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ONC Releases Healthcare Interoperability Roadmap
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Ariella
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Ariella,
User Rank: Ninja
6/6/2014 | 4:47:06 PM
roadmap
It definitely makes sense to get everyone on the same page in terms of interoperability. My guess is that the road to that end will not be altogether smooth.
Alison_Diana
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Alison_Diana,
User Rank: Author
6/6/2014 | 4:50:23 PM
Re: roadmap
I sincerely doubt it, @Ariella! And i would question the 10-year timeline, too, based on how other deadlines have shifted within CMS and ONC (for a variety of reasons). That said, it's glaringly apparent that interoperability is crucial. I'm not sure whether the decision to create another ID number -- a healthcare ID number -- is the way to go. We already have social security numbers and can't keep them safe. Who's to say health ID numbers would be any more secure?
Ariella
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Ariella,
User Rank: Ninja
6/6/2014 | 5:03:29 PM
Re: roadmap
@Alison they probably wouldn't, but people may feel it's better not to have everything linked to their social security numbers. It's ironic how they really do become one's primary ID when they started out only to track financial information, paricularly an individual's earnings. Perhaps, though, we can try using a system that was rejected when considering an identifier back in the 30s, and opt for fingerprints. According to The Story of the Social Security Number

the Post Office Department (for Postal Savings depositors) used fingerprints for identification. However, the use of fingerprints was associated in the public mind with criminal activity, making this approach undesirable (Wyatt and Wandel 1937, 45–47). A numbering scheme was seen as the practical alternative. Thus, the employer identification number (EIN) and the SSN were created.

 


Now that computers make fingerprints easier to track and identify, not to mention that the ID is not necessarily linked to criminals, perhaps it can be used for medical IDs.

Alison_Diana
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Alison_Diana,
User Rank: Author
6/6/2014 | 5:09:30 PM
Re: roadmap
Or if not fingerprints, then some other form of biometric? It would have to be a multi-use system to (rightfully) address the Americans with Disabilities Act, but I much prefer that approach to get another alphanumeric string. 
Ariella
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Ariella,
User Rank: Ninja
6/6/2014 | 5:15:19 PM
Re: roadmap
@Alison Yes, there's also the possibility of a retinal scan. Once DNA reading gets more economical, perhaps a bit of hair would do the trick. 
Gary_EL
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Gary_EL,
User Rank: Ninja
6/7/2014 | 9:04:37 PM
Re: roadmap
There used to be a term called "Islands of Automation". I live in one myself, in that every facility within the hospital network that I get my health care in uses the same interconnected computer system. Every clinician I see has instant access to what every other one has done or prescribed. The data also goes to both their financial offices to my insurance company. The prescription's go right to my participating pharmacist. About all I have to is to pay my bills.

The hard part about doing something like this nationally would be coming up with standards that would be fair to all the players and their needs. Once the serious discussions have drawn a critical mass of insurance companies and hospitals, it would be time for the federal government to come on board. Financial incentives would be put in place for cooperation, and gradual financial penalties could be established for not.
Ariella
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Ariella,
User Rank: Ninja
6/8/2014 | 9:57:28 AM
Re: roadmap
@Gary_EL so you would use both carrots and sticks? There were programs that offered medical practioners and facilities financial incentives for getting on board with EHR systems, but I don't think there were any penalties for not doing so. Of course, that doesn't mean it is unheard of. I believe HIPPA is enforced with the threat of penalties. 
Gary_EL
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Gary_EL,
User Rank: Ninja
6/8/2014 | 12:31:34 PM
Re: roadmap
Right, but not yet. After all, there are no standards as yet to adhere to. I don't imagine "the stick" will be much of a factor. Once it gets up and running, staying out will turn out to be it's own penalty in many ways.
Alison_Diana
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Alison_Diana,
User Rank: Author
6/9/2014 | 10:29:42 AM
Re: roadmap
Yes: There are financial penalties for HIPAA breaches that affect more than 500 patient records. The government has been penalizing organizations of all sizes which should, I'd imagine, sound a more chilling note to healthcare organizations that they must take HIPAA seriously. I know service providers like HIPAASecureNow have told me more practices are seeking risk assessment services.
Ariella
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Ariella,
User Rank: Ninja
6/9/2014 | 11:48:47 AM
Re: roadmap
@Alison thanks for clarifying. That's what I thought. 
Alison_Diana
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Alison_Diana,
User Rank: Author
6/9/2014 | 10:32:24 AM
Re: roadmap
From what I've heard, there are no more financial "carrots" coming to practioners from the government. Now, when it comes to government handing out money, I'd say never say never! It is going to be extremely difficult to change behavior and incentives are certainly one way of encouraging behavior changes. Penalties are the opposite form, and government has used both these forms in healthcare (and other industries) in the past.
David F. Carr
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David F. Carr,
User Rank: Author
6/10/2014 | 5:43:20 PM
Where's the health IT industry consolidation roadmap?
I have to wonder whether the interoperability problem isn't a factor of too many health IT vendors, sustained by government subsidies. Culling the market for health IT products might be the best thing for interoperability. Standards are nice, but it's really hard to make standards so standard that they work without tweaking across a large number of vendors for a wide range of uses. When there are so many different EHRs in use, it's difficult for every vendor to churn out compatibility tweaks for every other vendor -- and we wind up with patchwork, partial interoperability.

True? Or have I been spending too much time talking with Jonathan Bush?
Alison_Diana
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Alison_Diana,
User Rank: Author
6/11/2014 | 9:27:52 AM
Re: Where's the health IT industry consolidation roadmap?
By "culling the market for health products," do you mean have the government decide which EHRs stay or go, @David? I won't address that point until I'm clearer on the meaning! :)

As to interoperability, while I may be naive here (although after covering tech for 20+ years, it's hard to imagine!), plenty of other industries have accomplished this goal. It may not have been easy. It may not have been painless. But they finally arrived at the point where different vendors' products are interoperable. Customers demanded the capability -- and vendors were forced to comply. Government mandates created an artificial market, where providers were forced to rush into EHR purchases within a prescribed time, creating a fake bubble that allowed EHR vendors to meet only government requirements (eg, MU 1, then 2). Since interoperability was not part of that mandate, they were able to coast on this. And who can blame them. 

From providers' POV, many were scrambling to meet government deadlines and focused only on mandate requirements. If a vendor met those needs, then it could be in the list of candidates. Interoperability did not (always) come into it. Of course, now healthcare providers are living with the results -- and we are seeing many switching to alternative providers, sometimes for that reason.

 
David F. Carr
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David F. Carr,
User Rank: Author
6/11/2014 | 7:52:56 PM
Re: Where's the health IT industry consolidation roadmap?
The market, not the government. The question is whether the MU program has distorted the shape of the market.
Alison_Diana
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Alison_Diana,
User Rank: Author
6/12/2014 | 9:17:23 AM
Re: Where's the health IT industry consolidation roadmap?
Yes, I agree with you @David about the market naturally shaping EMRs. And I believe incentive programs and the government mandate distorted and created an unnatural market for EMRs, courtesy of MU et al. That said, it's hard to argue that healthcare organizations would have adopted tech without any government action (or interference, as some say). One problem with 'artificial deadlines' is, as we're now seeing, some organizations simply automated manual processes; they didn't use this investment as an opportunity to review, reconsider, and redesign inefficient procedures and create new and better workflows that leverage the full power of automated systems. So you basically have software doing what people have done for decades -- not always the best use of tech or skilled professionals' time. 
EMR Mike
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EMR Mike,
User Rank: Apprentice
7/31/2014 | 5:00:43 PM
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