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Ignorance Is Not An Option

November 5, 2010
by Joe Bormel
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Invest The Time To Attend, Learn, and Improve

I just attended another conference, “Achieving Meaningful Use Criteria with Electronic Health Record Technology.” The conference co-chairs, David McCallie and Brad Tritle, did a great job of assembling and facilitating a wide range of expertise. The two big special focus topics were the perspectives from the HIEs and the RECs. These kinds of conferences have a wonderful trait of highlighting issues that otherwise may be invisible.

Here are a Few Highlights:
There was a pre-conference workshop by Peter Waegemann who provided an extensive review of mobile devices and what this might mean for healthcare. He pointed out that there has been explosive growth to more than four billion mobile subscribers worldwide. This mobile device volume dwarves the number of people using PCs. The massive increase in communication and connectivity options will impact healthcare.

He suggested that in the future you won’t be prescribed a treatment or a medication, you’ll be prescribed an application for your Smartphone that will help you manage your treatment, medication, etc. Think about the “ patient activation” component of Accountable Care Organizations. Think about communicating with your patient-centric medical home with interfaces more powerful than simple, secure e-mail, text messaging, and twitter. Interesting!

Jeff Hinson, the regional CMS administrator, described how MU moves us beyond paying claims and more toward the triple goal: improving quality, reducing wasteful spending, and improving access. He was truly excited about the agency’s evolution of focus.

There was a lot of emphasis on physician readiness from several perspectives: EMR, HIE, and REC support. Steve Waldren, MD, MS of AAFP talked about the challenges primary care docs have with MU. He shared that 60 percent of family practice physicians have some degree of EMRs, as compared with 10 to 20 percent, in general, of docs in small group practice.

They all must have a foothold in two worlds:
1. Dealing with a transition from volume-based care payment to value-based care payment
2. Health plans directed to consumer-based models
3. Claims-based to quality-based retrospective reporting

Achieving Meaningful Use? For most, it largely reduces to:
1. E-prescribing
2. Patient registries
3. Patient portals

Laura Kolkman, the president and founder of Mosaica Partners, was one of the presenters, as well as a moderator on the topic of HIEs. She has a HIMSS guidebook coming out in January titled, "The Health Information Exchange Formation Guide: An Authoritative Guide to Planning and Forming an HIE in your State, Region, or Community."

During her presentation, Laura walked through and detailed a five-stage HIE maturity model (see graphic at top of this article). It began with stakeholder engagement and participation. Perhaps surprisingly, multiple speakers referenced HIE initiatives that tried to launch in stealth mode, not necessarily deliberately, with unintended consequences including a lack of adoption, backlash, or both. The other stages are governance, business, privacy, and technology/security, but the end-goal is still a sustainable HIE. Laura reviewed over a half dozen required attributes, only one of which was solvency. There isn’t a set of proven paths to sustainability; however, the key work is pretty clear. My description does not do justice to the model and thinking that Mosaica has developed and shared. I plan to buy the book!

There were a variety of perspectives presented about the realities and challenges of HIEs, with explicit discussions of initiatives in NY, MO, NC, NM, and OR. One such nuance was how such HIEs would participate in Accountable Care Organization models, versus the competing model of private networks by non-competing business entities [(trading partners)(See David Raths, The Rise of the Private HIE)]. The relationship of aggregated clinical data to claims data, the opt-in versus opt-out issues, and implications for what the Tiger Team calls "Meaningful Consent" raise old and new questions. One is a patient's concern that their insurance could be rescinded if some of the data in the HIE, which may be in error, invalidates their coverage.

To state the obvious, there's a lot of work yet to do in some basic areas. For instance, a recent HIMSS survey suggests that most providers are not prepared for a rudimentary security audit.

In his opening comments on both days, co-conference chair Brad Tritle pointed out that although HIEs can be very political animals, we need as much transparency as we can manage entering 2011. We know from recent history that there are many ways to fail. We need to share lessons learned as we start-up more than 50 newly designated state-level HIEs. Sharing things that aren't working as early as possible is hard but essential. The alternative is simply too costly.

Attendance, engagement and participation in such conferences is a critical step on the path toward developing improved ways to deliver higher quality, more cost-effective and available health care. I encourage you to do so. In the end, we, and the patients we serve, will realize innumerable benefits!

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