Future of RHIO Movement

Since the recent demise of several RHIOs, there has been a lot of interesting material on the net. I just received an eHealth smartBrief which had several RHIO items, Oregon RHIO plan stalls and RHIO experts talk problems, future of movement.

I have commented items from RHIO experts talk problems, future of movement that really made sense.

With our RHIO, SEMRHIO, based in South Eastern Massachusetts, our focus is on creating value to the physicians. Physicians are the ones actually taking care of patients directly and whose decisions can save and improve their patient's lives.

In order for a RHIO to have value to a physician, it must improve physician work flow by making critical patient data available at the right time in order to make the best clinical decision.

"One problem with RHIOs as they often are proposed is that they provide the bulk
of their benefits to patients and health plans, people and entities that
according to our current healthcare payment structure either don't pay at all
for RHIO startup and operational costs or pay a disproportionately small share."

It seem that many if not most RHIOs are the creation of non-physicians, such as health plans, business groups. They follow the typical game plan of seeking funding for setting up an organization and developing a governance structure. Unfortunately, only after spending substantial funds, they end up with a model that depends on grant funding for sustainability. As a result, several RHIOs have shutdown.

"For many areas, healthcare information exchanges need to address the limited business cases of the providers who will build and maintain these systems, according to John Regula, who served as chairman of the now-defunct Northeastern Pennsylvania Regional Health Information Organization, or NEPA RHIO."

This again highlights the issue that an HIE or RHIO needs to address the business needs of the physician/providers. After all, it is the providers that will use the system on a daily basis for day-to-day patient care.

"It does not make sense for a RHIO to have a consumer-centric model," said Regula, the chief information officer of Allied Services, Scranton, Pa...

"... "It's a noble idea to say put the patient first, but what you have to have are business plans within the provider community," he said. "

Exactly. Too many RHIOs try taking the "High road" of being consumer or patient centric. The only problem is, patients cannot be expected to micro-manage their data within the RHIO. As a physician, my patients expect that I manage their health data, test results, medication and problem lists. Sure, some of my patients do take an active role in this process, but in the end, there is an expectation that I ultimately am responsible for these tasks.

So for a RHIO to have a workable model, it must address the needs of the physicians. Physicians need to make critical patient care decisions based on data. There must be no hindrance to the flow of this data to the physician. For example, if I am prescribing my patient an antibiotic, it is important for me to know if my patient is on Warfarin. If this information is not readily available, I will not be able to safely prescribe medications for my patients.

Microsofts iPhone

I don't know how Microsoft is going to react to this, but knowing them, they probably have something in the works that is bound to make an impact in this area.

Medicare will stop paying for complications resulting from "medical errors"

Some interesting perspectives from the Healthcare IT Guy and Mark Frisse.
Mickey Tripathi has an excellent analysis as well.

The Healthcare IT Guy quotes from the New York Times:

In a significant policy change, Bush administration
officials say that Medicare will no longer pay the extra costs of treating preventable
errors, injuries and infections that occur in hospitals, a move they say could
save lives and millions of dollars.

This policy is to go in effect after October 2008. What type of conditions might be considered to be complications from "medical errors"?

Such conditions include:

• Catheter infections
• Pressure Ulcers
• Falls
  

Knowing from working in both nursing home and hospital settings, there is often a blame game when it comes to pressure sores. When patients present to the hospital from a nursing home with a wound, hospital staff typically blames the nursing home's care. The same situation happens in reverse when a patients present to a nursing home from a hospitals.

Who is at blame for the pressure wound? Now that there could be financial consequences to this condition, hospitals will need to document carefully the presence of any wounds on admission and discharge. I do not know how nursing homes will be effected by this new payment policy, but it will be in their interest to document the presence of wounds on admission and discharge as well. Wounds are a significant area of liability and the oversight will only become more stringent with this new policy in place.

Promoting RHIOs on YouTube: Tampa Bay RHIO

Here are 3 video clips from YouTube on the Tampa Bay RHIO. This may be a good way to get your message out on your RHIO. It seems this video may have been funded by Misyis

Clip 1: Full Video on Tampa Bay RHIO


Clip 2: Tampa Bay RHIO


Clip 3:

HL7 Resources

I thought it would be a good idea to put information and links to HL7 resources for those of us who live and breath HL7.

BizTalk, HL7 :
hl7-info.com – General HL7 issues, debugging HL7 messages and how BizTalk interacts with the messages
biztalk-info.com – general BizTalk issues, HIPAA related issues

HL7 Tools:
This company has a suite of other HL7 tools, take a look: Easy HL7
They have a product, HL7 Viewer which seems to be a fairly inexpensive HL7 viewer. It would be useful in examining the contents of HL7 v2x data.

Website with a List of HL7 Tools
This blog has a very extensive list of resources.

NeoTools has many HL7 resources.
The HL7 Evolution
HL7 Browsing Product
NeoIntegrate Interface Engine
HL7 Blog A great way to learn and improve your HL7 knowledgebase.

Microsoft HL7
HL7 v2 Developers Guide
Health Connection Engine (not an HL7 resource strictly-speaking, but is an open source project for a healthcare specific "Enterprise Service Bus". This has relevance for those interested in developing a Service Oriented Architecture (SOA) for their healthcare IT infrastructure.

HL7 Tools & Resources Page
Introduction
HL7 tools

Mapping Lab Values to normalized codes

We just presented at Microsoft MSHUG Tech Conference

We just presented our RHIO project, semrhio.org at MS-HUG, the Microsoft Healthcare Users group Tech Conference in Redmond. Our topic was "Winning Trust and Minimizing IT Resources".

Roberto Ruggeri , a Senior Technical Strategist with Microsoft Worldwide Health gave a review of our presentation on his blog. Roberto was very helpful and we would like to give him our thanks

Eric Stott, our "famous" BizTalk architect, was with us and commented on his blog. Byron Byfield, a fine specialist in healthcare payor-side data analytics, promises he will have something to say soon on his new blog.

I was joined in the presentation by Kate Sullivan, who provided an excellent background on SEMRHIO and the current RHIO climate.

The topic was on how choosing the "right" Trust model for data sharing and minimizing IT resources by centralizing common services, there is a greater chance for getting buy-in from competing community hospitals to join to form a RHIO, since the two main barriers to forming a RHIO, trust and IT infrastructure can be overcome to a large degree.

Typically, cost and security issues end up being why many RHIO fail to go beyond the planning phase. In fact, several RHIOs, after spending anywhere from $500,000 to a few million, end up closing their operations. A few weeks ago, the Portland RHIO, and a few months ago, the very high profile Sanata Barabara RHIO.

Next Generation of Clinical IT systems

I just came across an interesting white paper on the next generation of clinical ITT systems from FCG:
http://www.fcg.com/research/serve-research.aspx?rid=337

"Sharing" of data is not new

Once again, it makes it sound like "sharing data" between doctors and hospitals is somehow a new concept, as if though doctors order tests on their patients at the local hospital without expecting to get back the results. This "sharing" of data is going on now and will need to go on in order to provide patient care.

In fact, data sharing also occurs between physicians and pharmacies. Are physicians expected to get written permission from patients before faxing or calling in their patent's prescriptions? How about ePrescribing. Are physicians expected to get their patient's written permission for sending in medications refill request via the ePrescribing network?

The truth is, all this data sharing is already happening between doctors, hospitals, pharmacies and other healthcare entities under existing HIPAA guidelines for data sharing by covered entities “for treatment, payment, and healthcare operations” The HIPAA law was modified to allow sharing of patient data for the purpose of providing patient care ( "treatment and healthcare operations").

When the HIPAA laws were originally implemented, it became almost impossible for a physician to get clinical data on their patients from the hospital unless the patient signed a "HIPAA" consent. A common scenario was that of a patient calling their doctor's office to get results of the xray that was just done. When the physician would call the hospital in order to get the results, they would be told by the hospital that a signed patient consent needed to be faxed before the results could be sent to the doctor. As a physician, we would have to claim that our patient was "dying" before any result would be faxed to us. Because of situations like these, the law had to be modified to allow the flow of information when issue of patient care were involved.

EMR Resources

EMR videos showing how Dragon Voice recognition is used with several major EMR products.
Includes Amazing Charts, eClinical Works, Bond EMR, Spring Charts.



Indiana's OpenMRS

Indiana's Open Source EMR for developing countries. They use Infopath for developing XML based forms for data entry.

The Demo, username: admin and the password: test
Go to test patient, John Doe and then go into "Forms" to see how InfoPath is integrated.

Data Model:










Model for Alerts API


Contents[hide]
1 Action Items
2 Discussion Items
2.1 Auditing / Event Broadcasting
2.2 Message Service API
2.2.1 Methods
2.2.2 Implementing Class (example)
2.3 Alert API
2.3.1 Methods
2.3.2 Model
2.4 Transactions
2.5 Selecting Obs
2.6 Voided Bit
2.7 Concepts within the PATIENT table
2.8 Noting errors
2.9 Export Patient XML Format
2.10 Drug data model
2.11 Application properties
2.12 Task Scheduling
2.12.1 Scheduler Service
2.12.2 Task
2.12.3 Stateful Task
2.12.4 Schedule
2.12.5 Simple Scheduler Service
2.12.6 Simple Timer Task
2.12.7 Say Hello Task
2.12.8 Process Form Entry Queue Task #1
2.12.9 Process Form Entry Queue Task #2
2.13 User and Patient extend Person
2.13.1 Should obs.patient_id become obs.person_id?
2.14 Coding Concepts
2.14.1 THE OLD WAY
2.14.2 THE NEW WAY (I think)
2.15 UI portlets
2.16 Internationalization of non-Concept database objects
2.17 Orders and Order entry

Another RHIO closes

Record-sharing stalls
• Cash, privacy issues halt effort to electronically link patient information

Another RHIO unplugged! Same old reasons we hear, privacy and cost. What gets me is that they spent $500,000 in funding without even deploying any infrastructure. All this just to shut it down.
http://portlandtribune.com/news/story.php?story_id=118670243207447600

I found this comment interesting:
"Pettit said she has been working toward a local health information exchange since 2003, but she felt the business council’s plan, which would sometimes allow hospitals and physicians to exchange patient health records without the permission of the patient, did not adequately protect patient privacy."

I don't understand the so called privacy concerns. Patient data is already being passed around without explicit patient permission using the fax machine. Doctors and hospitals do this all the time. The fax machine is far less safe from a privacy standpoint than doing this electronically. Fax machines tend to sit in busy places in the office. Even the cleaning staff can see all the patient reports coming off the fax machine.

If one is really concerned about privacy, get rid of the fax method of sharing and do it electronically with proper security protocols. I think the real crime is that we are still using fax machines to pass around confidential patient data.

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