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ONC Releases Final Rule on Interoperability: How Might it Affect Public Health?

On March 9, 2020 the Office of the National Coordinator for Health Information Technology (ONC) released its final rule on the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program. Referred to by some people as the "Information Blocking Rule," since this is the primary topic, the document actually covers a host of other issues related to interoperability driven primarily by requirements of the 21st Century Cures Act. In addition to the final rule itself you can read the ONC press release, a comparison between the proposed and final rules, and lots of other resources.

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The Need for Speed - It's Time to Act!

As a society we also need to get moving on the population level as well - and the sooner the better! In his fascinating genomic epidemiology detective work Trevor Bedford conducted based on the COVID-19 research he and his team had done in the Bedford lab in Seattle WA, he concluded that the narrow testing that was done in the Seattle area in the early days of the Coronavirus spread allowed the virus to spread faster. In contrast, the Coronavirus testing-blitz in South Korea appears to keep the death rate lower than it could be. It's time to test! The FDA gave high-tech labs the green light to operate tests before receiving any agency review or authorization and both Quest Diagnostics and LabCorp already announced that they have test in the market. But according to CDC, as of March 8 there were only 1,707 tests performed in the US vs. 189,236 in South Korea.

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Coronavirus and the Recurring Mistake of Fighting the Wrong Wars

What do the coronavirus and Navy ships have in common? For that matter, what do our military spending and our healthcare spending have in common? More than you might think, and it boils down to this: we spend too much for too little, in large part because we tend to always be fighting the wrong wars.I started thinking about this a couple weeks ago due to a WSJ article about the U.S. Navy's "aging and fragmented technology." An internal Navy strategy memo warned that the Navy is "under cyber siege" by foreign adversaries, leaking information "like a sieve." It grimly pointed out...

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VA Tackles Medical Device Vulnerabilities and Cyberthreats

VA recently signed partnerships with Massachusetts General Hospital and Shepherd University. This collaboration's research will address cybersecurity and compatibility measures needed in devices used for VA patient care. It will also refine existing and emerging cybersecurity standards and practices for network connectable medical devices, medical data systems and other related technology. Beyond VA, the agreements could have a broad impact in standardizing cybersecurity and safety requirements within the larger public health sector. VA is contributing to industry-wide awareness of both medical device vulnerabilities and threats, while applying further tests of the Underwriters Laboratories criteria and other emerging standards.

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Why the Founder of Apache Is All-in on Blockchain

Brian Behlendorf is perhaps best known for being a co-founder of the Apache Project, which became the Apache Software Foundation. Today, he's the executive director of the Hyperledger Foundation, an organization focused on enterprise-grade, open source, distributed ledgers (better known as blockchains). He also says he "put the first ad banner online and have been apologizing ever since." In a recent conversation on my podcast, Behlendorf talks about the goals of the Apache Project, the role of foundations generally, and his hopes for blockchain...

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CMS Promoting Interoperability in 2021: All good things must come to an end?

We have spent years involved with the management of the Center for Medicare and Medicaid Services (CMS) Electronic Health Records (EHR) Incentive Programs which were created by the HITECH Act (2009). These programs were recently renamed Promoting Interoperability (PI) programs. In a nutshell, these programs were tied to the Medicare and Medicaid insurance programs and provided financial incentives over a number of years to ambulatory providers and hospitals to adopt and use EHRs. Vendors submitted their technology products for testing and certification that they performed specific functions and could exchange data using specified message formats...But the provisions of the HITECH Act are due to expire on September 30, 2021 (see CMS timeline). These are the programs affected...

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How The VA and UL Created an Orchestrated Approach to Healthcare Cybersecurity Assurance

In today's high-risk Internet of Medical Things (IoMT) and cyber-warfare environment, one tool or individual line of cybersecurity solutions would likely not be able to satisfy the requirements for security and safety put forth by an HDO; hence, the aggregation of solutions branded as MedFusion was derived. The VA UL CRADA discovered that healthcare is strengthened in terms of security and safety of connectable medical devices through in-depth cybersecurity defense...Learning from the VA and UL cybersecurity research results, with respect to product-level management of vulnerabilities and threats to medical devices and their associated software algorithms, we can impact the quality of adoption of electronic health records and other data collection systems connected to the IoMT and consumers...

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The Current State of Blockchain and Where it's Going

In an earlier post, Blockchain evolution: A quick guide and why open source is at the heart of it, I discussed the first generations of blockchains: the public Bitcoin and cryptocurrency blockchains, followed by the Ethereum blockchain capable of executing programs ("smart contracts"), leading to permissioned versions of code-executing blockchains (e.g., Hyperledger Fabric, Quorum). Let's step back into the blockchain jungle and take a look at the current state of the ecosystem and the projects trying to solve some of the limitations of blockchain technology: speed and throughput, cross-blockchain information and value exchange, governance, and identity and account management.

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What Are We Prepared to Do in the United States to Save Primary Care?

I propose two significant changes to help make primary care relevant in the 21st century...I wrote a longer piece on [Virtual Care] earlier in the year. In short, it's a disgrace that we've put so many hurdles on telemedicine, and that it continues to be so underused. It is widely available in health plans, but rarely practiced by physicians nor by patients. Instead, we still mostly go to our doctors offices, to ERs, or perhaps now to drugstores.A televisit should be the first course of action for non-emergencies. We must remove regulatory and reimbursement barriers, and incent patients to take advantage of the speed and convenience of the option. Moreover, as AI options for diagnoses and advice quickly become more viable, we can use them to triage our needs, help assure continuity with physicians, and eventually reduce the need to talk to a human...

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The Community-Led Renaissance of Open Source

In a revival and expansion of the principles that drove the first generation of community-led open source commercial players, creators are now coming together in a new form of collaboration. Rather than withholding software under a different license, they're partnering with each other to provide the same kinds of professional assurances that companies such as Red Hat discovered were necessary back in the day, but for the thousands of discrete components that make up the modern development platform. Today's generation of entrepreneurial open source creators is leaving behind the scarcity mindset that bore open core and its brethren. Instead, they're advancing an optimistic, additive, and still practical model that adds missing commercial value on top of raw open source.

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