Posts Tagged ‘interoperability’

innovationIf it is one thing that the healthcare IT industry doesn’t lack, it is innovation – or it least innovation on the edges. A quick search on Google for health IT innovation challenges will serve you up over 23K hits. From Sanofi, to HHS, to Cigna and other stakeholders, there seems to be no lack of challenges, code-a-thons and the like but one has to wonder, do the results of any of these challenges actually end up in the hands of consumers and/or clinicians? If yes, and I have my doubts, the number that actually make it over that last threshold is exceedingly small.

That’s not to say these challenge grants do not serve a purpose. Such challenges do attract young developers into the healthcare sector where they can apply their well-honed skills to solve a problem. Maybe it will never be a commercial success, but it does expose them to the market, the needs therein and maybe they’ll stick around by joining one of the many HIT companies.

Beyond these challenges though, larger healthcare organizations (HCO) have their own internal centers of innovation. A couple of weeks back I had the opportunity to participate in a workshop at Kaiser-Permanente’s Garfield Innovation Center where 22 innovation center leaders gathered together to share their successes, challenges, best practices and ultimately forge relationships for the future. This event was organized by BluePrint Healthcare IT, of which I am on the Advisory Board.

Participating in a number of breakout sessions and conversing with various leaders of these innovation center leaders I came to the conclusion that the greatest impact these centers could have on their respective organizations was to all join together to identify  and measure lost opportunity costs that are the result of poor or insufficient interoperability across systems.

The healthcare industry remains a cottage industry with even the largest HCOs, such a Kaiser-Permanente or Partners Healthcare not having enough clout to drive interoperability across systems, be they hardware or software. If innovation centers were to rally together, develop a clear and consistent set of metrics to measure lost opportunity costs, in aggregate, they may be able to start driving change that will lead to more open systems.

Yes, it is a tall order and will require strong leadership but frankly, this industry is long overdue for tackling this issue. In the manufacturing sector, this challenge was address over a decade ago with the creation of the HART standard for device interoperability. Continua Health Alliance is trying to do something similar but still has a long ways to go. Won’t even begin talking about interoperability across disparate IT systems.

Yes, there seems to be some movement, but it is almost entirely regulatory-driven. What will it take for this industry to wake up and actually do something? Hard to say, but I would place my bets on these innovation centers, if they heed the call to collectively define metrics, to be very influential in the future.

Note: As of midnight in Cambridge on December 4th we will be closing down the ability for one to leave comments on posts. This will continue till Dec 20th. The reason? We will be launching a completely new website that will have a lot of cool features that will make it easier for you to get to know Chilmark Research, engage with us and of course continue to receive our thoughts and view on trends in the HIT sector. Stay tuned.

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One of the treats of this week’s Connected for Health Symposium was the opportunity to moderate a panel entitled: Personal Health Information Platforms and Records: What’s the Nitty-Gritty Situation on the Ground?

Obviously, I could not provide notes on this session while concurrently moderating it, but did find the following article at Healthcare IT News that provides some flavor as to what was discussed.

I began the session with broad questions targeted at all panelists and concluded my questioning with pointed questions to each of the participants. Following are the questions and their answers:

Google Health:

Ques: You currently only support a modified version of the CCR standard and do not allow for unstructured data in Google Health. Will you support other standards and unstructured data?

Ans: Yes, we do intend to support other standards including CCD in the near future. We are also building out the capabilities to support unstructured data.

Assessment: Good to hear that Google intends to support other standards and quite pleased to hear that they will be offering users the capability to store unstructured data (important for journaling, loading up advanced directives, etc.)


Ques: How will you support portability of the record should an employee leave their employer?

Ans: We intend to support portability of the employee’s record. As of today, we have not worked out a pricing model should an employee wish to maintain their data on Dossia.

Assessment: This is the same answer they gave me last year – obviously a back burner issue that Dossia has not spent much time on.


Ques: You are currently working with Dossia and now being rolled-out to Wal-mart employees. Do you intend to become a part of either the Google Health or HealthVault platforms?

Ans: We will become a part of these other platforms when there is a business case for doing so. (In other words: Only when a client asks us to do so and basically pays for it.)

Assessment: Seems logical and why commit to something that to date is still unproven and none of your large enterprise clients have asked for.

Microsoft HealthVault:

Ques: Recently, both Google Health and Dossia became members of the Continua Alliance supporting Continua’s open standard for medical device connectivity. Since biometrics is an important part of HealthVault (and its proprietary Connection Center), why are you not a supporting member of Continua?

Ans: Microsoft wanted to move faster then Continua to deliver a solution to market. We continue to follow what Continua is doing and will reconsider joining Continua at a later date.

Assessment: Yes, Microsoft is correct in that Continua has been moving slowly and understand that they may not have wanted to be hindered, after all, Microsoft now has over 50 devices that can feed data through Connection Center into an individual’s HealthVault account while Continua has yet to bring a single certified product to market.

That being said, Continua standard compliant products will start rolling into the market, en mass, in 2009. Continua gave a very impressive demo (at least for the audience as I was bored having seen similar device connectivity over ten years ago in the manufacturing space, but that is another story), including numerous devices, as well as an upload of device data directly into a Google Health account. Also, Continua is not expensive to join – it is only $5K/yr to become a “contributor” member, chump change for Microsoft.

Just can’t figure out why Microsoft won’t pony up a measly $5K to at least show support for the concept of Continua, unless of course they have every intention to make the Connection Center a lock-in solution. Do not believe this is Microsoft’s intent, but their position on Continua naturally raises suspicion as to their intentions. Hopefully, they will reconsider this stance and join Continua in the near future.

On another note – Microsoft did announce, while up thereon the panel that they have an iPhone app in the works that will be released shortly.  Can’t wait to see what that may be – stay tuned as we plan to dig deeper.

After my questioning I opened up questioning to the audience. The highlight was when someone asked when will we see interoperability between the platforms. This generated some lively discussion between Google and Microsoft with Google’s Jerry Lin finally saying to Microsoft’s Grad Conn that Google was ready when they are. To which Grad responded positively and said let’s talk after the session.

Don’t know what came of those discussions and regret not holding their feet to the fire in front of the audience and asking them when, specifically, will we see such interoperability. Guess that will have to wait for the next such opportunity.

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It was only a matter of time as rumors have been swirling around for sometime now but CCHIT has announced the formation of an Advisory Task Force (ATF) to provide guidance to CCHIT on what should and should not be included as part of a PHR certification process.

While the announcement was extremely thin on details, I did some digging and came up with the following.

PHR attributes that may be considered for certification include:

  • Privacy: Of course, and we definitely need it as HON is inadequate,
  • Security: Why not and logical follow-on to privacy,
  • Interoperability: A CCHIT favorite – to be expected but unlikely to be necessary – market will rule on this one,
  • Functionality: No, they don’t need to go here, let the market decide what functionality is desired.

Proposed timetable:

  • May 2009: Publish criteria and test scripts
  • July 2009: Launch certification program
  • October 2009: First certified products announced

Odd, but somewhat predictable cast of characters on the ATF. You have the 3 platform play representatives in Dossia (Rick Benoit), Google (Missy Krasner) and Microsoft (Michael Stokes), several from non-profits (academia, government and others) and a couple of health plans.

Who’s missing?

A tried and true PHR vendor that is actually out there with a product and has been doing it for a few years. This panel is currently burdened with either big company representatives or what appears to be those who have never worked in a small company needing to take a product to market. There are unique challenges for such an entity that this ATF will have a difficult time empathizing with.

Hopefully there is still time to add another to the group.

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