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TECH: Portals as health care integration platforms

Here’s a piece I wrote for Health-IT World about portals and content management technology in health care. I learnt some interesting stuff talking to the folks at Vignette and CareFx and hope you will too by reading what I wrote!  Those of you who know more please comment here!

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  1. You probably heard more from them than I have got, but here are a couple thoughts
    > Crean says that “unstructured healthcare information
    > is growing at a faster pace than structured data.”
    One thing that frosts me is the idea that things like EKGs are not “structured”. They are structured: there exist information interchange standards to transmit all manner of time-domain signals like EKGs. They’ve been around for quite a while.
    What Crean’s getting at is that hospitals (and others) have not bought instruments that conform to the standards, and all they have is the paper strip. Hospitals and others have not structured their data, but the lack of structure is generally not inherent in the data or the work processes. I would rather have him talk about capturing data from legacy instrumentation and processes. Anything that can’t go directly from worksite into a standards-oriented EMR ought to be derrogated.
    I sincerely hope future purchasing behavior on the part of hospitals (especially) corrects the problem of EMR-unaware instrumentation and other information sources by demanding full and complete standards compliance. This goes up and down the line: if there is a standard for it, anything we buy from where the sun now stands ought to implement it fully, and not as an afterthought for the sales brochure.
    CareFx and others deserve props: they apparently rely on the HL7 CCOW (Clinical Context Object Workgroup) standard for what’s been called “desktop integration”. I like their word aggregation because it shows they are not trying to pretend they have integrated anything. And apparently a number of vendors have got on-board with CCOW sufficiently to allow a third party like CareFx to add value. Bully for everyone then — we finally(!) have the stopgap measure as a reality and we are not locked-in to a single vendor. They’ll have to compete on functionality and quality.
    What Vingette apparently do is “photograph” something and manage it as an electronic document (so-called). This does add value — it won’t get lost (unless you’re a GE customer. Sorry, couldn’t resist.), you can it in more than one place at the same time, takes a lot less space than paper, and so-forth. But you can’t “mine” the data for research, apply new interpretation algorithms to old signals; this kind of thing.
    I have resigned myself long ago to stepwise improvements in healthcare IT, and these approaches are definately that. I plead with CIOs and docs and everyone to keep their eyes on the prize though, and not to become satisfied with these halfway measures the way we have been satisfied with paper records for so long. And to cooperate with the academics in medical informatics.
    t

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