Meaningful Collaboration emphasizes collaboration between medical provides to reduce duplication of efforts and increase synergies from collaboration.

As a Doc who has passions for both healthcare and innovative technology, I had high hopes for the HealthIT Act after decades of manual processes. I envisioned caregivers/providers with the ability collaborate far beyond our immediate circles, and be able to leverage data into not only enabling earlier disease identification and perhaps cures – but also the ability to get a 360 on both the disease or any health trend – but also be able to leverage health expertise nationally, and globally.

Unfortunately, despite all our efforts, with providers investing and billions of tax dollars spent…we missed the mark. Though Electronic Medical Records (EMR) systems were primarily designed as data repositories of independent recording of transactional patient encounters or diagnostic testing, the EMR systems are generally designed by and for the benefit of the EMR company and in response to both regulatory proprietary business interests.  The meaningful benefits were to actually be received by patients. EMRs are simply not “playing nice”….at the expense of our industry.

I read this article of which resonated with me, reflecting my views:

Implementing clinical information systems at healthcare organizations can be a jarring experience. And when those systems conflict with long-used work processes for accomplishing clinical tasks, it s more than annoying. It can make an IT project a long, uphill slog.

Source: July Feature: EHRs Going Against the Flow | HDM Top Stories

The Meaningful Use incentification program dramatically increased utilization program dramatically increased the number of medical providers using EMR systems in the past few years although the criteria achieving and documenting Meaningful Use of electronic medical records emphasizes recording public health information information of interest to the finding Federal government but not the information generally required by most healthcare providers. As a result the EMR companies have developed methods to adapt to the MU regulations rather than to the evolving clinical needs of medical providers.

A second issue has been the relative scarcity of Clinical Informatists or MDs with training and experience in the design and operations of EMR systems. The 10×10 program and the ABMPM Board Certification in Clinical Informatics has engaged myself any other physicians in designing more clinically oriented solutions emphasizing meaningful collaboration between all healthcare stakeholders including, patients, providers, payors and regulators.

Until the obstacles to data interoperability is achieved, there is a need for independent Collaboration Platforms that facilitate interactive sharing of information and shared vision of treatment plans and health maintenance plans by all stakeholders within disparate health information systems. Patients do not select their doctors by EMR system and medical providers in different EMR systems cannot collaborate about their mutual patients.

There is a pressing need for a collaboration method that places the needs of the patient first. There are health IT methods that could facilitate collaboration between medical providers is disparate EMR systems. It is time to leverage HIT to facilitate Meaningful Collaboration(TM) or interactive medical consultation and exchange rather than large data dumps utilizing CCD  files (Continuity of Care Documents).

In upcoming BLOG posts, I will discuss how a healthcare collaboration platform could enhance interoperability.

Healthcare information technology (HIT) collaboration platform could break through the current EMR information silos and facilitate Meaningful Collaboration between healthcare providers.

Meaningful Collaboration(SM) is a healthcare provider centric approach to information sharing. A proxy collaboration platform is utilized to bypass these information blocking practices.

Information Blocking: A New Term And Promise of a New Era In Electronic Health Information Sharing | At the intersection of health, health care, and policy.

Source: Information Blocking: A New Term And The Promise Of A New Era In Electronic Health Information Sharing

ONC-HIT Interoperability “Imminent Domain”?!?

This is a great summary article that calls attention to the ONC-IT shot off the EMR bow(s).  It start with a quote from Report on Health Information Blocking from ONC-HIT to Congress dated April 2015.

“[…] some business practices, though they may arguably advance legitimate individual economic interests, interfere with the exchange of electronic health information in ways that raise serious information blocking concerns. At some point, ONC believes that decisions to engage in such practices are unreasonable as against public policy […]”

This article points out that the ONC-HIT statements seem to put vendors on notice that business policies that get in the way of the ONC interoperability roadmap plans will not be tolerated. This is the cyber equivalent of the Federal “Imminent Domain” of the Monroe doctrine, Lincoln’s railroad imminent domain, and the imminent domain of the 1950s required to complete the US highway system under Eisenhower. My high school history teachers pointed out that Federal “Imminent Domain” is a pre-requisite for overcoming business conflicts of interest and local geographic business interests that could derail (pun intended) a national initiative such as the Lincoln transcontinental railway project.

The ONC-HIT report define “information blocking” as containing the following three components:

1. Interference. There must be “an act or course of conduct that interferes with the ability of authorized persons or entities to access, exchange, or use electronic health information.”
2. Knowledge. “The decision to engage in information blocking [must be] made knowingly.”
3. No Reasonable Justification. Conduct must be “objectively unreasonable in light of public policy.”

These are fighting words but unfortunately the simple words “[must be] made knowingly” and “objectively unreasonable”remind me of the  burden of proof of Tobacco company “Knowing” that tobacco caused cancer. The legal debates went on for decades until memos and communications surfaced that demonstrated that the large tobacco companies had put business interests above the health of their clients.

The ONC-HIT suggests 4 potential actions (regulatory sticks) to replace the monetary carrots that created the EMR “too big to control” giants:

1. Threaten to decertify EMR systems that are proven to engage in “information blocking”.
2. Increase transparency about vendor behavior.
3. Establish a a set of governance “rules of the road”.
4. Clarifying HIPAA and other health information privacy laws will help remove the potential that exists today for provider organizations and vendors to use these laws as a cover to engage in information blocking.

While these Federal “sticks” may be successful in raising public awareness and appeasing Congress, history would suggest that similar to the Lincoln transcontinental railway project: it will be slow, expensive and may produce a nation of metaphorical displaced Indians and near-extinct buffaloes. Unless the Supreme Court rules about whether patients or proprietors own ePHI and whether the ONC-HIT railway has “imminent domain’ over the perceived squatting rights of the electronic medical records (EMR) dynasties that were created as an unintended consequence of the Federal “Meaningful Use” program.

The ONC-HIT interoperability train has left the [cyber train] station, it may be an interesting and very rough ride. We believe the inherent conflict between ONC-HIT interoperability roadmap and the EMR dynasties’ business incentive to block information sharing with inevitably lead to a Supreme Court showdown. In the meantime, we believe that the Accountable Care Organization (ACO) and shared risk initiatives will require “Meaningful Collaboration(TM)” between healthcare providers rather than just Meaningful Use to simply satisfy compliance requirements.

The basic concept of Meaningful Collaboration(TM) between healthcare stakeholders is a vendor neutral collaboration platform where stakeholders can share provider selected content similar to old hospital charts where doctors rounded at all hours and wrote succinct SOAP notes and contributed provider-centric external content. “Here is what you need to know” to render you consultation.

The radiology industry has experienced “information blocking” with each advance in technology as vendors create proprietary layers to improve business distinction and profitability. In an upcoming series of BLOGs I will discuss what we have learned form the past 30 years of Information Blocking in the Radiology Industry.

We hope for a High Speed Rail rather than Transcontinental Cyber-TrainWreck.

Douglas K Smith MD is ABPM Clinical Informatist and ABR certified radiologist, CHCIO, CPHIMS, serial doctorpreneur, inventor and “doctor centric software designer/developer”. 

Information Blocking by EMR systems threaten to disconnect the ONC interoperability roadmap.

Meaningful Collaboration allows medical providers within different EMR systems to collaborate and share content within a vendor neutral platform using a variety of interoperability methods including: Application Programming Interface (API), HL7 FHIR, and web services connecting applications that may be required to provide supporting features. Meaningful Collaboration(TM) is an physician inspired approach of leveraging technology to foster collaboration between medical stakeholders to enhance care and improve efficiency of healthcare/