Feature Articles

The (Awesome) Economics of Open Source

Successful open source software companies "discover" markets where transaction costs far outweigh all other costs, outcompete the proprietary alternatives for all the good reasons that even the economic nay-sayers already concede (e.g., open source is simply a better development model to create and maintain higher-quality, more rapidly innovative software than the finite limits of proprietary software), and then-and this is the important bit-help clients achieve strategic objectives using open source as a platform for their own innovation. With open source, better/faster/cheaper by itself is available for the low, low price of zero dollars. As an open source company, we don't cry about that. Instead, we look at how open source might create a new inflection point that fundamentally changes the economics of existing markets or how it might create entirely new and more valuable markets.

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ONC EHR Reporting Program RFI: A Public Health Perspective

On August 24, 2018, the Office of the National Coordinator for Health Information Technology (ONC) released a Request for Information (RFI) related to the EHR Reporting Program. This RFI is required by the 21st Century Cures Act and its primary purpose is to gather ideas and suggestions related to how ONC might provide better information about Certified EHR Technology (CEHRT). Apparently, the initial intention was to create a "star rating" like the type used in Consumer Reports to use to rate EHRs, but that seems to have been abandoned in favor of some kind of measurement system. But it is far from clear exactly how this would be done.

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CMS Promoting Interoperability Program: A Public Health Perspective

Well, here we go again. The Centers for Medicare and Medicaid Services (CMS) has now released a new Notice of Proposed Rulemaking (NPRM), titled Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program...As this NPRM was released, the CMS Administrator, Seema Verma, published an open letter to doctors which is focused on reducing the burden on doctors so they can spend more time with physicians. HL7 has begun a similar initiative on reducing clinical burden. So the key question is: Does this NPRM go far enough to reduce provider burden in the spirit of Dr. Verma's letter?

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A (Real-World) Tale of 6 Practices and 5 EMRs

We've all been there. Someone in our family (or ourselves) has a medical concern so schedules a primary care visit, gets some images or lab tests, and perhaps learns that surgery is needed. What starts as a fairly simple process can quickly turn into a near-comedy of inefficiency. My own recent story is typical...I invite you to learn how careMESH can take my above experience and make it all digital. We have exceptional knowledge workers in the healthcare industry and had any of the six medical groups in my story asked for a rating of their service, I would have given every one of them a 5 out of 5. They were all excellent, professional, timely, dedicated people and teams. So, let's empower them to communicate.

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What Burning Man Can Teach Healthcare

Oh, good: it's Burning Man week.  For some people, it's the highlight of the year, an expression of creativity, community, and freedom unlike any other.  It's Woodstock, Fashion Week, and the Fringe Festival all rolled together, only set in the Nevada desert. For others, it is 70,000 wannabe hippies/hipsters gathering together for a week of hard partying: public nudity, drugs, and sex, plus burning some "art." Either way, it couldn't possibly have anything to teach healthcare, right? Maybe.  But what many do not realize is that Burning Man espouses ten guiding principles, and it is worth taking a look at those and how they could or should be applied to healthcare.

Electronic Case Reporting (eCR) Takes Front Stage at PHI2018 Conference

But the real buzz at the conference seemed to be about electronic case reporting (eCR). This refers to the national effort to replace the current paper and FAX process of submitting reportable conditions from clinical care sites to state and local public health agencies with a more automated electronic process fed from electronic health records (EHRs)...HLN demonstrated the workflow for eCR at the HIMSS18 Interoperability Showcase. However, we did not see a lot of interest on eCR at the HIMSS conference. At PHI2018 we had significant interest, both among public health officials who were anxious to see how they could initiate eCR in their jurisdictions, and other vendor and stakeholder groups who seemed to feel eCR was becoming viable and more “real.”

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First, We Tear Down All the Hospitals

The problem is that hospitals are big and getting bigger, going from building to buildings to campuses.  They are expensive and getting more expensive.  At some point, we have to ask: is this really how we want to spend our healthcare dollar? Some hospitals are figuring other ways to spend their -- I mean, "our" -- money on our health.  Take Nationwide Children's Hospital.  Located in a somewhat blighted neighborhood of Columbus (OH), its Healthy Neighborhoods Healthy Families (HNHF) program "treats the neighborhood as the patient," as their summary in Pediatrics put it. The hospital is leading a partnership that has built 58 affordable housing units, renovated 71 homes, given out 158 home improvement projects, and helped spur a 58 unit housing/office development.  They've also hired 800 local residents and instituted a jobs training program.

Three Reasons the US is Not Ready for the Next Pandemic

One hundred years after the Great Influenza pandemic of 1918, global health leadership stands at a crossroads. The United States continues to expand its policy of isolationism at a time when international cooperation in health could not be more important. The state of pandemic preparedness and the necessary steps for protecting the people throughout the world was the topic of The Scowcroft Institute for International Affairs' 2nd Annual White Paper. As pandemic policy scholars, with two of us spending the majority of our career in the federal government, we believe that it is essential to prepare the country and the world for the next pandemic. It is not a matter of if, but when, the next disease will sweep the world with deadly and costly consequences.

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Keeping Patient Data Safe with Open Source Tools

Healthcare is experiencing a revolution. In a tightly regulated and ancient industry, the use of free and open source software makes it uniquely positioned to see a great deal of progress. I work at a scrappy healthcare startup where cost savings are a top priority. Our primary challenge is how to safely and efficiently manage personally identifying information (PII), like names, addresses, insurance information, etc., and personal health information (PHI), like the reason for a recent clinical visit, under the regulations of the Health Insurance Portability and Accountability Act of 1996, HIPAA, which became mandatory in the United States in 2003.

AIRA 2018: Is Open Source the Key to Immunization Software Sustainability?

On August 14-16, 2018 the American Immunization Registry Association (AIRA) held its 2018 National Meeting. This meeting brought together more than 350 informatics professionals, public health officials, EHR vendors, and other stakeholders who all care passionately about Immunization Information Systems (IIS) and their role in the healthcare community. IIS projects leverage interoperability with EHRs, PHRs, and other systems to promote clinical practice at the point of care; enable public health surveillance, and reduce cost by assisting in preventing both under and over immunization.

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Best Buy Buys Into Health

Best Buy generated a lot of positive press recently with its acquisition of GreatCall, which focuses on technology services for seniors.  Its move into health may not be a surprise since it seems lots of retailers -- think Walmart or Kroger -- and many big tech companies -- think Apple or Amazon -- want into health, not to mention more tech startups than you can throw $100 million at. It's the why and the how about Best Buy's moves into health that deserve more scrutiny, and that healthcare organizations may learn from.

6 Ways Programmers from Underrepresented Countries Can Get Ahead

Becoming a programmer from an underrepresented community like Cameroon is tough. Many Africans don't even know what computer programming is-and a lot who do think it's only for people from Western or Asian countries. I didn't own a computer until I was 18, and I didn't start programming until I was a 19-year-old high school senior, and had to write a lot of code on paper because I couldn't be carrying my big desktop to school. I have learned a lot over the past five years as I've moved up the ladder to become a successful programmer from an underrepresented community. While these lessons are from my experience in Africa, many apply to other underrepresented communities, including women.

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Preliminary Thoughts on CMS Proposed MIPS IP Rule Changes: A Public Health Perspective

Well, here we go again. The Centers for Medicare and Medicaid Services (CMS) has now released a new Notice of Proposed Rulemaking (NPRM)...The purpose of this NPRM is to address proposed changes for Year 3 of the Merit-based Incentive Payment System (MIPS), the provider (as opposed to hospital) side of the Quality Payment Program. The part that is most relevant to public health is the Medicaid Promoting Interoperability (IP) Program for Eligible Professionals (EP)” (the EHR Incentive Programs have been renamed). A major goal of this NPRM is to synchronize as much as possible the EP program with the hospital-based program that was addressed in a previous NPRM just a few months ago.

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Eaten Alive: A Patients’ Perspective on De-Identification of Personal Health Information

In 2018, the majority of people do not know that their PHI, like their EHR data, prescription data, insurance claims, and genetic data via direct-to-consumer (DTC) tests, are de-identified and sold for research and commercial purposes at massive profits. Medical health data trading is a multi-billion dollar industry. The process of de-identification supplies data that may be aggregated for a variety of analyses, such as basic scientific discoveries, policy & legal reviews, process refinement, pharmaceutical marketing, and other efforts. Data de-identification isn’t new but it is rampant. I’m gravely concerned about the free-for-all that is de-identification. You should be too.

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An interoperability update: Do we need more carrots and sticks?

Earlier this year, the ONC released the Trusted Exchange Framework and Common Agreement (TEFCA), which responds to a mandate included in 2016’s 21st Century Cures Act and lays out principles, terms and conditions on which to base an interoperability framework that healthcare organizations can embrace. “This means patients who have received care from multiple doctors and hospitals should have their medical history electronically accessible on demand by any other treating provider in a network that signed the Common Agreement,” said National Coordinator for Health IT Donald Rucker in a recent blog post. To achieve that goal, TEFCA is divided into parts A, the principles, and B, the terms and conditions, which is also where the rubber meets the road for many who live in the healthcare IT world...

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