Healthy Living Dealing Amongst Ehr Dissatisfaction (Part 2)

This postal service is a continuation; Part 1 is at this link.

The adjacent number turned to who should ultimately command a patient's data. Should it hold out the patient (patient access control), provider/clinician, tending team/ACO/PCHM, HIE/gov't/CMS?

Here's what I wrote:

Some believe patients should accept granular command of who gets to run into their wellness information and, if de-identified in addition to aggregated for population wellness research, that the patient should hold out compensated financially for authorizing such purpose of their data.

Concerns close PHI privacy in addition to gov't command are sure enough warranted and, I concur alongside Randall, that legacy systems accept been incapable of doing what's needed to give patients peace of hear that storing their PHI inwards the cloud provides a high plenty score of privacy protection. We cannot laissez passer the Triple Aim unless nosotros accept broad deployment of a secure, low-cost, e'er available, in addition to uncomplicated agency to telephone commutation information from EHR to EHR, EHR to PHR, EHR to Population Health in addition to After Market Surveillance repositories (with de-identified data), in addition to from Person to Person (patient to clinician, clinician to patient, in addition to clinician to clinician).

A pub/sub, loosely-coupled, mesh node network, alongside identity management in addition to endpoint-to-endpoint encryption, is 1 agency to laissez passer this.

The adjacent number raised is whether the actual finish of healthcare reform is to larn inwards fail. I responded past times saying:

I've heard from to a greater extent than than 1 individual that electrical flow healthcare reform efforts were designed to fail. While I'm non sure close that, I AM confident that the cost, complexity, inefficiencies, in addition to insecurities built into electrical flow implementation regulations are also large NOT to fail.

Nevertheless, the underlying goals of ARRA HIT--to improve tending character in addition to incorporate costs/prices (i.e., growth value to the consumer)--are absolutely essential. We accept a existent large occupation if all the spending in addition to hassles are simply a manipulation to funnel taxpayer's coin into the coffers of sure large corporations nether the guise of helping the mutual good.

As such, I believe physicians in addition to other clinicians, researchers/informaticists, in addition to HIT developers accept a duty to participate inwards loosely coupled collaborative networks focused on ensuring that the HIT existence developed is designed in addition to used to improve patients' wellness in addition to wellbeing, to minimize the burden in addition to maximize the competency of providers, in addition to to vantage delivery of high value care.

I in addition to then went on to depict my experiences every bit a committed fellow member of the government's HIT standards bodies:

Having been involved over the past times few years inwards a one-half dozen HHS/ONC technical workgroups that produce upward one's hear EHR/HIT standards, my associates in addition to I accept been similar David facing an arena of Goliaths. I've been dealing alongside the biggest EHR vendors, every bit good every bit Federal contractors in addition to agencies. It's been a really frustrating in addition to enlightening experience. We entered the arena alongside the faint promise that the powers-that-be would compare our simple, low-cost, highly capable, disruptive innovations to the complex, convoluted, expensive mainstream technologies currently existence adopted.  

What we’ve establish is that the standards-making procedure is rife alongside regulatory capture inwards which novel standards are built on pinnacle of sometime standards without due consideration of modifying those standards inwards low-cal of novel in addition to improve technologies. Simplicity, efficiency, in addition to usability are an afterthought. The effect is an extraordinarily complex laid upward of monolithic processes that few (if any) tin give the axe implement in addition to few are willing to use.  

Examples include, inwards no detail order: (a) an over-reliance on XML information representations in addition to Web services, (b) long delays due to HL7 voting processes, (c) changes to DIRECT taking it from what was supposed to hold out 1 pace higher upward the fax to a convoluted amalgam of HISPs that brand PHI vulnerable alongside exposure to man-in-the-middle attacks, (d) incestuous relationships betwixt vendors in addition to ONC that block conception from “outsiders,” (e) reticence to bargain alongside hard clinical workflow issues, in addition to (e) the natural tension betwixt making huge leaps inwards EHR organisation capabilities in addition to the “let’s simply hold crawling until nosotros tin give the axe walk” mentality. The effect is that coin continues to hold out spent alongside dismal progress inwards enabling HIT to growth value to the consumer spell enabling in addition to rewarding providers for delivering such value.

It seems to me that most of these problems are due to describe of piece of work organisation strategies in addition to tactics supported past times regulatory capture; it is non a technology issue, per se.

In business office 3, at this link, I elaborate close the problems identified above.

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