information exchanges

Health IT standards development likely to speed up

Mon, 28 Apr 2008 06:59:57 -0400

With some core data already defined, it's looking like the pace of health IT standards development is likely to pick up. According to John Halamka, chairman of the Healthcare Information Technology Standards Panel (HITSP), with standards in place for some areas--including biosurveillance, consumer empowerment and electronic health record exchange of lab data--moving ahead is going to be easier than it has been in the past. Halamka, CIO of Harvard Medical School, says that this year, HITSP will focus on patient-provider secure messaging, personalized healthcare, public health case reporting, remote monitoring/consultations and care transfers. As soon as 2009, vendors should begin to incorporate HITSP standards into their products, he predicts.

To learn more about health IT standards development progress:
- read this Healthcare IT News piece

Related Articles:
HIT group offers medical data security
HHS group accepts HIT standards, now eligible for safe harbors
Group to create health data security standard
Standards for healthcare supply chain get closer

Study: More providers joining HIEs

Mon, 21 Apr 2008 06:59:54 -0400

While the process is slow, it appears that more healthcare providers are gradually linking up with health information exchanges, according to a new study released by IDC-HII. For example, 15 percent of hospital respondents to one IDC-HII survey said they were participating in an HIE, and 35 percent more said they were in active discussions to do so. Meanwhile, in a February 2008 IDC-HII poll of community hospital CIOs, 22.7 percent said their health system was participating in an HIE, 18.2 percent planned to do so within less than a year, and 27.3 percent were considering the HIE option. One side note was that 33 percent of the CIOs who were involved in an HIE said they were part of a "proprietary HIE," one tied to a sponsor such as an integrated delivery network. To me, this suggests that while HIE penetration may be growing, the national health information network remains painfully far from being realized.

To learn more about IDI-HII's research:
- read this Healthcare IT News piece

Related Articles:
Joint Commission calls for national HIE
Study: RHIOs/HIEs backed by states will win
Report offers HIE keys to survival
What is the business model for sustaining a RHIO?

CDC grants to help RHIOs share public health data

Mon, 17 Mar 2008 07:59:56 -0400

The CDC has awarded $38 million in contracts to help health information exchanges and regional health information organizations to create data sharing plans used to deliver information to public health authorities. The money will be used as a means of getting trial implementations of the National Health Information Network rolling. Recipients include the Indiana University School of Medicine, which received $10 million to continue work started by its Regenstrief Institute, the state health department, and the Marion County health Department to detect and monitor data outbreaks through the HIE. Other grantees include the Science Applications International Corp., which will receive up to $8 million over five years, and New York non-profit Health Research Inc., which works closely with the state health department.

To find out more about the grants:
- read this Government Health IT article

Related Articles:
HHS awards $22.5 M in NHIN contracts. Report
IBM tests tech for NHIN. Article
NHIN, RHIOs and all that. Article

Report: HIEs/RHIOs are states' top HIT priorities

Mon, 25 Feb 2008 06:59:54 -0500

States consider health information exchanges and RHIOs (pick your acronym) to be their top e-health priorities, according to a new Commonwealth Fund report. When surveyed in 2007, 25 of 41 of states said that HIE adoption was one of their top two e-health priorities, and 12 said HIE policy development was a key initiative. Meanwhile, states cited the other usual suspects in third, fourth and fifth place as priorities, namely EMRs, e-prescribing and addressing health data privacy and security issues.

States said that the biggest obstacle to jump-starting HIE development efforts were getting together funding for implementation and long-term operations. (Reading between the lines, it appears that state policy-makers aren't too confident that HIEs or RHIOs can be self-financing, as some advocates seem to be.) Many said they had difficulty building a business case for HIEs, lacked adequate standards and shared terminology to use.

To learn more about the study's results:
- read this Government Health IT article

Watch out: Health IT is now a consumer buzzword

Mon, 04 Feb 2008 06:59:59 -0500

I don't know about you, but for me, the pre-HIMSS show excitement is building. I think this should be one of the most vibrant--and overwhelming--shows in the history of HIMSS itself. Why? Well, in part, it's because this has to be one of the first times in any of our professional lives when health IT went from the concern of group practice administrators and hospital leaders a topic that seems to interest everyone but my grandma. On the other hand, I'm not sure I like where this is going. Let me explain...

One of the most obvious indicators that health IT has gone public that there are bills and proposals directly affecting the industry mounting up daily. These days e-prescribing, PHRs, EMRs and health information exchanges are on the lips of elected officials who could barely use their own Blackberry otherwise. While President Bush has encouraged much of this, if the Democrats seize the White House, I don't think that's going to change. Health IT has moved from esoteric to a matter of mainstream discussion, and that's that.

This is something of a problem. After all, while legislators may be well-intentioned, they're usually not subject-matter experts, so they may not have a realistic picture of what problems you face. Besides, while they have to win some ill-defined popularity contest--if EMR is the flavor of the week in the mainstream press, well, then, everyone should have one--you just want to make sure your organization keeps delivering good care. We're talking a slight conflict of interests here.

I don't know about you, but when I'm at HIMSS, I'm usually more interested in talking with vendors who are solving non-trendy problems in a sensible way than listening to rah-rah new stuff. That's particularly true now that consumer interest has seeped into the industry and begun influencing how products are developed, sold and presented to you.

But hey, I don't want to be too cynical. Maybe there's some things that are both praised by the vox populi and worthy of being implemented. All I know is, when I'm at HIMSS, I'm planning to keep my trendiness quotient to a minimum. - Anne

Publisher's Note: For those of you attending HIMSS later this month, please join us for our second annual networking event "Opa!," on Monday, February 25. Along with our event partner Adobe, we'll be bringing you complimentary drinks and hors d'oeuvres as well as a chance to meet Editor Anne Zieger. This is a great opportunity to network with your fellow FierceHealthIT readers away from the hustle and bustle of the show floor. Click here to sign up for complimentary admission to the event. - Maurice Bakley, Publisher, FierceHealthIT

HIE may work best if starting small

Mon, 07 Jan 2008 06:59:59 -0500

So the VA EMR can't talk to the DoD's system--no surprise, given the gigantic bureaucracies involved. But it's daunting to consider that this is just one flavor of a nationwide problem we're facing as we fight to establish health information exchanges.

If two extraordinarily-well funded organizations can't link up their systems after nearly 10 years and almost $2 billion in effort, what does that mean for the "little guys" in regional RHIOs?

As we note below, one small Boston-area exchange faces big challenges just in getting patients with EMRs to agree to share information with other doctors. These community organizations don't have the ability to force the matter through legislation, and Lord knows they don't have the DoD's budget, so they're just going to have to wing it.

Ultimately, I'd say that administrative challenges like these, more than development issues, are the most daunting part of the logistics of building an HIE. If the two agencies can't get it together, even when they're in one sense under the same umbrella, imagine the hurdles local agencies have to jump.

Not only do they have to get patients to sign the necessary releases, set up trusted intermediaries everyone can work with and fund ongoing hosting and sharing of the information, they also have to convince everybody that this is in their interest. It's not easy.

On the other hand, if anyone can make it happen, I'd imagine it would be a small organization like the Massachusetts eHealth Collaborative. In this relatively small group--which includes only three towns--the players know each other, and that kind of intimacy is likely to work in their favor.

The more I think about it, the more it seems to me that the HIE may movement may need to emerge from small seeds of this kind. Otherwise, you end up with sprawling quasi-failures like the DoD integration project, and nobody wants that. - Anne

DEA may allow e-prescribing of controlled substances

Mon, 17 Dec 2007 06:59:57 -0500

Just last week, we took the DEA to task for its apparent resistance to letting physicians prescribe controlled substances electronically. Well, either I misread the situation or they've had a quick turnaround. Last week, the DEA published a timeline in the Federal Register under which it would phase in letting doctors e-prescribe controlled substances. That's quite a turnaround from DEA officials' recent testimony to Congress, in which they stated that they believe e-prescribing could increase abuse of controlled drugs. Among the first steps DEA execs plan to take is to draft a proposal by which this will happen. After that, the next step will be for the DEA to begin accepting comments on the draft, which it expects to continue collecting through September 2008.

To find out more about the proposal:
- read this iHealthBeat piece

Related Articles:
Group says controlled-substance rules block e-prescribing. Report
E-prescribing highlights barriers to data sharing. Editorial
DEA eases painkiller prescription rules. Report
E-prescribing: What's holding it back? Editorial
FL health plans lead e-prescribing effort. Report

FL pilots EMR for Medicaid recipients

Mon, 03 Dec 2007 06:59:54 -0500

The state of Florida has begun a pilot test under which it's checking out the idea of rolling out an EMR for all of its Medicaid recipients. The project, which (as far as we know at FierceHealthIT) is among the first of its kind in the U.S., comes as part of an 87-month, $308 Medicaid systems update being conducted by IT contractor EDS. If the current regional rollout goes well, the state plans to expand the EMR effort statewide.

Florida officials are beginning the effort by populating MRs for each Medicaid beneficiary in the Tallahassee-Leon County area with claims data. In the future, the records will also hold lab and radiology results as well as other clinical information.

To make sure the EMR doesn't become an information island, state officials have asked EDS to make sure the EMR data will be compatible with the region's Big Bend Regional Health Information Organization. It will be interesting to see if this approach--which uses the power of Medicaid to demand interoperability for health records--will give Florida a leg-up in creating an integrated statewide RHIO.

To learn more the EMR project:
- read this Government Health IT article

Related Articles:
Medicaid programs work on shared EMRs. Report
Mississippi Medicaid saves $14M with e-prescribing. Report
HHS grants improve Medicaid data management. Report
Groups launch campaign to promote e-prescribing. Report

Report: Local RHIOs aren't likely to become national

Mon, 12 Nov 2007 06:59:55 -0500

A new report suggests that despite its popularity, the dominant model for developing a national health information network may not be working. The report, from the Information Technology and Innovation Foundation, argues that we're not likely to see a U.S. health data exchange by building local RHIOs and interconnecting them. Why? While more than 100 RHIOs have been launched nationwide, most aren't making it financially, and few are sharing data due to problems with developing data standards, author Daniel Castro notes.

To foster HIE interconnectivity, Congress will need to pass strong legislation promoting EMR use and tighter health data standards, create a legal template for health record databanks, facilitate access to such data banks and make medical practices disclose health information electronically upon request, the report suggests.

To learn more from the report:
- read this Healthcare IT News piece
- read the Foundation's report (.pdf)

Related Articles:
National health networking: It takes a government. Editorial
Why RHIOs shouldn't exist. Editorial
Report: RHIOs need governance, technical standards. Report
Study: RHIOs grow slowly, rely on grants. Report
Study: RHIOs/HIEs back by states will win. Report
Long-lived CA RHIO shuts down. Report
A solution for RHIO privacy issues: EHR/EMR "banking." Editorial
Philly RHIO users visit competing providers. Report

National health networking: It takes a government

Mon, 08 Oct 2007 06:59:59 -0400

Last week, the federal government handed out $22.5 million in contracts to nine health information exchanges, whose job will now be to run trial implementations of the National Health Information Network. Another dull government program announcement? Not necessarily. We may be looking at something small here, as national projects go, but it's the start of something big.

As readers know, I'm not a huge fan of most current HIE/RHIO efforts, largely because I don't see them as sustainable. But as a little network known as "the Internet" reminds us, the government can slowly, stubbornly breathe life into networking projects that didn't have a leg to stand on before. So the fact that the NHIN has creeping along for years now doesn't mean the project is doomed by any means.

Ok, I admit that compared with the legal, strategic and financial issues involved in robust clinical data sharing efforts, building out the Internet was a carefree exercise. Nobody needed to be worried about sharing high volumes of mission-critical data with competitors every day, consumers weren't facing exposure of their most personal conditions to the broader world, and you didn't have to invest in a $500K+ enterprise system to get involved.

Not only that, while the development of IP networking standards wasn't trivial, the complexities involved in encoding and sharing clinical data put them to shame. Look at the Tower-of-Babel-like number of standards-development efforts out there. I don't have to implement them and it gives me a headache to contemplate it.

Still, if any entity can make national health data sharing a reality, it's the feds. Just imagine the grip of death the IRS puts on an errant taxpayer--then envision what can happen when similar levels of tenacity, thoroughness and institutional resources are turned towards the clinical data sharing problem.

Sure, it's still a long (maybe very long) term project, and there's probably obstacles ahead that will daunt even a massive agency like HHS. But even if you're buried in day to day enterprise IT problems, I would keep an eye on this project. That way, when you're called on to get involved, you'll know what to do.-Anne