By MICHAEL LAKE

This is a summary of the HIT Trends Report for October 2010.  You can get the current issue or subscribe here.

The evolving health information exchange market. The HIE segment was center-stage this month with a game-changing announcement by Surescripts. It will combine its national physician directory and EMR connectivity with apps from its strategic investment in Kryptiq to offer physician-to-physician clinical messaging beginning in December, extending its dominant market position.  As first to market with these functions, it will likely cement its standing as the country’s premiere neutral national network.  It also enables a platform for additional web services from collaborating partners in the future.  We are also reminded this month in Healthcare IT News of the relative dominance of Epic in the IDN and large practice market with the startling statistic that 75% of Wisconsin residents are in the databases of its state user group.  Using Epic tools and with patient consent physicians in the state can see patient information across institutions.  And there’s a story this month that Verizon is expanding its vision as an HIE by adding clinical lab and imaging results to its networking services with leading transcription companies.  These three lenses:  (1) Surescripts as the leading national network; (2) Epic as the leading national EMR; and (3) Verizon as the leading national telecom, exemplify the rapidly changing dynamics in this segment.

EHRs and HIT have become central to transformation of clinical practice. One large driver is the announcement by the insurance commission of the inclusion of HIT as well as wellness and care management as medical expenses for insurers under PPACA.  In the past these areas were generally allocated to the administrative budget of health plans which limited participation.  This will increase payer investment.  A CMS exec, Anthony Rogers, reported to Healthcare IT News on early results of CMS accountable care organization (ACO) pilots.  He noted that practices with EMRs were getting most of the $36M in incentives and said, “If that’s not a business case [for EHRs], I don’t know what is.”   The Patient-Centered Primary Care Collaborative, the organization driving medical homes released two reports this month also highlighting HIT’s role in transformation.  One report looks at best practices to engage patients in a medical home project using HIT.  It’s a compendium of 15 essays by a diverse set of experts on different perspectives about using health IT to engage patients, plus snapshots of two dozen case examples.  The other report focuses on five ways to implement HIT effectively to enable clinical decision support.  And CSC released a roadmap for HIT in ACOs with an elegant six factor model:  member engagement; medical management; clinical information exchange; quality reporting; business intelligence; and  risk and revenue management.

Comparative effectiveness research (CER) by any other name. ARHQ announced it awarded $473M to dozens of organizations for patient-centered outcomes research.   This is the new term for comparative effectiveness research being promoted by federal programs.  The Feds see this area as providing evidence on the effectiveness, benefits and harms of different treatment options as a result of comparing drugs, medical devices, tests, surgeries or other health treatments in practice.  As this segment heats up, two leading health journals made CER the focus of special editions.  However, neither Health Affairs or PharmacoEconomics focused on HIT aspects.  Kaiser Permanente advanced the CER field with its donation of its Convergent Medical Terminology (CMT) system so HHS can distribute it in the US. It includes 75,000 medical concepts and terms used by 15,000 clinicians in its EHR.  It allows multiple clinicians and patients to refer to the same clinical concept, such as diagnosis, with different names. And IBM and Nuance announced a partnership to work together to collaborate on Clinical Language Understanding (CLU) technologies that will automatically  derive structured clinical data from dictated blobs.  These tools will process, identify and extract problems, social history, medications, allergies, and procedures from dictation allowing it to be aggregated and analyzed.

Health 2.0 Conference, SF, 2010. And if it’s October, it’s Health 2.0 in San Francisco.  This year showed more integration among apps and with institutions.  Or in the language of the maturing Health 2.0 Model, emerging Unplatforms are integrating info about a person, his population and his environment in a collaborative mash-up of open applications that enable health.  Our government CTOs’ set the stage by providing open access to federal data ahead of the meeting and support for ideas like the Blue Button download.  They are also motivating speakers on the Health 2.0 stage.  Sharecare announced a star-studded cast of experts for its health Q&A site launch by Jeff Arnold and Dr. Oz.  And Castlight was impressive as a new technology bringing transparency to healthcare costs.  This conference remains a unique event with 1000 participants engaged in a market conversation with dozens of companies about emerging technology that is likely to change the nature of healthcare in the future.

The Art of HIT. The art this month is 5,537,594 Suns From Flickr (Partial), by Penelope Umbrico, from 2009.  It’s now up at the MOMA in SF.  A clear example of the crowd-sourcing that makes Health 2.0 exciting.  We are all hoping that our collaborative work together in Health IT, like the points of light from Flickr suns, will someday make great art.

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 www.michaellake.com.