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Monday Morning Update 6/3/19

June 2, 2019 News 11 Comments

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The vendor members of the HIMSS Electronic Health Record Association raise “significant concerns” about proposed federal rules covering interoperability. Their draft comments note that:

  • The rule limits EHR vendor profits and thus discourages innovation because it requires them to share their intellectual property. The proposed rule would require vendors to offer interoperability elements with “reasonable and non-discriminatory terms.”
  • The compulsory licensing rule would require developing documentation, APIs, and patents, creating a regulatory burden that might “outweigh the opportunity that remains.”
  • ONC’s definition of “interoperability elements” and “electronic health information” are overly broad and unreasonable, while some of the defined exceptions would be nearly impossible to enforce.
  • EHR vendors can’t deliver the programming necessary in the proposed 24-month timeline, especially when they are dealing with other CMS and ONC regulatory requirements.
  • The proposed rule includes ambiguous definitions such as “reasonable,” “as soon as possible,” and “near real-time,” which is risky when penalties can be issued of up to $1 million per infraction.
  • EHRA recommends publishing an Interim Final Rule this year to allow continuing clarification and feedback and to create a way that vendors can get quick answers to their questions.

The Health Innovation Alliance this week said the rule is too vague and contains too many loopholes, recommending that ONC and CMS “go back to the drawing board.”


HIStalk Announcements and Requests

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More than half of poll respondents say vendor and hospital burnout in health IT is caused by excessive workload and time pressure rather than organizational, management, and compensation issues. Furydelabongo says that work overload could be a symptom of having incompetent or overly ambitious managers, while Drex cites the nearly universal absence of good IT governance in hospitals that encourages employees work at whatever tasks they believe are important or that executives complain the loudest about.

New poll to your right or here: What method did you use the last time you communicated directly with a doctor who was providing care to you? I’m looking for your most recent exchange, the final one in your most recent encounter.

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Happy 16th birthday this week to HIStalk, which I started writing in June 2003. I think it was June 6, but I’m not certain since I sometimes think it was June 3. Back then:

  • Some big healthcare names were George W. Bush, Tommy Thompson, Tom Scully, Dennis O’Leary, Erich Reinhardt, Linda Kloss, Anthony Principi, and Neal Patterson.
  • Hospitals were struggling with early CPOE implementations.
  • Kaiser Permanente had just chosen Epic.
  • Cerner had just made its first UK sales and opened its new headquarters.
  • HIMSS offered HIMSS03 in San Diego (with keynotes from Jeff Immelt, Rudy Giuliani, and Patch Adams) following Summer HIMSS in Chicago and also launched Solutions Toolkit, the predecessor to HIMSS Analytics.
  • Computers ran Windows XP while users licked their wounds caused by Windows ME and awaited / dreaded the promised magic of Windows Vista as the effects of the “every other Windows release sucks” rule were about to be felt.
  • People sent messages on BlackBerry devices and talked on the Nokia cell phones that dominated the market.
  • Companies such as MercuryMD, Misys, First Consulting Group, Per-Se, IDX, Healthlink, Quovadx, Alaris, and Sentillion were making a few sales.
  • Health IT news came slowly and with little critical review other than from expensive, influential newsletters such as “Inside Healthcare Computing” and “HIS Insider.”

Listening: new from NF (Nate Feuerstein), a 28-year-old, Michigan-based, Eminem-influenced rapper whose lyrics are emotional but commendably free of profanity (a change he made in 2010, saying that he’s Christian even though his music is not) and misogyny. His vocal rhythms immediately embed themselves in your head even if the lyrics don’t. The link is for “Let You Down,” which is not only a dramatic video, but also a powerful song about the strained relationship between a disappointed father and his son who has bitterly decided that their superficial relationship is over.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Decisions

  • Bayhealth (DE) switched from Avaya To Cisco Systems for call center technology in April 2019.
  • Highpoint Health (IN) will replace Meditech with Allscripts in July 2019.
  • ProMedica Coldwater Regional Hospital (MI) replaced Meditech with Epic on May 1, 2019.
  • Chestnut Hill Hospital (PA) will go live on Epic in August 2019.
  • Baptist Health Floyd (IN) will replace Allscripts with Epic In June 2019.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


Announcements and Implementations

SailPoint earns a US patent for its application of AI/ML to identify peers among system users to detect those whose access profile is unusual enough to warrant review for potential security concerns.


Other

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Eric Topol notes the nearly identical, relentless price increases for competing best-selling injectable arthritis drugs Humira and Enbrel, which generated a combined $28 billion in 2018 sales. Today’s price is more than double that of 2012, with cash-paying patients paying more than $5,000 per month even with the best coupon offered by GoodRx. The cost is much less in the UK, which doesn’t allow endless drug company patent filings and lawsuits that block competition for biologic drugs.

CDC reports that the number of US measles cases has broken the 25-year-old record even though we’re only halfway through the year. Measles is classified as “eliminated” in the US, but that achievement is at risk for the first time in a generation.

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I’m fascinated that Cincinnati-based Bon Secours Mercy Health will sell its majority stake of an RCM company it bought for $60 million in 2016 for $1.2 billion. The Catholic health system, former in September 2018 with the merger of Mercy Health and Bon Secours Health System, had just announced its merger with Ireland’s largest healthcare provider, a five-hospital system in Dublin, with intentions I don’t quite understand (unless they’re using Ireland’s favorable tax status to benefit their for-profit ventures).


Sponsor Updates

  • Sansoro Health announces an integration partnership with OpiSafe, which provides clinical decision support for opioid prescribers.
  • TriNetX will exhibit at Academy Health June 2-4 in Washington, DC.
  • A study finds that hospitals using Meditech Expanse outperformed Cerner and Epic clients in CMS quality and value measures.
  • Wolters Kluwer Health promotes Greg Samio to president and CEO of health learning, research, and practice.
  • The SSI Group will exhibit at the Alabama HFMA Annual Institute June 2-4 in Destin, FL

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Currently there are "11 comments" on this Article:

  1. Tim— Congratulations for 16 years of HISTalk! Can’t believe it has been that long since my days at ibex Healthdata Systems when I stumbled upon the most insightful and entertaining IT blog ever. You’ve come a long way my friend! Keep on roll’in.

  2. EHR vendors “will need to create documentation and APIs”? Oh, the horror and the tyranny of the government.

    They also hilariously claim that:

    “Clearly this would have a chilling effect on innovation, by removing incentives for new or established companies to invest in emerging technologies or any significant effort to update existing ones.”

    EHRA – please enlighten us on the last time one of your members invested in an emerging technology! I believe MUMPS (hello Epic!) fully emerged in the 1970s and SQL (hello rest of you!) fully emerged roughly a decade after that.

    Your vendor members are worried that if they open up their platforms, smaller, and nimbler companies will be able to provide more innovative applications that will take away existing monopolies and rent seeking that is going on in the market. This is not that much different from Microsoft’s insistence in the 90’s that Internet Explorer cannot be separated from the underlying Windows OS.

    Please stop making excuses. You are fooling no one.

    • Documenting an API is a weak excuse. I do agree with the vendors that there are too many changes too quickly due to the regulatory environment. It seems that everyone forgets the complexity of the underlying terminology mapping and integration if the goal is seamless exchange of meaningful information. I don’t see M or SQL as barriers. There are training and adoption barriers, contextual barriers in the meaning of something someone is documenting, true issues in working with legacy documentation that was created BEFORE any semantic standards were defined, and most vendors have a potpourri of applications running in their suites. Simple API calls aren’t so simple especially when clinical teams rely in the integrity of the information.

      • Art – We all have to get used to the fact that healthcare is not a free-market environment because healthcare is not a commodity in the classic sense and is not consumed as such. It is already highly regulated for a variety of (valid and not so valid) reasons.

        Interop became a “regulatory” issue because despite making all that money on MU largesse, EHR vendors were not moving the ball on interop. On the one hand, EHRA vendors talk about innovation and on the other hand, they claim that creating an API based, standardized data exchange system is too onerous for them?

        Some of the reasons that you laid out are valid – but they are a direct result of poor application and data architectures of these platforms. If I have to take a guess, these vendors, over the years, have added new functionality and features without taking a pause to rearchitect some of the core aspects of their systems and without making an investment into paying down the technical debt. As a result, many, if not all of these systems are being held together by duct tape and bailing wire and even the smallest change causes big ripples in an integrated system, leading to tremendous testing and bug fixing efforts.

        But if interop is important (which most people agree that it is), then EHR vendors just need to suck it up and do it.

        • Again, we agree on some points. We violently agree on some vendor architectures requiring refactoring. The semantic interoperability challenge is not really the vendors’ to lead-out for a solution in my opinion. To meet customer needs, they provided capabilities for customers to add fields and field constraints like pick lists and these extensions make integration with other instances rather challenging (not to forget analytics within an organization) The example was provided a few weeks back on HIStalk of the color or characteristics of excretions. Making broad brushed requirements about interop is fruitless and will lead to pointless FAQs, wasted time and effort and the like from Government employees, vendors, healthcare organization personnel, etc. If you feel details in the prior scenario are too detailed, what about the problem list? The definition and contents aren’t consistent even within most “integrated” delivery systems. I believe the path forward is rooted in Government facilitating a vendor-healthcare organization team focusing on use case by use case priorities and working through the details with clarity and specificity. The use case should be aligned with our national health priorities. Those priorities would set the theme for supporting regulations like changes to eCQMs, use of clinical decision support, etc.

          • The reasons for interoperability failure are numerous.
            -Different schemas
            -Different encoding sets
            -Different dictionaries
            -Different MoSCoW (Must, Should, Could, Won’t)
            -Different CRUDE (Create, Read, Update, Delete, Exchangeable)
            -Different document types
            -Different enumerations
            etc

            Until the vendors are required to align to a standard — the whole standard — they will not align. We also have a problem with how the documents or calls are made. Some vendors have the ability to deliver a longitudinal record selectively, others dump the whole file. Imagine a 6-8 year patient with multiple conditions and frequent visits.

            Take that same patient and realize that several of the technologies do not align the disease/treatment — so that longitudinal record is degraded to pure data — maybe not so pure at that. Thus you have lost information or knowledge of the patient and degraded it down to text or data.

  3. Why is anyone in healthcare concerned about this? The rule explicitly states: interoperability will only be looked for from non-healthcare entities. If you are already in healthcare technology, it is not your concern, it is an “Everybody but you” construct.

  4. Happy birthday indeed! Though I’ve only been reading for 13 years, so I missed the terrible 2’s, I also want to thank you for continuously sending out my favorite newsletter; your music recommendations; your humor; and your no-nonsense take on the industry.







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