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Tag: RHIOs

Cats & Dogs: Can We Find Unity on Health Care IT Change?

Today we have a humming economy and insane politics. In early 2009 we were in economic meltdown and were about one week into the sanest, soberist Administration and even Congress over many recent decades. In February 2009 they passed a stimulus bill that had a huge impact on the health IT market (and still does). At that time there was much debate on THCB about what the future of health IT policy should look like and how the stimulus “Meaningful Use” money should be spent. My January 2009 summary of that whole debate introduced the notion of “Cats and Dogs in health IT”. They’re still around today. We’re reprinting it here as part of our 15-year THCB birthday party–Matthew Holt

 

Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.

Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.

Given that even among you smart THCB readers this may be all a little perplexing, I’m going to try to try to make what I hope are some elucidating comments to put this argument in context. I’m doing this partly because I’m perplexed too, but also because I think that there is some hope for a middle road.

First the basics: As sometime THCB contributor & uber-CIO John Halamka makes clear in this excellent post about The Greatest Healthcare IT Generation, some $20 billion of the soon to be passed “spend it as fast as you can” stimulus package is going to be targeted towards health care IT. Now, that’s by no means the biggest part of the $800 billion or so package, and it’s not even the biggest part of the health care spending in the bill. Nearly $87 billion or so is going to support Medicaid, although that will mostly will be replacing cuts being forced on states.

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The Health Internet vs. the NHIN — A Matter of Control, Cost, and Timing

David KibbeThere is growing tension within the Obama administration’s health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.

Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a “network of networks” that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO’s policies for access to their health information. It was also a massively expensive and time consuming – think decades – way to build a health data network.

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The Health Internet vs. the NHIN

There is growing tension within the Obama administration’s health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.

Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a “network of networks” that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO’s policies for access to their health information. It was also a massively expensive and time consuming – think decades – way to build a health data network.Continue reading…

Health 2.0 more interesting than porn!

Last Thursday I gave a talk to a very high powered group, the National Committee on Vital and Health Statistics. My old colleague Matt Quinn is now working for the soon to be very rich Agency for Health Research and Quality (another HHS agency), and he lined up a series of talks for the committee on non-traditional data sources. Non-traditional, by the way, means about anything that isn’t from one of the huge Federal government household surveys (like MEPS) that’s used by HHS to analyze health care spending and consumption. John Halamka, CIO of BIDMC and Chair of HITSP, gave an excellent summary talk about data sources that are being collated and integrated in Massachusetts. It’s available on his blog here. Bear in mind that a LOT of work has already gone into putting various patient data sets together in that part of the country. The most encouraging thing was how relatively easy it was for BIDMC to interface with Google Health and Microsoft HealthVault, and how problem free those interfaces have been.

My talk was about Health 2.0, and given that it was less familiar to the committee I both introduced the concept of social networking and consumer tools, and discussed how it might be integrated into a national data capture strategy to improve quality reporting and hopefully spur improvements in medical care processes. Both talks are available here. You need to go to 4.48.00 or so to catch where I start. John’s talk is after the discussion

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Cats & dogs: Can we find unity on health care IT change?

Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.

Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.

Continue reading…

Confusing ‘Standards’ With ‘Interoperability’–Lessons For The 111th Congress From HIPAA

As we debate whether or not the Obama Administration and the 111th Congress should work towards directly funding EHRs, one of the key questions seems to be whether or not EHRs and interoperability standards are mature enough.

My colleague, John Halamka, Chair of the Healthcare Information Technology Standards Panel (HITSP), made an rational and impassioned plea last week that we have reached a state of interoperability that is at least good enough not to delay allocating Federal funds for investments in EHRs. Dr. Halamka had earlier in December advocated direct grants from the Federal government of $50,000 per U.S. clinician to states to fund the purchase of CCHIT compliant commercial EHR products.

In the ideal world, I agree with John’s position, but have spent perhaps too much time in the real EHR world and in health care standards to truly believe we are where we think we are.  We have been here before and our best intentions were subverted.

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Health IT policy: the fur is flying

Some fur is flying in the rarefied world of health IT policy geeks this morning. Health Affairs has three articles. The first from Markle’s Carol Diamond, writing with Here Comes Everybody author and Internet guru Clay Shirky, more or less says that obsessive attention to rigid standards is not helping and actually may be hindering the IT adoption process. And yes, in case you were wondering they do mean CCHIT and ONCHIT’s current policies and agenda which has been going for four years and which they’re accusing of “magical thinking.” Instead, we need new policies which target desired outcomes measured in improved patient care, instead of assuming that creating new technology standards will get us there. And by policies I think they mean money, and its redirection by current payers. After all, if putting in a RHIO costs hospitals operating revenue in reducing admissions and tests, why would they do it?

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Seeking Sustainable RHIO Forest; View Obscured by Non-profit Trees by Martin Jensen

Martin_jensenHealth Affairs just published a study by a team of Harvard
researchers that has cast a pall on the
sustainability of Regional
Health Information Organizations (also referred to as Health
Information Exchanges). The report, The State Of Regional Health Information Organizations: Current Activities And Financing,
by Julia Adler-Milstein, Andrew P. McAfee, David W. Bates, and Ashish
K. Jha, seems to imply that the maladies suffered by RHIO efforts
around the country might be fatal, at least if you read the many news stories and blogs
that are talking about it.  I say "seems to" because our analysis
suggests that the industry echosphere is still missing quite a bit of
the big picture.  Let’s take this step by step, starting with the
Harvard study and moving into the invisible economy and the nature of
the RHIO challenge.

First, the "scary facts" presented by the researchers:

  • 25% of previously-listed RHIOs seem to be "defunct"
  • Only 20% of the remainder reported exchanging significant volumes of clinical data
  • Most of the data they were exchanging falls into the categories of lab results, inpatient data and medication history
  • A majority reported receiving in-kind donations, about half
    reported grants or financial contributions and slightly less than half
    reported no financial contributions

Read the rest at the Health 2.0 Blog

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