By David C. Kibbe

I’ve been spending a lot of time involved in several Work Groups of the NHIN Direct Project, being run by ONC/HHS. The Project is aimed at developing secure, affordable, health data exchange over the Internet so more physicians can participate in Meaningful Use. This project has major significance to physicians in primary care, to all doctors in small and medium size medical practices, and for many small hospitals, as it is a potential “game changer” with implications for both the EHR technology industry and quality improvement movement. Here’s some background and explanation about why and how.

Background on health data exchange — why paper and fax no longer suffice

As a means of getting information from point A to point B, the fax machine works pretty well. But there are three big problems with faxing health data and information. One, it’s expensive, mostly due to the staff time spent running the machine, changing paper and ink cartridges, and handling paper jams, busy signals, and wrong numbers. Two, faxes contain unstructured text that at best is stored as a document electronically, but usually turns out as paper. Paper is expensive to store compared with digital documents, but the real problem here is that fax data are “non-computable.” Data in a fax is almost always unstructured and therefore unavailable for storage as discrete data elements, e.g. name, address, HbA1c level, etc, in a database. In a database, discrete data can be acted upon by software, but in paper format the data just sits there. And third, faxes are not really secure, as anyone walking by an unattended fax during receive mode can attest.

Not a huge issue, perhaps, until we consider that in 2009-10 Congress and agencies of the federal government have created regulations that require physicians and hospitals participating in the ARRA/HITECH incentives awarded for “meaningful use” of EHR technology to:

• send data to each other for referral and care coordination purposes;
• send their patients alerts and reminders for preventive care;
• offer patients views of their clinical data, such as laboratory results;
• make clinical summaries available to patients after each visit, and: send quality measurement data to CMS.

Given this new situation, which will dramatically increase the flow of data out of medical practices and hospitals, the really pertinent question is this: “If we can’t use fax machines to deliver these messages, what can we use?”

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By Matthew Holt

Those of you who are keen on gaming and health will want to know that RWJ Pioneer Portfolio is sponsoring the upcoming 6th Annual Games for Health Conference in Baltimore Boston, May 25-27. THCB readers can save 10% by entering the following code on the registration page: PIO10.

Meanwhile Jay Parkinson and ePatient Dave are the two main health care attractions for health care geeks at Gov 2.0 which is also on the same dates.

What’s a DC health care geek to do? Of course they could also sneak out to Health 2.0 Goes to Washington which is on June 7 and doesn’t clash with anything!

By Brian Klepper

Last week my wife and best friend, Elaine, had massive abdominal surgery. We fully expected her to be an inpatient for a week, but she was home in four and half days. To watch her recover was to see what happens when everything converges: the deep knowledge and skills of excellent, humane physicians; a capable, caring clinical staff; wonderful new technologies; and a lifetime of eating right, being fit and tending to one’s health.

She lost two units of blood during the operation. It was four days before she’d be allowed any fluids by mouth, except ice chips, and 5 days before she’d have any food, which started with broth and Jell-O.

But the day following surgery, she moved from her bed to a chair and sat vertically for an hour! Twice! The first time she was dreadfully nauseous. The second time was better.

The second day, she circumnavigated the rectangular halls of the floor – probably an eighth of a mile – twice!

Several things made all this possible. One was the good judgment of her physician team, that did not assume that all was well, and methodically explored until they discovered the deeper problem. In this case, if they had waited, the damage would have been much more significant and the outcome much worse.

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By SUSAN NOACK, IBM BUSINESS ANALYTICS

To say that the health care industry is undergoing a significant transformation would be quite the understatement. Current economic conditions have challenged health care organizations to deliver optimal  services in the face of compromised cash flows, reduced resources, and declining margins.

President Obama’s signature on the Patient Protection and Affordable Care Act has effectively raised the stakes, shifting the focus of discussion within health care circles from talk of reform, to demand for transformation.

Facing pressures from both the public and administration, health care organizations are re-examining how the mountains of information at their fingertips can be better used to nurture future growth and drive high quality care. How can we provide safer, more cost-effective care to patients? What’s the financial payoff for quicker recoveries and short hospital stays? What’s the right mix of services at a particular location to ensure optimal care?

The latest advancements in business analytics technology – a key piece for any smart health care system – are helping organizations manage their existing data to both optimize clinical and business operations and differentiate services in their communities.

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Health 2.0 Presents:  A Conversation with the
Office of the National Coordinator for Health IT

A Webinar featuring Joshua Seidman, Acting Director, Meaningful Use, Office of Provider Adoption Support, ONC

Health 2.0 and the Health 2.0 Accelerator have teamed up to bring you a conversation with members of the Office of the National Coordinator for Health IT. On Wednesday, May 5, 2010 at 1pm ET / 10am PT Dr. Seidman will discuss meaningful use and its implications for health IT at a physician and hospital level. In particular, his talk will cover the central tenets of meaningful use and how it aligns with an overall vision of health IT as a catalyst for improved clinical outcomes and efficiency. Other issues such as external innovation from an infrastructure based on MU architecture will be covered, as well as implications for consumers/patients. For more background, check out the Federal Advisor Committee Blog.

Register today at http://www.health2con.com/webinars/.

And don’t miss out on the next Health 2.0 event, Health 2.0 Goes to Washington!  More details at http://www.health2con.com/dc-2010/.

By JOHN MOORE
The National Health Information Network (NHIN), which was the previous ONC head’s (Kolodner) top priority, or at least seemed that way is a concept that has its advocates and detractors.  To date, we have been more of a detractor as the original NHIN was a very heavy, top down approach by the federal government to establish a national Health Information Exchange (HIE).  Certain federal agencies loved the idea (e.g., Social Security Administration which has an embarrassing 18 month backlog of disability claims), but those in the field (local hospitals, RHIOs, HIEs, etc.) were not such a big fan of the concept.  Heck, we can’t even get RHIOs established, let alone an NHIN.  Adding to NHIN woes was its platform, built by beltway bandits with technology ill-suited to create a flexible, lightweight transport mechanism for the exchange of health information.

Thankfully, a new administration has come on board, new people have joined ONC and the bloated NHIN of recent history is getting a major rework – actually being split with NHIN referring more to the policy constructs that will define information exchange (the DURSA – Data Use and Reciprocal Support Agreement) and NHIN Direct, a much lighter weight technology stack to enable point to point communication.

Unfortunately, Chilmark has not had the time as of late (see previous post) to do a deep dive but while at the recent Governor’s Conference here in Boston, we bumped into Keith who works for GE and has represented GE in many of the discussions/meetings that ONC has held recently on NHIN and NHIN Direct.  Therefore, I asked him if he would be willing to write something on this topic, which follows below.  (Note, in conversations with some State Reps at the Governor’s conference, there is some significant consternation among many regarding the NHIN and NHIN Direct so this is far from a slam dunk for the feds – time will tell as to how this will actually be adopted and used.)

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