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Virginia creates information tech task force

Virginia Governor Mark Warner has appointed 33 people his recently created Governor's Task Force on Information Technology in Health Care. The Task Force was created in January and an initial report is scheduled for late this year. The Task Force is to evaluate:

• The use of electronic health records
• Additional data collection systems
• Other technologies to improve Virginia's health information structures
• How to ensure that patient privacy and security of health information is maintained.

Only a few of the Task Force members are State officials, the Health Department's CIO (a physician by the way who is also the Deputy Commissioner for Public Health), the head of Medicaid, the Commissioner of Mental Health, Mental Retardation, and Substance Abuse Services, the State's Secretary of Technology, and a member of the House of Delegates.

National health information network

A while back HHS released a RFI on health care interoperability. Here's a summary of the responses (PDF).

And there's more to come. HHS Secretary Mike Leavitt announced plans for development of a national health information network and creation of a federal advisory commission on standards for health care information technology. Leavitt will select up to 17 members to the commission, known as the American Health Information Community, and personally serve as its chairman. That's a nice symbol. The commission will focus on developing interconnectivity standards for health care IT.

HHS on Tuesday will issue requests for proposals for:

• Architecture and design of a Web-based national health information network.
• Assessment of potential privacy and security problems in a national network and development of solutions.
• A prototype process for harmonizing standards so that different manufacturers' software programs, particularly electronic health records systems, can exchange data.
• Criteria to evaluate features and functionality of electronic health records, including interconnectivity.

We'll link to them when they're up.

HIPAA doesn't cover employees?

What kind of lawyerly logic supports this decision? (Alternative link.)

An authoritative new ruling by the Justice Department sharply limits the government's ability to prosecute people for criminal violations of the law that protects the privacy of medical records.

The criminal penalties, the department said, apply to insurers, doctors, hospitals and other providers - but not necessarily their employees or outsiders who steal personal health data.

      

No lawyers that I know or have read discussing HIPAA support such an interpretation. And it certainly undercuts the Federal government's push for electronic medical records. Strange.

One assumes that it will be reversed somewhere in the Justice Department or (one hopes) by Congress.

Palm Pilot and the challenges of interoperability

Take a look here at John Faughn's Slashdot comment on the future of Palm as an indicator of the "complexity of integration" in health care. (The comment is repeated here at Faughn's own site.)

I've used a Palm Pilot for a number of years now and I use the Palm Desktop on my PC to synchronize with the handheld. It's pretty straightforward while working in isolation.

However ...

When I last worked for another company, they used Microsoft Outlook and Exchange and were pretty insistent that certain staff people publish their schedules openly so that others could know where they were and where there were schedule openings. But they did not buy PDAs for staff so we chose and purchased our own.

Synchronizing the Palm with Outlook was a horror. The process lost data or it duplicated data (imagine having to delete, one-by-one, 2,000 duplicate contacts on both the PC and the handheld). Ultimately, I printed my schedule and made copies. Pretty stupid for an IT company, right?

Now this process is dealing with relatively simple data: a contact list, calendar, task list, and notes and relatively simple processes, synchronize one device with another. Right?

Now let's step up to medical records embedded in multiple process organizations and processes. Ohhhh. Maybe that's why things are so slow. Vastly more complex data embedded in multiple vastly more complex processes.

So the next time I'm frustrated with the pace of integration, I'll open up my Palm.

These stumbles are to be expected, but ...

Buried in this HIStalk post from CIO Ed was the following:

One provocative development in the "battle" between the Continuity of Care Record (ASTM) and EHR (HL7). Some will say that the CCR can be a stepping stone towards an EHR and there are many strengths to the CCR concept. Others say that the CCR will be divisive and distract full adoption of the EHR. Lots of pros and cons that must be seriously considered.

Competing standards organizations ... competing standards. Check this from a year ago. (I've not been immersed in this process and don't yet know what the inner dynamics or the latest stories are.)

As I understand the CCR, it's not supposed to be the entire record itself, but the essential elements that can be passed across organizational boundaries. (I'm less familiar with HL7.) Say for example, a patient was in a hospital ICU last year. Whether atoms or bits, the volume of hospital data on that patient is immense. Now say the patient is seeing a physician for a routine visit. Does the physician need all of that hospital data? Not likely. They need to know the patient was hospitalized, was in the ICU, certain essential elements and how to get more data if necessary. So the CCR concept makes sense for interoperability, moving patient-centric information across space, time, and organizational boundaries.

ASTM has been voting on the latest version of the CCR standard. There was enough dissent that they're going to continue thrashing out the issues rather than count it as an accepted standard.

Yes, these stumbles are frustrating. But they're part of a long, hard, often tedious process that is essential to make progress.

TEPR and other IT stuff

Each year, the Medical Records Institute sponsors the conference "Toward an Electronic Medical Record" (TEPR). I didn't go this year, but a couple others did.

Here, here, here and here are Matthew Holt's comments.

Ned Versel posts several news items and links here.

E-Health-Insider covered the mock trial of EHRs. Mock trial? Seems a bit desperate doesn't it?

David Brailer was supposed to be there, but canceled. Another bad sign for the conference? He's been at damn near every other related event.

HIStalk has a couple of posts on the conference starting here and here.

HIStalk also quotes an anonymous conference-goer saying along with other criticisms, 

... it's a dying conference, remnants of medical records staff trying to make way in EMR world.

The same post at HIStalk zings HIMSS Analytics too.

HIMSS Analytics releases its annual report. You can buy it for $60 or, if you want to save the money, here's the first item listed in the summary: "Underinvestment in information technology continues." Franco still dead, full story at 11.

For those of you too young to remember the early SNL bit, it translates as "duh." Funny.

Elyse has a slightly longer and less wry summary here, but the essence is the same.

IBM moves

IBM has made two large moves this week expanding their presence in the market for hospital information systems.

The first was to buy Healthlink. Here's the New York Times story.

The second is their developing a test bed to evaluate standards for interoperability.

The third is their $400 million deal with the University of Pittsburg Medical Center to (note what they list first. Hmmmm.):

• Develop new technologies and organizational approaches
• Develop a patient record system that can be shared across a network of hospitals while ensuring patient privacy. Doctors and other medical personnel will be able to locate relevant treatment data via a global system while the public can be notified in emergencies
• Include use of wireless handheld computers, radio ID tags, monitoring devices in treatment and patient rooms, as well as tools for coping with large-scale epidemics or even human-initiated biological attacks

I guess they figure it's finally happening.

Chris Baldwin on interoperability

Chris Baldwin is CIO of Northeast Health. These folks were thinking about information integration across the full spectrum of service a half dozen years ago - and at the most senior levels. They've been consistently among the "most wired."

Chris knows his stuff and he's an all-round good guy. He has just summarized where we should be focused in Two Paths to Interoperability. Take a look.
 

He talks about organizational interoperability and regional interoperability. Chris has been practicing what he's preaching and, because Northeast Health has a quite comprehensive range of services, he's had the opportunity to actually make it happen.

More recently, he's started taking on the regional issues in earnest. These latter issues will be more challenging both technically and organizationally. Technically, there is no means of enforcing standards compliance even where they exist. Organizationally, because there's no central authority, such efforts rely totally on collaboration and cooperation - often among competitors. So you've got to be a diplomat as well as a wizard.

But no matter how challenging, enabling the smooth and timely flow of critical information across organizational boundaries is one of the few opportunities for leaps in  productivity and improved patient care and satisfaction.

CareFirst to pay for electronic records systems

CareFirst, the Maryland/Washington, D.C., Blue Cross health plan has started a program to pay physicians for installing and using electronic patient records.

The effort is tied into Bridges to Excellence. Rather than focusing on the diabetes or cardiac care options in that program, CareFirst chose to focus on the "Physician Office Link," by way of records and information systems. Here's the BTE release with some more background.

Here's a story from the Baltimore Sun.

Kentucky moves toward a health information network

Kentucky's Governor and Legislature have authorized the creation of a statewide health information network that will enable physicians, hospitals, insurers and others to exchange patient information electronically.

Funding is not yet determined.