much of the business of release-of-information, estimated to be a $1B market [1], depends upon the proper redaction of sensitive information from medical records. Codifying privacy preferences will eventually allow automated release-of-information processing. Mature data classification techniques may enable a disruptive technology to upend this market, which is currently dominated by HealthPort with a $250M annual revenue stream.
  3. Data De-Identification: De-identification is currently a somewhat manual process if you want data that retains some degree of usefulness. HIPAA requires a person with knowledge of general statistical principals to certify that reverse engineering of identity is not easily possible or it requires the removal of 18 fields that remove personally identifiable information. Data classification takes us one step closer to automated de-identification.

While on this subject, see Keith Boone's contention that redacted documents should not be considered the same as the original document and hence should not retain signatures that were used to sign the original.

[1] market sizing from HealthPort, Inc. S-1 filing with the SEC, 2009

Monday, August 9, 2010

Gold Rush Redux?

The Boston Globe's story this weekend on Athenahealth CEO Jonathan Bush confirms what is becoming increasingly apparent: the EMR revolution is indeed a gold rush and federal incentives will define the agenda in Healthcare IT for the foreseeable future. A survey of news items in HIStalk also lists several stories supporting this conclusion.

If you compare the current environment to the pre-bubble days of the internet, you could assume we are in 1994. Netscape has not been launched yet, but there's a wide expectation of a revolution to come. Web 2.0 proponents will claim that the first wave of the internet did not produce productivity improvements comparable to those from Web 2.0 technologies. Similarly, skeptics might believe this gold rush will not truly transform healthcare IT, but it will set the stage for an eventual revolution in technology, patient engagement, and evidence-based medicine.

Whichever way you look at it, participants in the market will adapt their strategies in order to profit from this environment. News satire site, The Onion had a memorable headline a few years ago:  "Recession Plagued Nation Demands New Bubble to Invest In." I think that call is being answered.

Friday, August 6, 2010

The China Study

One of my good friends who is a senior-level executive at a major national Payer (and sometimes an industry source for this blog) recommended The China Study. It sounded like an odd title for a book on health and nutrition so I was eager to find out what it said.

The book is authored by T. Colin Campbell, who has spent his career in science. This book isn't an opinion piece, it's a fact-based reporting of the correlation of several lifestyle factors on health outcomes. The book criticizes the "scientific reductionism"--the practice that assigns outcomes to single variables rather than considering the systemic nature of influencing factors.

The author shows, for example, how the presence of carcinogens themselves do not lead to as many cancers as carcinogens in combination with complex proteins (such as found in non-plant sources like red meat). The China Study itself is the analysis of relationship between diet and disease for about 100 communities in China that were relatively isolated and with differing diets and disease outcomes. This provides a snapshot of the effect of varying amounts of diet components in a manner that was not possible before.

The conclusion I have drawn from this research is that there's a large unexplored theme of modifying diets to improve patient outcomes. Much of the debate in Healthcare revolves around insurance, Healthcare IT, cost-reduction, technology innovations. So little time is devoted to the source: the foods we eat and the lifestyles we lead.

Wednesday, August 4, 2010

Ingenix buys Executive Health Resources

Ingenix is continuing its buying spree. Just after acquiring Picis two weeks ago, Ingenix is now adding medical necessity compliance and physician medical management solutions for hospitals by purchasing Executive Health Resources. In a blog post this morning, John D Halamka suggested that Ingenix may also be looking at entering the HIE space. If that's true, expect additional M&A activity on that front.

Is there a theme here? Some commentators have suggested that Ingenix is putting together the elements of a Kaiser-like solution. For example, Dana Blankhorne at ZDNet writes this about United Healthcare, Ingenix's parent:
It’s trying to be more like Kaiser. That is it wants to control the hospitals and clinics it pays money to and see that they’re managed efficiently. Kaiser does this directly. It owns hospitals and clinics. UnitedHealth plans to do this indirectly, through Ingenix.
Kaiser Permanente has an good track record of outcomes vs. dollar spent. One would expect it to have an overwhelming share of the market. Yet, it has garnered just a 24% share in California while failing to gain traction in other states (e.g. 5% in Georgia). Commentators believe this is because Kaiser limits patients freedom in choosing how they receive care

The success of the next Kasier-like solution will be affected by how much choice it enables. I wonder what UnitedHealthcare thinks about patient choice?

Monday, August 2, 2010

Public Health Data

Google makes it really easy to visualize large amounts of data. In the chart below, I've modified an example from the Public Data Explorer website: the chart compares Life Expectancy at Birth with Fertility Rates and the bubbles represent GDP of that country. I've only shown BRIC countries, the US, Canada, Cuba, Afghanistan and Somalia.

Click "Play" above. 

Notice how Somalia's life expectancy falls dramatically in the 1990s due to the ravages of war. Also, it appears there's an inverse correlation of fertility with GDP. Not entirely surprising. What is surprising is how much the other countries are catching up (to the US) in terms of life expectancy. When you layer the fact that the US spends a lot more on Healthcare than most other countries, it's easy to think we're not getting better outcomes for more investment. 

Perhaps, that's another obvious conclusion?

Friday, July 30, 2010

How to deal with Deb Peel

For those of you following the battle over Privacy rights in Healthcare, today's post by Lygeia Ricciardi on The Healthcare Blog is a must read.

Ms. Ricciardi suggests that factual responses to fear mongering often don't work because our response to fear is often stronger than our response to reason. She writes that one way  to counter alarmists like Deb Peel is to offer your own alternate scary scenarios:
If it’s fear you’re after, we hardly lack material:
- How about being given a drug you are dangerously allergic to?
- How about receiving a radical misdiagnosis—and the treatment to match?
- How about enduring prolonged, unnecessary pain?
- What abut the cures not found, or contagions not contained?
But, the post continues, a better way is to also use holistic, moving stories. Look for this battle to heat up in the coming months as more companies monetize de-identified data. Alarmists must not be allowed to derail progress.

Thursday, July 29, 2010

The Best Care Anywhere?

I'm reading the second edition of Philip Longman's classic: "Best Care Anywhere". The book is a fascinating read into the story behind the VA's transformation from a case study in Government mismanagement to a model of modern medicine with manageable costs and outstanding outcomes.

The book offers some surprises, and I need to research them more.
  • One story concerns Beth Israel New York and Duke Medical giving up promising studies into better patient outcomes because the programs were not profitable. This highlights the disconnect between incentives and goals that everyone talks about. I imagine other hospitals aren't any different and these two should be lauded for at least trying outcomes-based programs.
  • The other bigger story for me was the apparent success of the VistA EMR system which is Open Source. There are emerging companies like WorldVistA, vxVista, and others following a "Red Hat strategy" of wrapping maintenance, enhancements, and support around VistA. Could this be an alternate world to the commercial EMR vendors?
See also the RAND Corporation's research brief on quality of care at the VA from 2005. Apparently, the VA's success isn't new.

Monday, July 26, 2010

IT Priorities and Government Mandates

With the release of Stage 1 Meaningful Use guidelines two weeks ago, it is increasingly evident that these rules will drive IT agenda at most providers. A  new survey today by Embarcadero technologies seems to confirm this. I also read about a HIMSS leadership survey from a few days ago that stated Meaningful Use was listed as a priority by 42% of respondents versus 27% for other clinical initiatives.

On the other side of the debate are commentators like Paul Romer who believe Meaningful Use does not contribute towards better patient outcomes. Mr. Romer writes:
Meaningful Use, if used as a way to obtain incentive money is at best meaningless, at worst, without numerous other initiatives; it can disrupt your business. It seems to violate the dictum, “Do no harm.”
Stakeholders in the healthcare IT world need to develop a position on whether Meaningful Use will set the agenda for Providers. This question affects the very core of their strategy.

Thursday, July 22, 2010

Ingenix Buys Picis

Many of you must have seen the announcement this morning: Ingenix acquired Picis. In a previous life, I was a management consultant and through that experience, I have some familiarity with M&A. It's always interesting to investigate the back story that's never included in a press release.

On the surface, the acquisition makes sense if you believe analytics will quickly evolve beyond its current claims-data world. That certainly seemed the trajectory of the industry until recently. However, many observers believe that Stage 1 Meaningful Use (MU) will dominate the Healthcare IT agenda for the next few years [1] and I tend to agree with them. If  that's true, then Ingenix may have moved too early and made a bet that would not pay out for quite some time. Also, the commentary on HISTalk suggests revenues at Picis have grown less than $7M over the past few years and that the "$1B in 3-4 years" comment in the press release is dubious at best.

My personal impression is that Ingenix has made a speculative bet in the hopes that this merger will make sense a few years out. Part of the rationale may be the belief that if they pick up Picis before the stated synergies are operational, they may be striking a bargain.

As with most acquisitions, time will tell.

>>>UPDATE: Since I posted this, I came across this analysis from ZDNet that suggests this acquisition could be a positioning to improve Ingenix's ability to sell consulting and coding services. From the article:
But Ingenix hopes that its presence in the ER and ICU can give it an entree to sell consulting services and coding resources, as well as a play in the growing area of Health Information Exchanges (HIEs) — moving EHRs among hospitals and doctors under the emerging NHIN Connect standards.
[1] There are some notable dissenters who believe MU is not all it is cracked up to be

Wednesday, July 21, 2010

"EMR Enablement" from Iron Mountain

Close on the heels of Kodak's announcement recently of a new health records solution, Iron Mountain this week released its "EMR Enablement Solution" to link historical and modern (electronic) records as hospitals climb the adoption curve of EMR systems.

The press release states:
While EMR systems promise to improve patient care and cut treatment costs, healthcare organizations are uncertain how to implement digital records using existing resources and without disrupting patient care. The Iron Mountain EMR Enablement Solution makes the paper-to-EMR transition easier and faster for hospitals by helping them identify which records to digitize and which to destroy.
This solution is geared towards hospitals and emphasizes outsourced document management, in sharp contrast to Kodak which appears to target smaller practices using existing staff for in-house scanning. Iron Mountain has a very large customer base and claims the solution is already operational at many of its clients, including Lahey Clinic.

Tuesday, July 20, 2010

Seinfeld and the Move Towards Patient Engagement

Today's Wall St. Journal has an article on patient access to physician notes. It reminded me of a sketch from Seinfeld from several years ago, where Elaine is trying to get a hold of her medical charts because she thinks the physician's notes are not fair to her. Turns out, you can legally request physician notes and some hospitals like Beth Israel Deaconess Medical Center in Boston are piloting a program to make such data more accessible.

In case you haven't heard enough about Meaningful Use this week, I'll just add one more insightful analysis: John D. Halamka believes that patient engagement is actually one of the more challenging aspects of Meaningful Use Stage 1.

Step 1 in the path towards patient-centric healthcare. Clip from Seinfeld included below.

Monday, July 19, 2010

De-Identified Patient Data and The Right to Privacy

"It's personal. It's private. And it's no one's business but yours.......Privacy is as apple-pie as the Constitution."
And so began one of the most important essays on Privacy in recent times. The essay was authored by Phil Zimmerman, the author of PGP--a public source encryption program that broadened access to secure electronic communication. And yet, scholars will tell you that, despite Mr. Zimmerman's "American as apple pie" comparison above, the US Constitution does not include an express right to privacy [1]. The Bill of Rights does, however, acknowledge the need for privacy and the US Supreme Court has firmly implied such a right through numerous rulings over the past century.

Healthcare records were not always afforded the same level of privacy as today. The road to HIPAA--today's governing legislation on healthcare records--was long and paved with some spectacular cases of misuse of personal health information. In recent times, HIPAA has strengthened privacy protections and emphasized enforcement. The penalties are steeper and the access terms are stricter than before.

The challenge with HIPAA, as with any other legislation, is to balance individual interests with those of society. For example, an individual has a self interest in protecting his or her health records from prying eyes. Yet, aggregate health information is extremely valuable to analyze trends, predict disease migration patterns, link treatment to outcomes, etc. The personal privacy protections from HIPAA make it difficult to get these societal benefits. The industry's approach at de-identified data appears to be a good compromise, but privacy advocates such as Deb Peel of Patient Privacy Rights have strongly clashed with industry advocates like Matthew Holt, the author of The Healthcare Blog on this subject.

For a recent example of how privacy alarmists can derail efforts to improve healthcare see this article. The issue described here was the selling of de-identified patient data by a free, hosted EMR system called PracticeFusion. The sale of de-identified data enables PracticeFusion to provide a free service to 30,000+ small physicians, but, the company's practices has privacy advocates up in arms.

Some of you may recall Facebook's Mark Zuckerberg claiming privacy was dead. Zuckerberg, of course, was referring to personal privacy in the context of what you do or share online and he was probably not thinking as much about personal health records. Are these two related? Will changing outlook on personal privacy affect how we view health information?

[1] a fact noted by Mr. Zimmerman later in his aforementioned essay.

Thursday, July 15, 2010

Analysis of the Final Rule on Meaningful Use

Inga from HIStalk provides a helpful summary of the changes between the preliminary and final rules for  Meaningful Use. Also John D Halamka has posted a very nice summary slide deck for those who need to present a synposis of the changes. Finally, Keith Boone's colleague, Dan Sepulvada helped compile a table summarizing the differences between the preliminary and final rules.

Two quick observations are below; look for a separate post in the coming days on how these new rules affect document management, particularly Release of Information.
  • Across the board, the final rules are a lot less ambitious than the preliminary ones. This is mostly a good outcome because we still don't know the behavior these rules will motivate. More* on this at the end of the post. 
  • The preliminary rules were written with an assumption that medical records will be mostly electronic by 2015. Several studies suggest this goal is not realistic, so it will be interesting to hear whether these rules will indeed prevail or whether there would be further changes down the road. A Bass Diffusion model applied to physician EMR systems by Prof. Eric W. Ford and others claims true adoption will take a decade longer than anticipated. And that's the optimistic scenario!
I look forward to hearing your thoughts in the comments section below.

*Why less ambitious rules may be a good thing: Rob Lamberts at The Health Care Blog draws an analogy between Meaningful Use rules and those in No Child Left Behind--another well intentioned legislation that introduced undesirable behavior on the part of the actors (the teachers). One would rather have rules that are realistic than those that are so strict everyone has to find workarounds.

Wednesday, July 14, 2010

Kodak-Medco Data Partnership

This week, Kodak announced a partnership with Medco Data to provide conversion of paper-based charts to digital files. There are a number of local vendors currently serving this space, so the entry of a major brand like Kodak appears to validate the belief that EMR adoption improves when there is continuity with historical records.

The press release states:
"Conversion of paper-based patient charts represents a critical consideration for practices implementing EMR/EHR systems. Scanning charts prior to the installation of an electronic records system can significantly improve the chance of a successful adoption."
The product is targeted towards physician practices and ambulatory care. It emphasizes the ability for existing staff to perform scanning work.

It will be interesting to see what physician practices and ambulatory care EMR systems, particularly AllScripts, do to better integrate paper and electronic medical records.  Stay tuned.

Tuesday, July 13, 2010


EMR (Electronic Medical Records) and EHRs (Electronic Health Records) refer to two very distinct concepts. Unfortunately, government officials, vendors, respected journalists, and consultants have used these terms interchangeably in order to refer to EMRs.

HIMSS Analytics provides clarity on the meaning of these terms:
  • Electronic Medical Record: An application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications. This environment supports the patient s electronic medical record across inpatient and outpatient environments, and is used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO). The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO.
  • Electronic Health Record: A subset of each care delivery organization’s EMR, presently assumed to be summaries like ASTM s Continuity of Care Record (CCR) or HL7 s Continuity of Care Document (CCD), is owned by the patient and has patient input and access that spans episodes of care across multiple CDOs within a community, region, or state (or in some countries, the entire country). The EHR in the US will ride on the proposed National Health Information Network (NHIN). The EHR can be established only if the electronic medical records of the various CDOs have evolved to a level that can create and support a robust exchange of information between stakeholders within a community or region. While some forms of early EHRs exist today in limited environments, it will be difficult to establish effective EHRs across the majority of the US market until we have established clinical information transaction standards that can be easily adopted by the different EMR application architectures now available.
John at "EMR and HIPAA" argues that this distinction is irrelevant and that these terms will always be used interchangeably. He writes:
"My favorite in the EMR world is when people go crazy if you use the term EMR and not EHR. Let’s just get over it. The doctors I talk to really are. They use them interchangeably to mean everything that you might technically consider an EHR."
What do you think?

Meaningful Use Criteria Announced

The Department of Health and Human Services (HHS) and the Office of the National Coordinator for Health Information Technology (ONC) has released the long-awaited announcement on meaningful use. See news article.

Also, see the New England Journal of Medicine's Perspective on the new rules, authored by David Blumenthal and Marilyn Tavenner