Healthcare // Electronic Health Records
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11/27/2013
08:06 AM
Mark Braunstein
Mark Braunstein
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In Healthcare, Time To Free The Data

To justify optimism about healthcare IT, we need to free the data tied up in electronic health records -- and it is happening.

I've been accused of being an optimist, based on my initial InformationWeek Healthcare post. Since I've already pleaded guilty as charged, I feel obliged to support my position.

The next few posts will focus on what I feel are the some of the most significant innovation drivers unleashed by the US government's Electronic Health Record Certification and Meaningful Use programs. For the most part, these posts will have a common theme: freeing the data. It starts with the healthcare provider.

For decades, electronic records have usually been closed, proprietary systems. I'm pretty familiar with this, since I was involved in developing some of them. I can assuage my guilt a bit by pointing out that, in my last company, we tried to move data recorded by patients to the electronic records of their home care nurses and, from there, to the enterprise electronic record systems of the hospital, where they could be viewed by physicians. Unfortunately, physicians really weren't interested in seeing the data come back to them -- but that's an incentives issue better left for another column.

[ Tech to improve care: Kaiser Shifts To Preventive Care In Mobile Apps.]

Even so, the data we collected stayed within the essentially closed database of the hospital information system. Getting it out was possible with effort, but it was still in proprietary formats and terminologies. Moreover, as this paper points out, "The deployment and maintenance of multiple point-to-point interfaces between a clinical information system, such as a laboratory information system, and other systems within a healthcare enterprise is expensive and time consuming." This points to the need for some sort of data integration hub.

Things is finally starting to change. As you probably know, certified electronic medical records must provide at least patient summary data in standardized XML formats. The standards aren't as tight as they might be, but this is a huge step forward. With health information exchange, another area that's innovating, this creates a framework for a more coordinated approach to care. Keep in mind that there are, on average, 14 providers caring for each patient with five or more chronic diseases. These 20% of Medicare patients drive half the cost. It seems intuitively obvious to the most casual observer (a phrase I heard often back in my undergraduate days at MIT), and has for a long time, that data sharing is essential for coordinating such a complex care network. We're now moving down the road to that, courtesy of new standards (the CCDA for exchanging continuity of care documents), new approaches (direct health information exchange), and new outcomes-based incentives.

It may even be that freeing up the data is addictive. Greenway Medical's App Marketplace premiered at last year's HIMSS conference. By my count, it has more than 60 apps in 10 categories, and most of them are being sold by third-party developers. Some of our Georgia Tech students are thinking about building and selling one. Allscripts and Athenahealth have something similar, but Greenway is near Georgia Tech, so I'm more familiar with what it's doing.

All three companies are charter members of the CommonWell Health Alliance, which is, of course, focused on interoperability, so we could be only one step away from the beginning of what's really needed -- a standard app platform that works with any certified EHR. Some time ago, ASU's Bob Greenes, one of the old timers of HIT, hosted a meeting to discuss this exact concept -- a universal app platform. Free the data.

Even I, the optimist, would not have predicted it might be this visible -- still far off but on the horizon -- as we leave 2013.

Though the online exchange of medical records is central to the government's Meaningful Use program, the effort to make such transactions routine has just begun. Also in the Barriers to Health Information Exchange issue of InformationWeek Healthcare: why cloud startups favor Direct Protocol as a simpler alternative to centralized HIEs (free registration required).

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Alex Kane Rudansky
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Alex Kane Rudansky,
User Rank: Author
12/2/2013 | 11:23:08 AM
HIEs
I'm excited to see what HIEs will mean for data liberation. It seems like providers are increasingly on board, although some patients are hesitant because of privacy concerns. The technology is there -- the question is how to balance the concerns of the patient and the provider while providing access to health data. 
Mark Braunstein
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Mark Braunstein,
User Rank: Moderator
11/27/2013 | 3:48:43 PM
Re: Tighter standards for healthcare data
I think that's right.  A tighter definition of the CCDA would be a good first step.  A related issue and not one that is often thought of as a "standard" would be a means by which systems that need a CCDA could request one from any EMR using a standard API.  This is conceptually somewhat similar to a standard API for EMR apps.
David F. Carr
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David F. Carr,
User Rank: Author
11/27/2013 | 3:26:40 PM
Tighter standards for healthcare data
What data standards in particular need to be tightened?

One thing I've heard is that CCDA continuity of care documents output by various systems are inconsistent and not as portable as they ought to be.
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