The Healthcare IT Guy

I recently learned about Vimo and they intrigued me because they look to be the Lending Tree of healthcare and offer comparison shopping for surgical procedures, insurance, doctors, health savings accounts, and hospitals. They claim to even be able to help consumers negotiate down medical bills they already received. Vimo seems to be a company worth watching because if they can achieve even part of what they plan it could make a direct impact to healthcare consumers. Given my interest in consumer-directed healthcare I asked Chini Krishnan, founder and CEO of Vimo, on the importance of empowering the consumer and putting them in the drivers seat of their own healthcare choices. Here’s what Chini had to say:

It’s no secret that people are turning to the Internet for healthcare advice, bypassing even their trusted doctors to access information. Some people think this is a good thing: You develop a symptom — a rash, a cough, a headache — and immediately you go online to get a diagnosis. Others, especially the doctors, are dismayed that people are getting false or misleading information from Web sites. Online advice, they say, is often not credible and raises unfounded fears among the public.

But the public is not listening. Now, more than ever, folks are online searching for information, treatment options and any piece of data they can access regarding their own health challenges and those of loved ones.

So it stands to reason that this fervor to capture information electronically about disease states would transcend to other areas impacting healthcare, such as coverage, procedures and providers. Online comparison shopping has emerged as an important aspect of “electronic healthcare delivery” and people value this service — it’s part of the great American way.

Think of all the electronic venues for making decisions regarding clothing, computers and virtually anything consumers have their eyes on — from low cost appliances to big-ticket items. When it comes to choosing a healthcare provider, service, hospital, specialty offering or treatment, our citizens want the best value for their dollar. And the power of the Internet is delivering the information that everyone is seeking.

Now, turn this up a notch. People are getting even choosier because under Health Savings Accounts, it’s “their own money” they are spending, not the dollars of the HMO or insurance company. It’s nearly three years since Health Savings Accounts (HSAs) emerged, and while they’ve faced substantial criticism, Americans are voting with their feet and signing up. Consumers are taking control of their own healthcare costs and watching every dollar they spend. Consumer-directed healthcare (CDH) is clearly on the grow.

I suspect critics of CDHPs forgot to factor in the impact of the Internet — the now trusted ally of the consumer for healthcare advice and guidance. The Internet (and yes, sites like ours, Vimo.com) have given people instant access to healthcare price, quality and comparison information that they didn’t have even three years ago. In a previous era, CDHPs probably wouldn’t have worked: people simply wouldn’t have been able to find the data they needed in order to make informed choices. But today, the stars all seem aligned for consumer-directed care, plans and health financial vehicles.

Internet technology again appears to be the backbone for healthcare decision-making. To fully take advantage of CDH, consumers need access to information only the Internet can deliver. For our part, we’re hearing very positive reviews of CDHPs from people who use our site (Vimo.com) to gain the information they need to make smart healthcare purchases. But more people need to know about the information that’s available.

More and more Americans are discovering that the “hidden” price and quality information that used to be the domain of the big insurance corporations has finally come to their own desktop. As far as Vimo is concerned, we like this freedom to choose and applaud the technology that is making it all possible.

A number of my readers have asked me about open source software for clinical research; I recommend taking a look at OpenClinica. From their introduction:

It facilitates protocol configuration, design of case report forms, electronic data capture, retrieval, and management. OpenClinica supports HIPAA guidelines, and is designed as a standards-based extensible, modular, and open source platform.

It has all the right buzz-words: it’s web-based, written using Java, and is pretty simple to use.

There’s recently been a steady uptick in new micro-job sites that eschew the “single site fits all” strategy pioneered by Monster.com. Basically, the new niche-oriented sites focus on specific jobs of very specific markets. Well, I bring this up because I ran across Med IT Jobs which is focused on, you guessed it, healthcare IT and medical informatics jobs.

While it’s pretty small and doesn’t represent many companies yet, it’s free for a limited time so it’s worth giving it a shot if you’re looking for a job or if you’re an employer with an open position. Of course, it requires you to enter all your resume information yet again — this is one of the principal weaknesses of micro-sites: if I register at 10 micro-sites, I have to enter my information 10 times instead of just once at something like Monster.com.

What do you guys think about these micro- or niche-oriented job sites? Do they have better jobs or are the jobs just easier to find?

All hospitals must have disaster and emergency response systems in place. FEMA’s National Incidence Management System (NIMS) is something that all of us need to be aware of and be able to obtain alerts from and provide information to. I ran across FastCommand, a system which implements the NIMS recommendations, and thought it might be something useful if you don’t have automated systems in place. It has one of my favorite attributes: it’s a web-based solution. They claim to enable hospitals to comply with national emergency response requirements when responding to both minor incidents and major emergency situations. I haven’t had a chance to do a trial yet but it seems useful.

One of my readers, Tim McLung, did me a huge favor recently by answering a question I posed in my recent post Who Owns Your Data? I asked if anyone had seen some work done in this area about data ownership and Tim left a comment pointing to the recently completed report from AMIA entitled “Toward a National Framework for the Secondary Use of Health Data“. Thanks, Tim.

The document doesn’t answer all my questions but it’s a pretty good start because there are numerous recommendations. Here’s introduction from the executive summary:

Secondary use of health data refers to non-direct care use of personal health information (PHI), including but not limited to analysis, research, quality and safety measurement, public health, payment, provider certification or accreditation, and marketing and other business (including strictly commercial) activities. Secondary use of health data can enhance health care experiences for individuals, expand knowledge about disease and appropriate treatments, strengthen understanding about the effectiveness and efficiency of our health care systems, support public health and security goals, and aid businesses in meeting the needs of their customers. Yet, access to and secondary use of data poses complex ethical, political, technical, and social challenges. Many of the issues surrounding the secondary use of health data are not new. These issues are however increasingly critical and complex in light of public and private sector activities that are expanding the volume of data available to be used and the availability of tools to access that health data. The lack of coherent policies and practices for the secondary use of health data presents a significant impediment to the goal of strengthening the U.S. health care system. A national framework for the secondary use of health data that includes a robust infrastructure of policies, standards, and best practices is needed to facilitate the broad and repeated collection, storage, aggregation, linkage, and transmission of health data with appropriate protections for legitimate secondary use.

If anyone else knows about similar work, please let me know since it’s an area I’m quite interested in.

This summer I wrote about HIMSS’ interest in bloggers and blogging and I got a number of positive comments indicating that we’d all be happy to see HIMSS join the Blogosphere. Well, HIMSS has launched their first blog, centered around the 2007 HIMSS Annual Conference and Exhibition in New Orleans. Available at www.HIMSSLive.com, the blog is designed to provide the most current information about the conference along with related healthcare IT news.

Like any blog, HIMSS07 Live! is designed to start a conversation with the community, in this case the entire HCIT community that HIMSS represents. So, check it out and start letting them know what you think.

We all know that an IT organization’s effectiveness is significantly impacted by change. Be it an installation of new hardware, replacement of networking devices, or deployment of software upgrades, change is good; however, everytime something changes there’s a chance for failure because something that worked before may suddenly stop working.

Change management strategy is so important that there should be people who are in charge of it in your organization (usually a configuration manager). But, some of us don’t manage change well. Here are some questions to ask yourself to see if you’re managing change appropriately:

• Do you know what’s changed in your environment today? During the past week? During the past month?
• Do you monitor your environment for unauthorized changes? Do people get fired for making unauthorized changes?
• Do you have a formal process for configuration management so that changes are duly authorized before they’re implemented?
• Can you describe your change control process to your current employees? How about new employees? How do you tell people what they are allowed to change versus not?

If you don’t have effective change and configuration management policies and procedures in place, your job as a technology manager will be tough at best and very stressful at worst. I’ve been to customer sites where things work fine one day and then stop working the next because of unauthorized configuration changes. If that’s happened to you, do yourself a favor and put in some change management policies. You’ll sleep better at night.

Something as simple as a Change Control Board (CCB) that meets weekly to go over change requests along with installation of an issue tracking system is a great way to start.

I routinely get asked about online health records that can be private labeled. Here are some of the options for open source health records management:

• ClearHealth
• MirrorMed
• FreeMed
• OpenEMR
• VistA Office

If any of you out there would suggest others, let me know.

While independent EMRs and EHRs functions are useful, the most important feature of any product in this space is its support for interoperability. As such, make sure that whatever you choose has some support for standards:

• HL7
• ANSI X12’s transaction protocols used for electronic transfer of patient data.
• CEN’s EN13606 and HISA (if you’re planning to use it in Europe)
• DICOM (if you want to store diagnostic images)
• ISO 18308
• openEHR
• ASTM International’s Continuity of Care Record

Neotool is a company I like a lot — they have a great set of products and they know the HL7 space. I’ve met the folks at HIMSS a few times and they’ve always impressed me. Recently I was pleased to find out that they were starting a corporate blog but I was afraid it might be a glossy brochure-style blog. Now, after having read their blog entries for a little while I’m happy to say that they’re adding real value to the HIT Blogosphere — their postings are informative, practical, and provide some great advice without either promoting or advocating their own products. They’ve also been invited to join HITSphere.

Nice job, guys.

HHS released an interesting RFI recently. Here’s the summary:

Advances in medicine, biomedical science, and technology present opportunities for enabling health care practices to be increasingly patient-specific by taking into account individual differences in health states, disease processes, and outcomes from interventions. Often referred to as personalized health care, the desired impact of these types of health practices is improved effectiveness and safety of medical practices. These health benefits may be manifested through new approaches for predicting disease risk at an early time point, enabling preemption of disease processes prior to full manifestation of symptoms, analyzing the effectiveness of different interventions in specific populations based on their genetic makeup, and preventing the progression of disease and the related complications.

For the purpose of achieving a broader understanding of rapid changes occurring in the health care setting that may have an impact on the future of personalized health care, HHS requests input from the public and private sectors on plans for developing and using resources involving health information technology (IT) and genetic and molecular medicine, with specific reference to incorporating these capacities in evidence-based clinical practice, health outcomes evaluations, and research.

It will be interesting to see what responses they receive, but if you have any interest or expertise in the matter I’d suggest putting in your two cents. I’ve been on the review committee for some Federal RFIs before and I am surprised at how much the government staff learned from the responses; so, it’s a great way to teach the government something they may not know.

Many health plans, hospitals, and even physician offices are putting patient data on the web to help connect to consumers. Many of us are also using service providers (SaaS, ASP, etc) to manage our data. All of these things are great and many of us have thought about the security implications: don’t put things on laptops, keep data from traveling onto USB drives, etc. Lots of thought goes into security these (though probably not as much as is really required).

But, what about privacy implications? Who owns the data that we capture from our end users? Sure, HIPAA lays out some privacy guidelines but what about sharing rules and data ownership guidelines? Have you looked at your contracts recently to see what rights vendors/consultants who have access to your data have with respect to that data? When all the systems are in your own environment you have a bit more control but in the case of ASPs and SaaS providers you’ll want to be sure you have roles, rights, and responsibilities fully worked out so you don’t get caught with a privacy violation due to an error in omission. I think giving your partners and vendors shared data rights and reuse rights makes sense for many reasons but how do you articulate those rights?

The presumption of privacy and security by visitors to our sites is fundamentally tied to the confidence they hold in us. If our policies and procedures aren’t clearly identified internally we can never really tell our visitors what they should expect.

One of the biggest issues in data sharing is the agreement on data ownership and privacy guidelines. If you’ve done some work in this area and would like to share your thoughts, drop me an email, leave a comment here, or better yet give us the opportunity to learn from you by posting a guest article.