Ontario Diabetes Registry – Doomed from the start?

Over the week several readers of my blog, eHealth Musings, have asked me to comment on eHealth Ontario’s recent decision to terminate its contract with CGI to build an electronic Diabetes Registry.  Check out my article on this topic at Technology for Doctors.

Mike

The Applification of the EMR

Perhaps one of the Steve Jobs’ greatest legacies is the iPhone and the app ecosystem that it supports.   Rather than trying to define and develop every bit of functionality that an iPhone has to offer, Apple handed the opportunity to do so to hundreds of other organizations, large and small. Apple gave up some control in exchange for unprecedented growth in market share and, ultimately, stock price.  Imagine for a moment if a similar approach was applied to the design of EMRs and other eHealth applications.  Might the same level of innovation and user adoption result?   A team led by Harvard University seems to think so and was awarded $15M by the U.S. Office of the National Coordinator for Health IT to turn their ideas into reality.

You can read the rest of my monthly Technology for Doctors column here.

Mike

U.S. funds Health IT Comptency Exams

As the U.S  engages in major effort to drive adoption and meaningful use of electronic health records, a shortage of Health IT professionals threatens to impede progress.   Indeed, the U.S. Bureau of Labour Statistics predicts a possible shortage of approximately 50,000 qualified Health IT professionals.

To combat this problem, the American Health Information Management Association (AHIMA) has launched the HIT Pro™ exams which, according to AHIMA, are designed to “assess basic competency of individuals who are seeking to demonstrate proficiency in certain health IT workforce roles integral to the implementation and management of electronic health information.”   These exams consist of 125 multiple choice questions and are expected to take three hours to complete.

The HIT Pro™ exams offer individuals who have taken a short-duration, non-degree health IT workforce development program or who have acquired relevant, on-the-job experience the means to demonstrate their health IT competency.   At this time, exams have been developed for six distinct competency profiles:

• Clinician/Practitioner Consultant
• Implementation Manager
• Implementation Support Specialist
• Practice Workflow & Information Management Redesign Specialist
• Technical/Software Support Staff
• Trainer

For a limited time, there is no cost to U.S. citizens to write one of the HIT Pro™ exams.   The cost is covered through funding from the U.S. Department of Health and Human Services (HHS). This program illustrates yet another way that the U.S. government is moving forward aggressively to deploy electronic health records across the continuum of care.  When potential roadblocks such as a potential shortage of qualified Health IT professionals is identified, it seems that program is quickly developed to address the problem in the most practical way possible.

Mike

• Clinician/Practitioner Consultant
• Implementation Manager
• Implementation Support Specialist
• Practice Workflow & Information Management Redesign Specialist
• Technical/Software Support Staff
• Trainer

Feedback May Impact ONC Timetable

The U.S. Office of the National Coordinator for Health IT (ONC) recently issued a call for comments on its proposed stage 2 and stage meaningful use requirements.  This call for comments has generated considerable feedback, most of which has been posted publicly and has been reported in various publications.   According to recent healthsystemCIO.com article, an ONC workgroup “will review the timing of its staging structure”.

Of particular interest to me was workgroup member Judy Murphy’s observation that “There appears to be a groundswell movement which has people sending (blog) postings back and forth.”.  Apparently, public debate using social media tools such as a blog can have an impact.

Mike

NIST Publishes EHR Usability Guidelines

Regular readers of my blog and the articles that I write for several publications will know that I have considerable concerns about the usability of physician office health IT systems (typically referred to as EMR in Canada and EHR in the US). The US Office of the National Coordinator for Health IT (ONC) shares my concerns [or, perhaps, I share their concerns ] and has funded the US National Institute for Standards and Technology (NIST) to provide advice on how to improve the usability of EHR software.

According to a post on MedHealthWorld, NIST has released two publications related to EHR usability design and testing:

• NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records (NISTIR 7741) which offers advice on how to employ “user-centered-design” processes throughout an EHR product life cycle.
• Customized Common Industry Format Template for Electronic Health Record Usability Testing (NISTIR 7742) which provides a standard reporting format (known as the Common User Industry format) adopted and customized for testing EHR systems.

I am huge fan of user centered design. I have personally witnessed the level of user acceptance of the software produced using this approach. By actively engaging users throughout the design and development process, the likelihood of user acceptance is greatly increased. Indeed, I have seen users literally nagging developers as to when the software that they helped design would be ready for them to use.

Mike

Quality Measures – Stage 2 and Stage 3 Meaningful Use

Having announced the Stage 1 Meaningful Use rules this past summer, the U.S. Office of the National Coordinator for Health Information (known to most people as the ONC) did not wait long to start work on stage 2 and stage 3 Meaningful Use rules.    Earlier today, David Lansky, Chair of the Quality Measures Workgroup, posted a request for comments on proposed new clinical quality measures.  These measures were developed by five tiger teams, each focused on different measure domain:

• Patient and Family Engagement,
• Clinical Appropriateness/Efficiency,
• Care Coordination,
• Patient Safety, and
• Population and Public Health.

The resulting measures were reviewed and consolidated by the Quality Measures Workgroup which is now calling for public comment. In addition to general comments, the Quality Measures Workgroup also seeks specific examples of measure for each measure concept.

Comments will be accepted until December 23, 2010 [which, by the way, also happens to be my oldest son's birthday ]

Mike

 

ONC Musings on Engaging their Stakeholders

The Office of the National Coordinator for Health IT in the US (more commonly known as the ONC) continues to amaze me with their willingness to listen to and react to what they are hear from their stakeholders.  In a recent post on HealthITBuzz, the ONC blog, Jodi G. Daniel, Director of the Office of Policy and Planning, shares her thoughts on what the ONC has learned from the input they have received to date.  Highlights include:

• “We should take greater advantage of social networking tools (and this means much more than blogging) when bringing our policy conversations outside of the walls of HHS.”
• “We have been reconsidering the label “consumer” and thinking about using “individual” instead. Calling people consumers implies that they are necessarily consuming something, whereas an individual may not need to consume anything (health care or otherwise) to manage his/her health more effectively.”
• “It is not just about changing the behavior of consumers. Health IT offers a tremendous opportunity to change the health care system to become more “consumer-centered.”
• “In order to include consumers in the health IT policymaking process, we cannot expect them to come to Washington or to find this blog online (although the ones that do are amazing!). To truly be representative, we must go to consumers’ conversations.”
• “Data liquidity, including consumer access to their health information, is the first step to fostering innovation. Innovation is not just about technology; there is also a real need for innovation on implementation, replicating successes, and using data in advanced ways. But it is the industry that will be leading any such innovation, not the government.”

Engaging the community using social media is a scary prospect for many healthcare organizations.  Fortunately, there are some good role models to emulate and many great resources from which to draw ideas and lessons learned.

Mike

 

 

Barriers to Health IT Adoption

According to a recent iHealthBeat article, Dr. David Blumenthal, the U.S. National Coordinator for Health IT, identified four barriers to health IT adoption in the US in a recent speech.  These barriers include:

• A lack of adequate funds;
• Not having the necessary infrastructure to support the exchange of health information;
• Concerns among health care providers about what type of EHR system to purchase and whether it will become outdated; and
• The need to convince the general public that health information will be exchanged privately.

In the same speech, Dr. Blumenthal stated that many of these challenges will be full or partially addressed by the various initiatives driven by HITECH Act funding.

Does Canada face similar challenges to the US regarding adoption of health IT?  Are our various funding programs (provincial EMR programs, Infoway programs, etc) addressing the Canadian challenges or are additional initiatives required?

Mike

ONC Seeks Input on Consumer eHealth Strategy

A recent post on the ONC blog seeks  input on their strategic goal to “Empower Consumers to Better Manage Their Health through Health IT”. Specifically, the ONC asks for input on two questions:

• First, do you agree with the four objectives listed below?
• Second, what specific activities would you like to see the federal government take on? See the bullet points below each objective for some starting ideas of possible activities.
  

The ONC’s strategic objectives for Consumer eHealth include:

• Objective A. Engage consumers in federal health IT policy and programs
• Objective B. Accelerate consumer access to electronic health information
• Objective C. Foster innovation in consumer health IT
• Objective D. Drive consumer-provider electronic communications

Mike

ONC use of Social Media

I have made comment in several blog posts regarding the use of social media and other online tools by the ONC to seek input and communicate plans and priorities.  Several people have asked me for specific examples.   One such example is use of a blog by the Privacy & Security Tiger Team to gather community input.

On Oct 21st, I received the following email from the ONC:

The Privacy & Security Tiger Team seeks your comments on how the identities of provider organizations are authenticated for the electronic exchange of protected health information.

Specific questions to consider include:

1. What strength of provider-entity authentication (level of assurance) might be recommended to ensure trust in health information exchange (regardless of what technology may be used to meet the strength requirement)?
2. Which provider-entities can receive digital credentials, and what are the requirements to receive those credentials?
3. What is the process for issuing digital credentials (e.g., certificates), including evaluating whether initial conditions are met and re-evaluation on a periodic basis?
4. Who has the authority to issue digital credentials?
5. Should ONC select an established technology standard for digital credentials and should EHR certification include criteria that tests capabilities to communicate using that standard for entity-level credentials?
6. What type of transactions must be authenticated, and is it expected that all transactions will have a common level of assurance?

You can submit your comments on the Federal Advisory Committee Blog. Take the opportunity to join the discussion today. Remember, the deadline for feedback is October 29.

As of this evening (October 26th), there are seventeen comments posted on the blog.

Mike