The Cloud in Healthcare – Top 10 Takeaways from iHT2 San Francisco

March 30, 2012 / CloudPrime, Healthcare / 0 Comments

In the spirit of David Letterman’s top 10 lists here are our takeaways from the San Francisco iHT2 event this past week. ihealthtran.com/

  1. IHPs (large integrated health providers, like university systems, etc), are by and large going with EPIC for EHR solutions, thereby automatically forgoing a degree of flexibility and any chance of real near-term interoperability.
  2. The historical problems of security, reliability, and control with Cloud-based solutions are being rapidly overcome, and the cost savings from hosting data and applications in the Cloud are becoming so compelling that increasingly complex medical organizations and systems will require the Cloud in order to be effective and efficient…..or risk becoming extinct.
  3. The HealthCare system, as usual, is the last great industrial complex to accept collaboration and efficiencies based on advances in information technology.
  4. There has been a dramatic shift in the last two years toward the use of mobile and portable devices in all aspects of care, and this will only increase.
  5. Nobody can really define the phrase  “HIPAA compliance,” it is best approached and understood as a process, it is not just about security.
  6. 30% of the vendors sponsoring were cloud-oriented.
  7. Edge, last-mile connectivity in a HIPAA compliant fashion was a common pain point from small patient practices to large integrated health providers.
  8. Cloud-based or service platforms having the ability to be more nimble and in turn handle the growing complexity of connectivity, interfacing, and interoperability are available and should be considered.
  9. The cloud mitigates the need for traditional software upgrades and release cycles.
  10. CIO’s and CMIO’s are opting to outsource for best-of-breed services and applications.  Driven by skilled resources in healthcare IT becoming increasingly scarce and more robust SaaS/cloud-based options being available.

Response to NY Times’ Steve Lohr — Healthcare Connectivity

horse-before-cartMr. Lohr, great article and thank you for covering this topic.

Any story about hospitals taking steps towards connectivity is great, but I fear that most think that connectivity is a little easier than it really is, that it’s just a matter of getting everyone together. Integrating hospital systems is challenging enough, but it’s “everyone else” that will pose the greatest challenges and thus making connectivity a fragile vision if it cannot be streamlined for smaller practices, independent physicians, clinical labs, etc.

Mr. Lohr points out that only 25% of physician practices today are computerized, and that should improve given incentive payments and consequences for non-compliance. However, the real issue is that we are putting the carriage before the horse; physicians will adopt patient management systems, EHRs, and EMRs, but the connectivity piece will still be unanswered. Furthermore, smaller practices and physician groups most likely will not understand why it is that further steps for compliance need to be taken as most of them are being educated (by the very software vendors selling them their wares) that if they merely install software that allows them to manage patient data digitally, they are going to get compensated.

Recently on a call with a hospital CIO, we discussed how they had to put a connectivity project on hold because of the 200 physician practices outside of her hospital she had to bring onto the network, only 120 had EMRs and none of them wanted to deal with having to deploy and manage a VPN. Seems trivial, but the reality is that doctors are doctors 1st and anything not related to treating patients is a distraction and is perceived to decrease their bottom line (In the Docs’ defense, VPNs are a blunt instrument and I don’t blame them).

Healthcare connectivity is a long, windy road that needs better planning, better ideas, and better solutions. The Direct Project sponsored by NHIN is a great foundation for simplifying and standardizing connectivity, but this battle also needs to be won with hearts and minds.


Direct Project — Hooray!?

Fortunately NHIN will not even tell you that the Direct Project is the end-all solution to making the ubiquitous exchange of health information a reality.

That being said, many interpret it as a simple evolutionary step to secure health information exchange and compliance. Let’s take a look at what the Direct Project is and specifies:

  1. The Direct Project is a specification or recommendation about how secure health information exchange can be achieved via the SMTP protocol,
  2. In order to interface to the Direct Project network, you will still need to rely on a health information service provider,
  3. Each participant in the Direct Project will have a published Health Domain Name or HDN which is used for authentication; this will look like an email address or domain to users and is how other participants will identify each other

There are many other requirements that outline what is needed to adhere to the Direct Project specification, but above are the high-level concepts. In itself, it is a great and elegant approach to solving the problem of interoperability and health data exchange, but there are some items of concern that need to be addressed when determining how to gain widespread adoption:

  1. While some vendors are supporting the Direct Project in software patches and new releases of software, what does this mean for healthcare professionals that do not have applications that will comply? How will they interface to the Direct Project?
  2. What about large hospitals or groups that have many systems from multiple vendors? Will their router be able to interface to the Direct Project network without increasing the work load of already over-stretched IT staff?
  3. While some vendors have updates and patches for adhering to the Direct Project specification, are there other requirements needed in order to comply, e.g. changes to a hospital’s SMTP server?

At Cloak Labs we are very excited about the Direct Project and believe it does provide a solid foundation for improving health information exchange. Our concern, however, is that it will require that healthcare providers to allocate over-stretched resources to meet the requirements of Direct and get their health IT systems to integrate with the network even if their EMR/EHR supports Direct.

We believe that as an added goal of the Direct Project, implementation and integration should not be difficult and that health IT folks need a solution that will minimize the impact to their workflows and current workload.

Cloak Labs is defining a better way for health IT professionals to take advantage of everything the Direct Project has to offer while minimizing the impact to their IT infrastructure and workflows.


HIMSS — What You Would Have Learned If You Went

February 25, 2011 / CloudPrime, Healthcare / 0 Comments

I think Ascendian’s CEO Shawn McKenzie’s interview is a great summary of HIMSS 11 and what is happening in Healthcare IT:

If you don’t have time for watching videos at work, then I will try to sum it up the best I can:

Widgets, lot’s of them. Mostly unimportant.

Shawn makes a great point that there is no real plan for Healthcare IT and interoperability. Instead (as we have commented before) there is a focus on EHRs and building “widgets” for healthcare professionals, which is essentially creating healthcare “silos”. While there is a ton of innovation being made at the practice side, very little is going into interoperability and the traditional medi-evil VPN solution for connectivity still reigns.

After walking the floor of HIMSS for days, we learned on our own how true this was. Most EMRs and EHRs didn’t care about interoperability and were content to tell us it was the customer’s problem. This seemed odd to us in 2 ways: 1. The idea is to solve customer problems, not ignore them, and 2. As a business, they are leaving opportunity on the table.

The Direct Project also had a showcase that demonstrated interoperability, but it was not clear who should be interested and why.

Once people realize that connectivity and interoperability are a big issue, they will also realize that the old way of doing things will not be sufficient. Real investment in new technologies that utilize the Cloud and provide real solutions to the connectivity and interoperability problem are needed. To borrow from Mr. McKenzie again, what we have now is the coal but not the train or the tracks.


Preparing for Health Application Interoperability

2011 is going to see a dramatic increase in the adoption of EHR software and digital patient information exchange will become an even greater priority in order to meet Stage 1 meaningful use requirements.

If you are an IT Manager, this looks like it will require an all hands on deck and a huge shift in how things have been run throughout your organization. Since all patient data will need to be exchanged digitally in a safe and reliable way, you will be tasked with:

  • Ensuring application interfaces can connect internally as well as make connections outbound through your firewall
  • Making sure your IT ecosystems are documented carefully to determine where the holes are in internal and outbound connectivity
  • Allocating resources for managing all new connections and configuring your firewall to accept new connections
  • Dedicating staff to managing the new network; either adding to overhead or detracting from other initiatives within the organization

Some things to think about in 2011 as you prepare to meet these new requirements are:

1. Meaningful Use Incentives: Registration for the EHR Incentive program started on January 3rd: http://www.healthcareitnews.com/news/government-ehr-incentive-program-ready-go

2. New Infrastructure: New processes will need to be learned as you begin interfacing to all the EHRs, PMS’, HIEs, Physician Groups, Clinical Labs, etc. being brought onto the network.

3. Security: All patient health information will need to be encrypted and transported securely in order to meet HIPAA compliance.

4. Training: Staff will need to be trained and allocated to manage these networks. As your network continues to grow, so will the resources required to support and manage it. Changes in your firewall will need to happen and application interfaces will need to be built.

5. Solution Providers: HISPs (Health Information Service Providers) will need to be selected. Not everything can/should be done in-house, so you will need to determine how to minimize the total impact of these new application interoperability requirements. Your EMR may already provide application interfaces, but it is possible that many of your systems do not support outbound connectivity.

2011 will bring a lot of change for the healthcare industry as a whole, and with that change, progress. Despite the huge burden these new regulations will have on IT departments large and small, the end game will produce a cohesive, secure and reliable patient information exchange that improves the quality of care for all Americans.


Application Messaging Integration: Look into my Portal

Let’s face it, Middleware is not sexy. It is the stuff that literally can be found in “the middle” or lying below the surface of what a general user of software technology experiences. CloudPrime, to many, is just that: a service that allows applications to communicate in a scalable, secure, and cost-effective way. Yep, that sounds like Middleware.

However, what is not typically available through Middleware services, is a portal; a window that allows a user or manager gain visibility into a system. Cloak Labs is an exception to that rule and offers a very detailed interface that allows professionals to have better visibility into their messaging network.

Cloak Labs’ messaging portal provides a variety of features for network managers and users alike, including:

  • Simple, graphical interface for easier management
  • File-level tracking
  • Security Gateway management
  • Message network reporting
  • Exception reporting
  • Network message alerts

Whether you are a Healthcare Application Integrator, EHR Vendor, or Healthcare IT Professional, how you connect systems and manage the messaging infrastructure between them is extremely important, especially in the context of compliance.

The idea behind the Cloak Labs portal is to give Health IT Managers and users more out of their Middleware, and expose as much information as possible, allowing these users make intelligent, well-informed decisions about how they connect systems.


Is Healthcare Interoperability Achievable?

We have written numerous times applauding Dr. Blumenthal and the ONC for pointing out the importance of Health Information Exchange and interoperability in the context of bringing healthcare into the digital age. However, it is not totally clear that the dollars are actually making it to backend systems and that the main focus has been on patient and physician interfaces for collecting data.

In the end, there are some very simple things that need to be understood in order to achieve interoperability:

  1. People need to understand that there is a backend system that needs to be in place in order to achieve healthcare interoperability;
  2. Health Information Exchange needs to be more than just people and physician focused, i.e., only concerned with front-end systems such as a PMS;
  3. Untill all the endpoints are connected, there is no Health Information Exchange;

sand-castlePatients are no doubt important, and they are the raison d’etre for the HITECH Act, but how well will they be served when their doctor’s Patient Management System or EHR cannot connect to the regional HIEs? Or if one patient medical record cannot be shared across hospitals?

To date, millions of dollars have been awarded as grants to regional HIEs and state coalitions to implement and enhance how healthcare systems connect, but there is no real plan for making this happen. This is not a criticism of the people who are trying to find a solution to their problem, but it shows that the current solutions for achieving interoperability are not up to the requirements and healthcare IT professionals need new solutions and ideas.

The backend systems that will provide interoperability are the backbone of HIE. Without interconnectivity between all healthcare systems, HITECH is a castle built on sand.

So the question to you is: how will Healthcare Interoperability be achieved?