Andy Oram

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Epic and Other EHR Vendors Caught in Dilemmas by APIs (Part 1 of 2)

Andy Oram | EMR and HIPAA | March 15, 2017

The HITECH act of 2009 (part of the American Recovery and Reinvestment Act) gave an unprecedented boost to an obscure corner of the IT industry that produced electronic health records. For the next eight years they were given the opportunity to bring health care into the 21st century and implement common-sense reforms in data sharing and analytics. They largely squandered this opportunity, amassing hundreds of millions of dollars while watching health care costs ascend into the stratosphere, and preening themselves over modest improvements in their poorly functioning systems...

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Epic and Other EHR Vendors Caught in Dilemmas by APIs (Part 2 of 2)

Andy Oram | EMR and HIPAA | March 16, 2017

The first section of this article reported some news about Epic’s Orchard, a new attempt to provide an “app store” for health care. In this section we look over the role of APIs as seen by EHR vendors such as Epic. Dr. Travis Good, with whom I spoke for this article, pointed out that EHRs glom together two distinct functions: a canonical, trusted store for patient data and an interface that becomes a key part of the clinician workflow. They are being challenged in both these areas, for different reasons...

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Gathering a Health Care Industry Around an Open Source Solution: the Success of tranSMART

Andy Oram | EMR & EHR | May 18, 2015

The role of open source software in healthcare is relatively hidden and uncelebrated, but organizations such as the tranSMART Foundation prove that it is making headway behind the scenes. tranSMART won three awards at the recent Bio‐IT World conference, including Best in Show. The tranSMART Foundation is a non‐profit organization that develops creates software for translational research, performing tasks such as searching for patterns in genomes and how they are linked to clinical outcomes. Like most of the sustainable, highly successful open source projects, tranSMART avoids hiring programmers to do the work itself, but fosters a sense of community by coordinating more than 100 developers from the companies who benefit from the software.

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Graph Tools Forge Path To New Solutions

Graph databases haven’t made the news much because, I think, they don’t fit in convenient categories. They certainly aren’t the relational databases we’re all familiar with, nor are they the arbitrary keys and values provided by many NoSQL stores. But in a highly connected world–where it’s not what you know but whom you know–it makes intuitive sense to arrange our knowledge as nodes and edges.

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Harvard Law Conference Surveys Troubles With Health Care

Andy Oram | EMR & EHR | March 30, 2016

It is salubrious to stretch oneself and regularly attend a conference in a related field. At the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, one can bask in the wisdom of experts who are truly interdisciplinary (as opposed to people like me, who is simply undisciplined). Their Tenth Anniversary Conference drew about 120 participants. The many topics–which included effects of the Supreme Court rulings on the Affordable Care Act and other cases, reasons that accountable care and other efforts haven’t lowered costs, stresses on the pharmaceutical industry, and directions in FDA regulation–contained several insights for health IT professionals...

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Health Care Costs Traced to Data and Communication Failures

Andy Oram | EMR & EMH | April 12, 2016

Most of us know about the insidious role of health care costs in holding down wages, in the fight by Wisconsin Governor Scott Walker over pensions that tore the country apart, in crippling small businesses, and in narrowing our choice of health care providers. Not all realize, though, that the crisis is leaching through the health care industry as well, causing hospitals to fail, insurers to push costs onto subscribers and abandon the exchanges where low-income people get their insurance, co-ops to close, and governments to throw people off of subsidized care, threatening the very universal coverage that the ACA aimed to achieve. Lessons from a ground-breaking book by T.R. Reid, The Healing of America, suggests that we’re undergoing a painful transition that every country has traversed to achieve a rational health care system...

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Health Care, Stop Using: Insurance, Market, and Quality (Part 1 of 2)

Andy Oram | EMR & HIPAA | August 22, 2016

The health care insurance industry looks like no other insuranceAndy Oram
industry in the world. When we think of insurance, we think of paying semi-annually into a fund we hope we never need to use. But perhaps every twenty years or so, we suffer damage to our car, our house, or our business, and the insurance kicks in. That may have been true for healthcare 70 years ago, when you wouldn’t see the doctor unless you fell into a pit or came down with some illness they likely couldn’t cure anyway.
The insurance model is totally unsuited for health care today...

 

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Health Games Platforms Mature In Preparation For Mainstream Adoption

For the past several years, researchers have strived to create compelling games that improve behavior, reduce stress, or teach healthy responses to difficult life situations...These efforts have born fruit, and clinical trials have shown the value of many such games. Ben Sawyer, who founded the Games for Health conference more than 10 years ago, is watching all the pieces fall into place for the widespread adoption of games. Business plans, platforms, and the general environment for the acceptance of games (and other health-related apps) are coming together. Read More »

Health Information Exchange Resist Cures (Part 2)

Andy Oram | EMR & EHR | March 23, 2016

The previous section of this paper introduced problems found in HIE by two reports: one from the Office of the National Coordinator and another from experts at the Oregon Health & Science University. Tracing the causes of these problems is necessarily somewhat speculative, but the research helps to confirm impressions I have built up over the years. The ONC noted that developing HIE is very resource intensive, and not yet sustainable. (p. 6) I attribute these problems to the persistence of the old-fashioned, heavyweight model of bureaucratic, geographically limited organizations hooking together clinicians. (If you go to another state, better carry your medical records with you.) Evidence of their continued drag on the field appeared in the report...

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Health Tap: Intelligent Interface for Patients

Andy Oram | EMR & HIPAA | January 9, 2017

    allows patients to connect with doctors online, and additionally hosts an enormous repository of doctors’ answers to health questions. In addition to its sheer size and its unique combination of services, HealthTap is ahead of most other health care institutions in its use of data. I talked with founder and CEO Ron Gutman about a new service, Dr. AI, that triages the patient and guides her toward a treatment plan: online resources for small problems, doctors for major problems, and even a recommendation to head off to the emergency room when that is warranted. The service builds on the patient/doctor interactions HealthTap has offered over its six years of operation, but is fully automated...

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How Can Open Source Projects Support Themselves in Health Care?

High prices and poor usability hasn't driven the health care industry away from megalithic, proprietary applications. What may win the industry over to open source (in addition to the hope of fixing those two problems) is its promises of easy customization, infinite flexibility, extensibility, and seamless data exchange. As we will see, open platforms also permit organizations to collaborate on shared goals, which appeals to many participants. But if open source projects can't charge hundreds of thousands of dollars for installation as their commercial competitors do, how will they pay their developers and hold together as projects? This article compares three major organizations in the open source health care space: the tranSMART Foundation, Open Health Tools (OHT), and Open mHealth. Each has taken a different path to the universal goal of stability.

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Ignoring the Obvious: Major Health IT Organizations Put Aside Patients

Andy Oram | EMR & HIPAA | November 18, 2016

Frustrated stories from patients as well as health care providers repeatedly underline the importance of making a seismic shift in the storage and control of patient data. The current system leads to inaccessible records, patients who reach nursing homes or other treatment centers without information crucial to their care, excess radiation from repeated tests, massive data breaches that compromise thousands of patients at a time, and–most notably for quality–patients excluded from planning their own care.

A simple solution became available over the past 25 years with the widespread adoption of the Web, and has been rendered even easier by modern Software as a Service (SaaS): storing the entire record over the patient’s lifetime with the patient....

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InnerSource: a practical application of open source techniques within organizational boundaries

Using open source methods within your own company--without offering up your resulting source code to the public--is called InnerSource. A report I wrote for O'Reilly Media titled Getting Started with InnerSource lays out some of the benefits of the open source model and how one company, PayPal, is carrying out both open source projects and InnerSource. Why would you want InnerSource? According to the report, your organization can grow and become more productive in several ways...

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Instead of a Weapon For Health Care Improvement, Monitoring Becomes Another Battleground

Andy Oram | EMR & EHR | September 3, 2015

If you wax enthusiastic about “patient engagement,” or work with health and fitness devices, or want to derive useful data from patient monitoring in the field, or–basically–read this blog for any reason at all, you should check out a recent study in the Journal of Medical Internet Research. It warns about psychological and logistical factors that trip us up when we try to get patients to monitor their vital signs. The paper has a catchier title than most: “You Get Reminded You’re a Sick Person”: Personal Data Tracking and Patients With Multiple Chronic Conditions (citation: J Med Internet Res 2015;17(8):e202)...

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Interview with Open Source Health IT Project: LibreHealth

Andy Oram | EMR & HIPPA | December 7, 2016

LibreHealth is the largest health IT project to emerge recently, particularly in the area of free and open source software. In this video, Dr. Judy Gichoya of the LibreHealth project explains what clinicians in Africa are dealing with and what their IT needs are. Both developed and developing countries need better health IT systems to improve patient care. In the developed countries, electronic records and other health IT systems sprout complexities that reflect the health care systems in which they function. But these IT systems are far removed from real-life needs of doctors caring for patients, and have transformed physicians in the US into its largest data entry workforce...

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