Much has been written about the prospect of using blockchain technology as a key component of achieving EHR interoperability. It has been widely reported that 55 percent of surveyed hospitals indicated a desire to initiate some sort of blockchain program within the next two years.
However, as with many game-changing approaches, the devil is in the details. Blockchain technology presents a huge challenge when it comes to impact on the data center–whether that data center is on premises, in the cloud or a hybrid cloud configuration. The tsunami of data added to the already overwhelming amount of required information could swamp a healthcare organization. In addition, the performance decline from this mass of information may negate the positive aspects of using blockchain for EHR interoperability.
Let’s first look at the positives. Defined by the Office of the National Coordinator for Health Information Technology (ONC), interoperability under the health information technology arm includes three specific functions. First, it involves the secure exchange of electronic health information without special user effort. Second, it “allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable state or federal law.” Third, it prohibits specific information blocking, the act of “knowingly and unreasonably” interfering with the exchange and use of electronic health information. If implemented properly, blockchain can meet these requirements exceptionally well.
Now for the challenge. Blockchain is slow. In the most recently available study, the Bitcoin network — the largest and most widely tested application of blockchain technology — achieved maximum throughput nearly 50 times slower than PayPal and 14,000 times slower than VisaNet. If blockchain-based applications come in on top of the already staggering load of data handling required of IT in the healthcare sector today, the danger of major system slowdowns, and even system crashes, will increase dramatically. In the healthcare environment, these IT disasters could have life-or-death consequences.
Guest post by Tom Bizzaro, RPh, vice president of health policy, FDB.
National Health IT Week has come and gone. The industry is focused on how far IT has come and how far it needs to go in healthcare. As most organizations have now adopted electronic records, one of the big themes this week has been EHR interoperability — getting these systems to work together.
Earlier this year, the Office of the National Coordinator for Health IT (ONC) published a 10-year vision to achieve an interoperable health IT infrastructure. The ONC publication is meant to move the industry toward the much coveted interoperability that will enable healthcare organizations to seamlessly share patient information. The simple fact that the federal government has issued this call to action and the industry is embracing it is a good sign for the future of healthcare. We will finally be able to share vital patient information that helps us improve care for individuals and populations, while cutting some of the unnecessary costs out of the system.
While the report is encouraging, this is a very real industry where change only comes after considerable effort. To help move toward the interoperable nirvana quicker – or at least make the journey more palatable — we need to:
Guest post by James Hofert, Roy Bossen, Linnea Schramm and Michael Dowell of Hinshaw & Culbertson.
In 2013, healthcare industry stakeholders, including associations, EHR vendors, practitioners and providers, raised significant concerns relating to the implementation timing of meaningful use Stage 2 and 3 criteria, including problems with interoperability, usability and regulatory failure to assess “value added” by implementation of meaningful use criteria to date. On December 6, 2013, federal officials announced that Centers for Medicare and Medicaid Services (“CMS”) were proposing a new timeline for the implementation of meaningful use stage criteria for the Medicare and Medicaid Electronic Health Record (“EHR”) incentive programs. The Office of the National Coordinator for Health Information Technology (“ONC”) further proposed a more regular approach for the update of ONC’s certification regulations.
Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers had completed at least two years in Stage 2. The goal of the proposed changes is twofold; to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2, as well as evaluate data from Stage 1 and Stage 2 compliance, to date, to create and form policy decisions for Stage 3.
Roy Bossen
CMS expects to release proposed rulemaking for Stage 3 in the fall of 2014, which may further define this proposed new timeline. Stage 3 final rules would follow in the first half of 2015.
Despite CMS’s positive response to stakeholders concerns relating to the timeline for implementation of Stage 2 and Stage 3 meaningful use criteria, significant reservations continue to be enunciated, on a monthly basis, by providers at both Health information technology (“HIT”) policy committee and work group meetings. Providers continue to urge rule makers to institute consensus standards that could be adopted broadly across the healthcare industry to ensure both usability and interoperability.
In early 2013, former national coordinate Farzad Mostashar chastised electronic health record vendors for improper behavior in the marketing and sales of systems that continued to frustrate interoperability goals. This frustration with EHR vendors continues to be enunciated in HIT policy committee and work group meetings as recently as January of 2014.
CIOs in healthcare face the constant challenge of doing more with less. Most are being asked to dramatically cut costs while continually tackling an ambitious list of responsibilities, including maintaining their organizations’ ability to demonstrate meaningful use, making the transition to ICD-10, sharing information through healthcare information exchanges (HIEs) and maintaining stringent patient privacy and HIPAA compliance programs.
Three key and often overlooked elements can help to address these tasks: document scanning, clinical language understanding and integration standards. Mastery of this electronic health record (EHR) trifecta can significantly simplify the healthcare CIO’s challenge.
Document scanning
Electronic health record adoption levels are steadily increasing, but ongoing interoperability issues result in high volumes of paper-based communications between providers. In fact, a survey conducted by the Bipartisan Policy Center in Washington, D.C., found that 71 percent of physicians identified lack of EHR interoperability and exchange infrastructure as major barriers to HIE.
Guest post Ruby Raley is director of healthcare solutions at Axway.
One little-discussed but widely recognized aim of the HITECH Act’s meaningful use Stage 2 requirements is to stem rising costs and improve outcomes by engaging the consumer to take control of their healthcare. But how is the consumer supposed to take control of anything when their health plan determines which clinicians and hospitals they can visit, and their doctor controls their health record?
That’s an issue the Department of Health and Human Services (HHS) recognized as they developed the incentives for the HITECH Act. To address it, they adopted the electronic health record (EHR), a tool that (1) helps clinicians and hospitals reap incentives and avoid penalties by proving they’ve achieved meaningful use, and (2) puts the certification burden on EHR vendors instead of clinicians and hospitals.
