This is a summary of the HIT Trends Report for March 2011.  You can get the current issue or subscribe here.

Government drivers. Federal communications dominated this month’s news.  ONC defended its core EHR strategy through a report published in Health Affairs analyzing the most recent studies to prove the benefits.  It found that 92% of studies reported positive or mixed but predominately positive results.  The study updates prior research by Chaudhry (2006) and Goldzweig (2009).

It also released its 5 year HIT strategy that is more of a comprehensive tactical plan of the work over the next years.  The plan seems generally aligned with most industry expectations.  (Adopt EMRs.  Exchange patient info.  Make it secure and private.  Get patients empowered.  Measure everything.)  ONC is asking for public feedback.  Early comments wish the plan contained more on fraud prevention and innovative solutions and architectures.

There’s also some pushback on its Stage Two and Three requirements.  A CCHIT industry survey indicates some potential overreach in areas such as agency reporting, formulary checking, medication reconciliation, patient info access and other areas.  Yet CMS put out its first rules on ACOs for comments, and the HIT requirements are ginormous.  Writing in the NEJM, CMS head, Don Berwick says, “Information management — making sure patients and all health care providers have the right information at the point of care — will be a core competency of ACOs.”

HIE as a verb*. There is a lot of innovation this month in the process of health information exchange.  Chilmark Research published (earlier) a useful stage model around the functions of exchange while Fierce Health ran an analysis of health info service providers (HISPs).  These are companies using Direct Project protocols and other means for secure clinical messaging.  They include many EMRs, Surescripts, many HIEs and HealthVault.  This part of the market is developing quickly, an encouraging signal that simple standards can unlock market creativity.

Doximity launched as a physician community with designs on physician to physician communications.  It is led by ex-Epocrates execs.  Physicians as individuals linked to other providers as individuals for secure messaging could be a key component to emerging models of care collaboration in medical homes and accountable care arrangements. J&J and Sermo, another physician community, report a partnership to also include physician to patient communications with smartphones and tablets on both ends.  And AMA’s Amagine physician portal aligns with HIE interests in Michigan and launches nationally with a collection of all web-based applications.  Central services include single sign-on and a common physician dashboard framework.  Physicians engage online and fill out an assessment survey.  Amagine consultants pick up the process from there.

*HIE as a verb, according to Art Glasgow at Ingenix writing for Healthcare IT News, “In simple terms, HIE as a verb describes the “science” and HIE as a noun the “art” of health information exchange, although there is certainly crossover.”

Clinical analytics. HIE and clinical analytics solutions see the benefits of collaboration. This time it’s dbMotion, the HIE, and Elsevier MEDai, the analytic engine, according to this month’s announcement.  This is an example of the market trend toward combining HIE and semantic interoperability with deep data analytics.  There are elements of this in Orion/Health Language, Ingenix/Axolotl, ActiveHealth/Medicity, IBM/Nuance and others. MEDecision published a report encouraging health plans to use these kinds of analytics for medication therapy management.  This has been made a bit easier this month because RxNorm, a drug standards vocabulary, is now linked to NDC codes from First Databank according to a release from the NIH.  The standard is a result of the collaboration between the NLM, the FDA, the VA and commercial drug info companies.  Multum and Gold Standard drug information has historically been referenced.  The addition of First Databank, the segment’s leader, is a big step ahead. And the requirements for ACOs imply lots of clinical analytics to meet the evidence-based care and predictive modeling goals.

Art of HIT. The art this month is False Start, Jasper Johns, 1959.  It uses stenciled names of colors that in their uniformity prevent innovation and in their color and position create viewer confusion.  This is just a reminder that we need both clear direction and innovation.

Michael Lake has been a healthcare technology strategist for over 30 years.  He is President of Circle Square Inc., a San Francisco-based strategy, business development and market research firm, focused exclusively on the healthcare information technology market. The company works with healthcare, life sciences and technology companies on developing strategies, products and business models for complex multi-stakeholder healthcare environments.  He publishes the HIT Trends Report monthly.  For more information, please see

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