Interoperability, SOA and Healthcare

Dr. Lynn, CIO of M.D. Anderson, Houston, Texas had an interesting guest article on HisTalk blog on interoperability and healthcare and how it is an oxymoron given that the Health Information Exchanges are using existing intra-organization architecture as a basis for enabling inter-organization sharing of data.

In summary Lynn highlighted the need for two different architectures for intra-organizational clinical workflows and inter-organization interoperability.  And provided a great  Internet analogy to get a sense what this architecture would look like.  The inter-organization interoperability architecture should not duplicate data collection and should facilitate quick searches of relevant data variety of sources and link data to a unified patient index.

Here is my take on the subject:

To see interoperability architecture in principle and practice you don’t have to look far.  IHE’s XDS architecture framework enables inter-organizational interoperability.   At a high level there are three components, XDS Registry, Repository and Consumer.   XDS registry is a search index of clinical data and XDS repository is a wrapper around existing clinical repository to update the search index(XDS registry).   There is an XDS Consumer- essentially a portal that enables a clinical user to view unified EHR on a patient.   Essentially its a federated architecture that leverages existing clinical data sources and investment and enables interoperability for a HIE.

And IHE XDS is based on SOA framework( to answer RadioGuy) and uses web services for communication between the relevant systems.   For some reason, IHE doesn’t seem to strike a chord with HIT folks in US where as, its not the same in rest of the world.   Is this the reason for HIEs focus or reliant on EMR’s intra-organizational architecture ?

If you want to see IHE XDS based inter-organization interoperability systems live and running, you just have to come to Canada (currently implemented in Diagnostic Imaging). Its being currently implemented in province of Alberta, Quebec and Ontario all using IHE XDS as a framework and funded by Canada Health Infoway ( a Canadian Federal Organization) that funds Canadian equivalent of US HIE’s.

eHealth Ontario announces short-list for Diabetes Registry Project

eHealth Ontario and Infrastructure Ontario have announced the three companies short-listed to submit proposals for a chronic disease management system that will be used initially to establish a Diabetes Registry for Ontarians and an eHealth Portal framework.

The three short-listed companies are:

• xwave, a Division of Bell Aliant Regional Communications, LP

•  CGI Information Systems and Management Consultants Inc., and

•  TELUS Health Solutions GP

The short-listed companies will be invited to respond to a request for proposals (RFP) later this fall.

“Diabetes management is one our top clinical priorities since we know that more than 900,000 people in Ontario have diabetes and this number is expected to grow to 1.2 million by next year,” said Rob Devitt, eHealth Ontario’s Interim President and CEO. “I would like to thank the vendors who demonstrated an interest in this project and I look forward to the next stages of this process.”

The online Diabetes Registry is part of Ontario’s Diabetes Strategy to improve health outcomes for the growing number of Ontarians living with diabetes and reduce healthcare costs. It will be an interactive, real-time information system designed to track the care of diabetes patients in Ontario against evidence-based guidelines. It will track the dates of important tests and lab results to help clinicians and patients better manage their care.

The companies responded to a request for qualifications (RFQ) issued this summer. Following a process that involved demonstrations and reviews by evaluation committees, the three short-listed companies were selected.

Infrastructure Ontario is a Crown corporation dedicated to managing some of the province’s larger and more complex infrastructure renewal projects – ensuring they are delivered on time and on budget.

Visit www.infrastructureontario.ca or www.ehealthontario.on.ca for more information.

http://www.ehealthontario.on.ca/pdfs/News/ShortlistedBidders_DiabetesRegistry.pdf

Healthcare IT Vendors News!

1. IBM inks 3.3 million$ eHealth deal

Here is some niche business that IBM is starting to execute enabling sharing of diagnostic images across jurisdictions using a registry framework based on IHE XDS (Cross Enterprise Document Sharing) framework. Kudos to Quebec to act on it quickly before the Canada Health Infoway money runs out.

2. Cerner has launched healthcare development community

Here is what the PR claims,  “The uDevelop platform, modeled on the principle of open source software development, will allow the more than 2.5 million healthcare professionals who engage with Cerner® solutions to provide direct feedback on solution enhancements and to have a hands-on role in customizing and developing Cerner solutions”

In fine print, you have to be a Cerner client to be part of this community.

Web Services and Healthcare!

HisTalk blog had an article submitted (by Mark Moffitt) on web services and healthcare and how it can bring change to the healthcare industry, although slowly.

Here are few highlights, where Mark was right on about the healthcare lay of the land dominated by heavyweights like GE, Epic, Siemens, Cerner, McKesson, Meditech etc.,

1. Sunk costs of single vendor poses a significant barrier to change for providers who follow a single vendor approach in their IT strategy.

2. That tax is much higher in the US than in other countries (Chart 2). Healthcare cost as a percent of GDP cannot continue at current levels if the USA is to compete against other global economic powerhouses in the 21st century.

3. Agreed,  webservices is better integration approach compared to point to point integration provided by HL7 (V2.X)

All other sections, I have a different opinion and here are my comments below.

1. The article claims that there is not enough competition between healthcare IT vendors. When are major 8 vendors like GE, Epic, Siemens, Meditech, McKesson, Cerner, Eclipsys, Healthland controlling the market share to the tunes of around 80%, I think the competition is healthy.

2. Though best of breed might be a better approach to healthcare, significant integration costs and numerous failed approach to integrations makes single vendor approach attractive from a Total cost of Ownership

3. The big vendors are taking step towards web services in their own product portfolio or through partnerships. GE recently partnerd with InterComponentWare(ICW), a really niche eHealth vendor who has all componets in their eHealth framework to enable interoperability at all levels from with in a provider’s infrastructure to across providers in a jurisdiction.

3D comes to Electronic Health Record

3D EHR

While 3D is making a comeback in movies and entertainment business to get viewers back to theaters or to provide a new experience,  3D enters Electronic Health Record business as well.

Nhumi Technologies in Denmark recently released a demo version (currently being tested in a hospital) of 3D EHR .  Here is the press release from big blue, who is partnering with Nhumi to commercialize the technology.   It’s not clear yet, when will the technology get introduced in North America.

So what’s the under the hood of this product ?

Nhumi website states that their 3D EHR uses Primal Pictures derived from the Visible Human project in US and specific information derived from the patient’s medical history is added to personalize the model.

Where the technology scores is presenting visible image, which is really worth more than 1000 words.  But it has to be seen whether the model is flexible and programmable enough to personalize using patient’s health information.  I am looking forward to HIMSS 2010 to get a demo of this solution if it gets presented.

And sure this will be a slick demo in trade shows compared to other EHR solutions.  Will patients be interested to see their personal health record in anatomical model ? I will be very interested. Microsoft HealthVault or ICW LifeSensor and other PHR vendors please note.

State of Health Information Exchanges in America

There is a news from HealthBridge Health Information Exchange(HIE) that they can exchange data with other HIE’s enabling mult-region information exchange as a pioneer to national electronic health record in the US.

The PR from HealthBridge adds on that with this type of exchange “for example, if a baby goes to a hospital in Indianapolis, doctors at her pediatrician’s office in Bloomington(another region) can now access her current medical information, including test results and radiology notes – so the information follows the patient.”

Health Information Exchange

Kudos to organizations like HealthBridge for enabling a vision of Electronic Health Record(EHR) on a regional basis in America when this type of information exchanges are hardly scratching the surface compared to other OECD nations. Out of 6000 or so hospitals in America only 50 or hospitals are connected to a HIE, that’s barely and not even scratching the surface in this market. Though there is lot of talk to enable HIE for several years now.  ARRA spending might change that in the next few year similar to the Canada Health Infoway spending(~ 2billionCAD) on HIE that simulated the Canadian HIE market few years ago.

Another report that was released in July 09 about the State of Health Information Exchanges,shows that most of the initiatives are still reliant on federal support contrary to what the report claims. Just because that 6 less organizations(compared to 2008) are not reliant on federal government support, you can’t really conclude that organizations are not reliant on federal government. Given the ARRA spending that’s coming out more and more HIE initiatives are going to be relying on federal funding.

So there will be more HIE activity in the coming years resulting in busy / boom market for HIE enabling vendors like ICW, GE, Karos Health, Cisco, Microsoft etc., in the coming years.

Future at the Top of the Pyramid: Enabling connected personal healthcare

Using technology to manage personal health care is not new, as most of us have pedometers, weighing scales etc., to regularly or occasionally check our progress.

For people with certain type of diseases there are variety of devices in the market to monitor glucose to blood pressure and what have you, to monitor the progress or digress from the recommended care plan.

What’s missing though, is that these devices are not connected to anyone – for example a care provider, a family member, care team – who are interested in the patient’s well being and care progress.

That’s where Continue Health Alliance , an alliance of more than 200 companies,  comes in – as stated in their mission – to enable an eco-system of interoperable personal health systems for that empower people & organizations to better manage their health and wellness.

Here is a video from Continua that shows the outcomes of a connected personal health care.

If it sounds like the StarTrek of personal healthcare, here is where Continua sees the opportunity in the cream of the pyramid (western world)

• 1 billion adults overweight
• 860 million chronic disease patients
• 600 million elders age 60 or older
• 75-85% of healthcare spending is on chronic disease management

And there are already few devices that are Continua certified which can connect to personal health record softwares like Microsoft’s HealthVault or ICW’s Life Sensor

More to come on the technology behind Continua certified products…

“Meaningful Use” – Tale of two words in Healthcare

Meaningful Use – That is it, those are the two words that is stirring up the healthcare providers, consultants, vendors,
lobbyists, bloggers, analysts in the US healthcare industry.

Its interesting to see a take on these two words after their new life as part of the HITECH (Health Information Technology for Economic and Clinical Health Act) investment act part of ARRA (American Reinvestment and Recovery Act), a stimulus plan for US recovery.

Who gave new life to this words: Department of Health and Human Services in US, who is going to be doling out ~30 billion USD in financial incentives for the adoption of electronic medical records in provider’s care infrastructure as part of the HITECT act, which is part of ARRA.

What caused the stir: HHS stated that funds will be distributed through Medicare and Medicaid incentive payments to EPs, physicians, and hospitals who are “meaningful EHR users.”

What “Meaningful Use” means and how do you define whether a doctor/provider is using technology in a meaningful way. Well that was the first reaction
of everyone in the industry. That was quite the sticker shock for getting money from the feds!

For example if I am using a car to drive to work, am I having a “Meaningful Use” of the car ? If I look from my perspective, of course yes, the meaningful use is Transportation. If you try to look from an environmentalist perspective, of course I am not a having a “meaningful use” of our planet by polluting it with my car.

That’s the way everyone involved in the US industry is looking it from their perspective and having war of words with it.
Here are some reactions in the industry:

From my friends at Medseek, they looked at it from the users(patient’s) perspective. Anything done in the name of tax payer’s money better be of “meaningful use” to the citizens.
http://medseekblog.typepad.com/medseek_weblog/2009/05/two-words-that-have-changed-healthcare-forever-meaningful-use.html

From Clickmark Research

On June 16th: HHS came up with a definition, which you can read here
http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_872720_0_0_18/Meaningful%20Use%20Preamble.pdf

Quote from HHS “We recommend that the ultimate goal of meaningful use of an Electronic Health Record is to enable significant and measurable improvements in population health through a transformed health care delivery system”

The key words are “population health”. The definition of “meaningful use” is still in draft phase and it will be interesting to follow
how the HITECH investment act follows through to achieve improvements in population health while balancing the competing goals of healthcare providers.

Improvements in population health is key in terms of managing chronic diseases like diabetes, heart disease, COPD, asthma etc, which
is the key focus both in Canada and US.

More on “Meaningful Use” later…have a meaningful rest of the week and weekend that follows.

healthcare…once upon a time!

“Once upon a time, going to your doctor was simple. You knew his first name, or perhaps just called him “Doc.” He lived just down the street and made house calls. And if you were sick, you would see him that day, because, well, you were sick” … that’s how the story starts for Hello Health! (founded by an American and Canadian in NY)

Hello Health attempts to make healthcare simple and accessible to patients and promises  to taking medicine to its basics.  With Hello Health, you can interact with your doc in your favourite means of technology.  If you have query and you would like to just e-mail, you just e-mail and its Free!  You make your appointments online and access your records as well.

At the primary care level, as the first point of contact for the patients, accessibility and responsive care is crucial for patients and especially for patients with chronic diseases like diabetes, cancer, heart disease and COPD.

So is Hello Health disruptive ? Absolutely in private healthcare market like US, its bringing the medicine back to basics and attacks the complex payer/physician centric model.  In market economics, as the value propositions of the consumers change, new players emerge to provide the missing value and this is often called as invisible hand and works in most cases. It remains to be seen whether it will work in healthcare.

Can a service like Hello Health, work in a single payer system like Canada ? Of course, it can, provided it meets the regulatory requirements of the government and the docs adopt the government certified EMR

Hello Health!

(Electronic Medical Record), of course with lots of incentives.

Accessing a primary case physician is  relatively easy (caveat: if you have a family physician) in the Canadian Healthcare system and every one is aware of the improvement needed in terms of technology adoption.

In US, the question remains whether the proposed mandatory legislation by Obama administration can hinder a service like this. Boston Globe has a good coverage on this. http://bit.ly/WE67p

Also this type of pay for use service only serves the basic healthcare needs and Can it fix the completely ailing US healthcare system, where complex care consumes most of the resources in the system ?

It remains to be seen and the quest for solving the healthcare puzzle continues.

Benefits of e-Health system: good coverage by CBC

Good coverage on CBC this morning, with a series of videos on what does it mean to have an electronic access to healthcare information for patients, family members and care providers (clinicians).

Please check out the metro morning reports at CBC’s website

http://www.cbc.ca/toronto/features/marywiens/ehealth.html

So what made the CBC and its talented reporters to focus on what e-Health means to the Canadian public ?

As stated in the CBC’s website this specific feature on collaborative nature of the technology “e-health portal would allow family members to not only see their lab tests on line but to share the information with each other” , is key piece to puzzle in managing chronic diseases in this province.

That’s BANG ON. As consumers we collaborate online using facebook, myspace, twitter, linkedin etc., and we are limited to do the same when it comes to our own healthcare as the data needed lies with in the walls of hospitals, clinics, doctors offices and most of it in PAPER.

Kudos to CBC! on expanding the horizons on e-health coverage and educating the public on what this could mean to Canadian citizens and especially their loved ones, who are suffering from chronic diseases like diabetes, COPD, cardiac related illness or cancer.

As I heard on the CBC radio one this morning, chronic diseases requires discipline in management from the patient and care provider and a colloborative portal absolutely benefits by increasing the efficiency of the care plan catered uniquely to each patient.

I cannot agree more and there are pilot projects that were executed in Ontario, Canada by various family health teams and Ontario Telemedicine Network to prove the clinical outcomes.