#‎NoMUwithoutMe. Has the Patient been Left Out ?

There is now a debate raging over ‪#‎NoMUwithoutMe.  Several patient advocates have been swept up in a debate over a non-issue regarding meaningful use.  The  term itself is meaningless to most physicians.

To what group does meaningful use apply ?  Is it providers, analysts, medicare, or patients>? The group caught in the middle are the vendors.  That is where the rubber meets the road…

Several  hundred providers have already adapted stage I of meaningful use, while there has been more reticence to adopt stage II .

The artificial incendiary action was CMS proposal to shorten the attestation period from one year to 90 days for the next stage of M.U.  This, in response to provider pushback regarding the overwhelming confluence of conversion to ICD-10, something effecting every EHR. Many are saying to hell with the incentive, I’d rather get penalized. The increase of time, loss of efficiency and investment of more capital does not equate with better medical care.

According to Adrian Groper M.D. writing in The Health Care Blog…..the patient is being left out of the end game and recipient of their own health data.  Some of this becomes highly technical as to what a patient can download from a patient portal.

To quote Dr. Groper,

“Meaningful Use (MU) requirement for Stage 3, in the final stage of a $30B + initiative to advance interoperable digital health records. The focus is on something called View / Download / Transmit (V/D/T) but the real issue and the Last Chance is broader and more important. The bad news is that MU may leave patients as beggars for own data. The good news is that the Office of the National Coordinator (ONC)  and Congress are paying attention and patients still have a chance to shift the terms of the debate to what HIPAA calls “the patient’s right of access” and demand that it apply strictly to MU Stage 3 Appication Programming Interfaces (API).”

So, at this point in time MU stage III is dead on arrival with a required re-definition of what it will require from software APIs.

What makes this even more interesting is that many large health systems have already included MU III in their new software.  Large healthcare systems have considerable capital to send to software vendors, in contrast to smaller hospitals and medical groups.

Meaingful use has become fodder for the software industry, and does need to be re-directed toward patients. The bottom line is if it ain’t good for the patient/provider….don’t do it. Primum non nocere.

Medical Informatics World Conference Will Unite Healthcare and IT Leaders to Address Solutions for Prevalent Industry Issues and Common Pain Points

Cambridge Healthtech Institute and Clinical Informatics News today announced that its third annual Medical Informatics World Conference will take place May 4-5, 2015 at the Renaissance Waterfront Hotel in Boston. This professional forum will focus on the cross-industry connections and innovative solutions needed to take biomedical research and healthcare delivery to the next level.

Connecting more than 400 healthcare, biomedical science, health informatics and IT leaders, the 2015 Medical Informatics World Conference will navigate the emerging trends and opportunities in the ever-evolving industry. The event responds to the challenges in collaborating and maximizing the benefits of enabling technologies, offering inspiring keynotes combined with focused expert-led presentations and discussion. The 2015 program features six conference tracks, including two that are new to this year's event -- which will focus on mHealth and the cloud and enterprise architecture and hospital information systems.

"The healthcare technology and policy landscape changes so rapidly that IT leaders are challenged to deploy solutions fast enough to meet user and regulatory needs," said John Halamka, M.D., MS, CIO, Beth Israel Deaconess Medical Center. "Medical Informatics World convenes experts from across the country to share best practices, providing the guidance we all need to be successful."

A Focus on Healthcare Reform, Emerging Policies and Patient Data Sharing Will Provide Attendees With Real-Life Case Studies and Best Practices

Featured tracks include:

• Provider-Payer-Pharma Cross-Industry Data Collaboration to Enable Value-Based Delivery Models - Integrating real time data analysis to manage costs and improve outcomes in the health care ecosystem.
• Coordinated Patient Care, Engagement and Empowerment - Delivering care to patients and consumers in all settings to improve outcomes.
• Population Health Management and Quality Improvement- Using technology and analytics to predict outcomes, target high-risk populations and increase compliance.
• Security and Access of Healthcare Data for Patients, Providers and Payers, Anywhere and Anytime - Navigating the evolving landscape of health data in a BYOD, cloud and increasingly regulated environment.
• Leveraging mHealth, Telehealth and the Cloud - Achieving the "triple aim" with mobile tech, POC devices, wearables and telemedicine.
• Building Enterprise Architecture and Hospital Information Systems to Improve Outcomes - Delivering data-driven infrastructures to support clinical and financial transformation.

"As this event continues to grow year over year and gain considerable traction in the market, we are constantly looking to raise the bar for attendees by bringing fresh ideas and topics combined with leading speakers to the forefront," said Micah Lieberman, Executive Director of Conferences for CHI and Medical Informatics World. " 

Medical Informatics World Conference Will Unite Healthcare and IT Leaders to Address Solutions for Prevalent Industry Issues and Common Pain Points

The Jagged Path to Electronic Health Record Interoperability

The early vision of EHR interoperability was formulated by the first ONC head, David Brailer M.D. in 2006. It was part of a greater study on Information Technology by George W. Bush when he created ONC with an executive order.

Since that time we have had a series of ONC chiefs, each one with a different emphasis and focus on the growth of infrastructure to support health data exchanges.

Interoperatiliby is actually a misnomer, because EHRs, regardless of harmonization do not communicate with each other directly, and only contain certain data sets that can be decoded by intervening software.  There are some networked EHRs that provide true communication among multiple site using their own proprietary software. However, these are actually closed silos unless conntected to a regional health data exchange.

The extent and cost of a HDE is a function of the number of fields to be linked. The most common set is the CCR and it is also the basic standard.

Connecting two or more disparate systems is a technical challenge, however the legalese and bureaucracy are also challenged by state regulations.  Trust agreements are a necessity to ensure security and privacy as well. Networks that cross state lines present a special set of challenges.

Economic stability for the HDE is a critical ingredient, and that may vary greatly according to region. The most challenging cases are those connecting multiple small institutions, small hospitals and medical groups.  Large institutions and metropolitan areas have the financial strength to invest in HDEs.

In order to qualify for certain Federal incentives the HDE must contain functions such as secure portals, messaging, all in accord with HIPAA regulation.

Fast forward to 2015

ONC's Karen DeSalvo outlines 3 steps to interoperability

National Coordinator for Health IT Karen DeSalvo continues to tout "the bright future" of health IT, outlining in a post atHealth Affairs what needs to be done to get to full interoperability.

Her steps to getting to interoperability include:

1. Standardizing application programming interfaces and implementation standards.
2. Creating clarity around the environment of trust. "What are the shared expectations and actions around data security and privacy?" she asks.
3. Providing incentives for interoperability and the appropriate uses of electronic health information.

However, she also writes about the problems states still face when it comes to adoption. In Alabama, for example, providers face a lack of broadband access in undeserved communities. In New Jersey differing privacy laws in neighboring states are a barrier to information exchange, she writes.

 We will need an unprecedented amount of cooperation, collaboration, and transparency to see that there is the best public private partnership possible .…

Her undaunted cry is:

 "We will need an unprecedented amount of cooperation, collaboration, and transparency to see that there is the best public private partnership possible" .…creates the challenge to all vendors, state and federal entities and cooperation at the local  to achieve.