Connecting the Dots in Healthcare Data

Interoperability – connecting the dots in a fragmented landscape of health data in this country – is emerging as the central theme for 2012. Clinicians who have been working towards Stage 1 Meaningful Use this year have noted that 3 of the criteria – electronic data exchange (core item), immunization registry data exchange (menu item), and syndromic surveillance data exchange (menu item) – assume that a secure way of connecting to places outside your EHR exists (or will soon exist). This is not currently the case.

Fortunately, for Stage 1 Meaningful Use, actually connecting with outside places is not required; you only need to attempt to connect, with the assumption that such an attempt will likely fail in most instances.

However, for the ONC’s vision behind moving this country from paper-based medical recordkeeping to an electronic platform to really work, then the ability to connect all those disparate pieces becomes necessary.

To date, the main approach supported by ONC grants (created by the 2009 ARRA legislation that created the Meaningful Use program in the first place) has been to designate a collection of organizations around the country to be local/regional Health Information Exchanges (HIEs) – a sort of public-utility monopoly model for health data exchange. Many, including us, have questioned the long-term viability of this approach, as the business models for sustaining these HIEs is uncertain. It is likely that many HIEs will go out of business once the initial ONC seed money runs out.

Other businesses that have already created connections with users – like Surescripts, which connects doctors and pharmacies to exchange prescription information, or Emdeon, which connects doctors, billing systems and insurance companies to exchange billing information – are trying to broaden the types of data they can move along their already-existing connections, to include CCD, CDA and other standard data types. So far, however, there has been no meaningful uptake of this pathway either.

At the current Health 2.0 conference, and at the pre-conference Doctors 2.0 last weekend, many innovative ideas are emerging among start-ups. Granted that, from year-to-year, there is something like a 50% attrition of companies – half the companies seen at Health 2.0 last year are no longer in business – I would argue that such is the nature of a start-up incubator environment. Many companies don’t get off the ground, but a few do. And those with bright, innovative solutions to vexing problems, who are able to gain traction with a viable business model, will be the taken-for-granted solutions of the future.

I have seen some very innovative and sophisticated approaches to connecting systems together. At Practice Fusion, we are moving on our roadmap of creating true Chart Sharing (making one’s chart on a given patient visible to referral-recipient practices on the same Practice Fusion platform, based on appropriate permissions). Our view is that a significant (and growing) percentage of small-sized clinical practices are using our web-based EHR, and these practices are already connected to each other (via the Internet), even if they don’t realize it. As we roll out programs like Chart Share, the true value of a single web-based EHR platform across the country will become more apparent.

This reduces the burden of HIE work significantly – the job of connecting disparate systems together is made simpler when you don’t have to think of making separate connections to each-and-every small practice “out there” in the field. A single connection to a web platform like Practice Fusion will instantly connect tens- or even hundreds-of-thousands of practices all at once. The job then is to build bridges to the other traditional self-contained systems in the landscape – the hospitals, the large groups using locally-installed enterprise solutions, and the like.

Some of the innovative ideas I have seen at Health 2.0 make me hopeful that true, viable solutions to the connectivity problem will emerge. It is a very important focus of attention for 2012. It will be necessary for Stage 2 Meaningful Use (which measures actual connection with outside disparate systems).

The current embryonic state of the “connectivity space,” which is underscored by the difficulty in creating actual, real connections for the three Stage 1 Meaningful Use criteria that involve data exchange, will (must) evolve into a network of more sophistication. To use a telecom analogy – a cell phone is only as good as its supporting network. We can build a great EHR (a very cool cellphone), but for it to be actually useful, it needs a great cell network. And, like with cellphone networks, multiple overlapping and competing networks may emerge (and will need to talk to each other – a Verizon-based cellphone must be able to call an AT&T-based phone). I would expect that health IT data-connectivity networks will compete based on coverage, cost, reliability, and ability to support the EHRs that are used by their end-users (clinicians). The world will look quite different a year from now.