Wes Rishel
Is there an IT person who hasn’t chuckled at a thumbtacked picture of these little guys’ response to “you want it when?” Managers tell us Real IT Folks when they think they need to have it and we give it to them when we can (chuckle). The only REAL deadlines we have ever faced are Y2K and tradeshows.
This is very relevant to the recent thread of my blogs about simplifying interop for healthcare. The most recent post there was Guest David McCallie on Simplifying Interop.
Those little guys are the real key to understanding what we are driving at. We are looking at the challenge of achieving ubiquitous interoperability to permit meaningful use of interoperable healthcare IT. The current ideas about realizing this are driven by — or mired in — healthcare policy problems surrounding the exchange of personal health information.
The whole point HIEs is to overcome policy and trust issues. Some have succeeded, although they took many years.There have been also failures. The recent grant program of a half a billion dollars over three years is probably structured to involve the states’ bureaucracies in part because the states are the largest jurisdiction that sets PHI sharing above the HIPAA floor. God bless them all; I expect to see more successes and fewer failures over three years’ time, particularly when the three years in IT dog age stretch out to be six on the calendar.
But HIEs are not a ubiquitous solution to health information exchange any time soon. The concept is also rough around the edges because of overlapping trading areas and the need to present a singular interface to multi-regional stakeholders like the VA, large non-governmental IDNs and national payers. We need something like the nationwide health information network to connect them, but its own business approach and architecture is tied up in policy issues across states and across the government-private systems chasm.
Even were we to solve the policy issues tomorrow it will take years proliferate new protocols across all the systems in the country. I say this in full recognition that IHE has achieved a lot in terms of achieving a cohort of vendors with tested code developed for XDS. IHE has not dealt with all the vendors and the time lag between tested code in the lab and ubiquitously rolled-out products is measured in years.
So why not take a really important use case — care transitions — that fits in David’s category I? It doesn’t present the policy problems that limit the pace of adoption. Our hypothesis is that we can find a very simple solution based on widely available code that implement standard Internet protocols and get some real, widely used healthcare interoperability that isn’t crimped by state and trading area borders. It can happen without creating intermediate organizations with the delay and risk associated with those approaches.
The answer to “you want it when” becomes much more predictable.
What happens next? Well, there are a bunch of other use cases in David’s categories I and II. Beyond that, the lesson of the Internet crowd is that if we get something simple actually into operation we will find that enterprising developers find a lot of ways to make use of it. The lesson goes on that it is a mistake to take to big a bite at solving a complex set of problems.
I can dig that.
Category: Healthcare Providers Interoperability Uncategorized Vertical Industries Tags: ARRA, EHR, EMR, Health Internet, Health IT, Healthcare Interoperability, Healthcare Providers, Meaningful Use, NHIN, Stimulus
2 responses so far ↓
1 Charles Parisot December 3, 2009 at 7:11 pm
Wes,
Good questions. In my humble opinion, what ever we do will take time. But, if we capitalize on the significant momentum with IHEand HITSP, the mix of large and small EHR vendors, the rapidly maturing infrastructure, it seems that we have the quickest route to simple and operational interoperability:
– Open source code is widely available from many sources including Microsoft, Eclipse OHT, NIST, CONNECT.
– Products are now available for establishing small scale HIE in a box of the complexity of a router (CISCO, with the MDES product is actually shipping XDS and XDR on its routers),
– Thorough test tools are available from NIST and CCHIT,
– Ease of implementation has been verified.
– The XDR point-to-point version and the XDM media interchange (USB and CD) are also available when policy boundaries have to be crossed.
I am afraid that a continued search for the simple interoperability that requires hardly any effort may be elusive. Much simplification has already been performed.
You are absolutely correct, there is a time lag between tested code in the lab and ubiquitously rolled-out products. Once the goal is set, it is about two years.
Other countries have demonstrated that small scale HIEs, and point-to-point can be deployed (with gateways and portals initially) in less than a year and are paying for their investment in about 13 months (Netherlands-Friesland, Austria-Lower Austria region).
That is achievable for 2011.
2 John Moehrke December 10, 2009 at 12:06 am
I wish you well. I think it is not hard to find a simple use-case that would do exactly what you say. In fact I think that the standards are ready for some of these use-cases. http://healthcaresecprivacy.blogspot.com/2009/11/implementing-standards-takes-time.html
But, the experience of CCHIT, HITSP, and now HIT-Standards/Policy; is that those on the outside are not happy that their use-case is not being worked on. To them their use-case is the most important use-case in the world. CCHIT experienced this two years ago when they were pressed to go beyond a general purpose EMR for small clinics. HITSP went through it this year with almost 2 dozen use-cases coming at it from I think 3 or more different directions. I am sure that the writers of Meaningful Use would like to keep-it-simple, but are receiving lots of pressure from those that are not in the short list.
I would rather see some movement that benefits a significant population, than stagnation because we are trying to do too much at the same time. The successful Providers have done this, the successful RHIO/HIE have done this. It takes discipline, but it can be done.