The HIT Transition Weblog

HIT Forums Point the Way for 2008 (Part 2 of 2)

Crystal Blue Persuasion
The mid-week shift to the Blue Health IT Symposium was a bit of a culture shock.  The venue was the elegant-but-somewhat-shopworn Biltmore hotel in LA.  The ornate downtown showpiece was the glitzy scene of a number of the early Oscar ceremonies, with oversized black and white photos of grinning film stars adorning the Historical Hallway.

The symposium is held by the Blue Cross Blue Shield Association for the benefit of its member organizations, whose IT and management staff make up the lion's share of attendees. There were also a number of vendor/sponsors in attendance.  I was among a much smaller handful of speakers who hadn't bought booth space or carried boxes of enlogoed pens, notepads or bouncy balls to distribute.

It was nice to be back among my doers and persuaders, of course, but for the rest of the week, no one insisted upon buying me a single-malt scotch or told me about the night club they built to avoid boredom on their horse ranch in Cucamonga.

I wasn't wearing my journalistic hat at the Blue conference, so I better keep quiet about that breakout session called Mandating Serial Colonoscopies for Documentary Producers: Medical Necessity vs. Karmic Comeuppance.  I can report on a couple of the things I did and said, though.

Standards Development Organizations in Development
One panel session addressed standards development and implementation, and featured a number of speakers I hold in high regard, along with others whom I hadn't met, but had earned high positions in industry-leading private and public organizations.  One of the former was Alix Goss, chair of X12N, the group responsible for developing administrative transaction standards for the insurance industry, including the familiar 837 claim formats.  Earlier in the day, Alix told me that X12 had rolled out a more interactive web presence, and had added a forum for the (unofficial) Provider Caucus, of which I had once been a member.  She knew I would be pleased, because a few years back, I made a case for expanding provider participation in standards development work [NOTE: MS-Word doc file] through the engagement of collaborative technology.

She should have known not to encourage me.  Because when I realized that before me sat the people responsible for developing and implementing healthcare standards at X12, HL7, BCBSA and CCHIT [mynorca limit exceeded for this article-- look them up yourself -ed.], I made the case for SDO 2.0.

[continued]

Gates' Way to Healthcare

In what must be one of the all time editorial coinky-dinky's in recent memory, an editorial from Bill Gates appears in today's Wall Street Journal -- just one day after Microsoft released its Health Vault Personal Health Record portal! 

But we must admit it's timely.  As Bill points out, "a groundbreaking 1999 report on health-care quality" pointed out that our healthcare system kills nearly a hundred thousand Americans a year, and a 2001 followup "urged swifter adoption of information technology."  And George Bush Jr. even mentioned HIT in his 2006 State of the Union.  Stop the presses!

I'm from Bellevue and I'm Here to Help You
Not to worry, Microsoft is on the case.  "We envision a comprehensive, Internet-based system that enables health-care providers to automatically deliver personal health data to each patient in a form they can understand and use."  That's a relief!  We thought you were building an information silo and hoping patients would somehow deliver information to their providers.  Knowing that your expectation is that all providers will start pushing data back through your narrow, proprieary pipeline is a real relief.  For a minute, there, we thought you were clueless.

Not to Harsh Your Buzz, Dude, But....
Meanwhile, in the non-healthcare press, there's this little line in the Economist about how the industrialized world has managed to make it for nearly 20 years without a major recession, a phenomenon referred to somewhat oxymoronically as "The Great Moderation."  The finding, from a report by Stephen Ceccetti, et al, appears somewhat mundane.  "More than half the improvement in the stability of economic growth in the countries they studied is accounted for by diminished inventory cycles."

You mean it wasn't Windows for Workgroups?

Building the Round Table
That took me back to a book I bought a couple years ago, "Challenge and Consequence....forcing change to eCommerce."  It's a geeky and somewhat breathless account of the evolution of Electronic Data Interchange through the establishment of X12 and other standards development organizations.

Each generation has its challenges and responsibilities.  Some of us born during the period from 1915 to 1950 were challenged to invent electronic commerce....  People worked at this in a spirit of service to company, industry, country, world and each other.  Their work significantly contributed to the outsanding improvment in economies that was experienced during the 1990s, and will continue to be effective for many years to come....

Ralph Notto's book was published in 2005, but most of the content seems to have been written much earlier.  He names names and lists specs.  He tells stories and gives history lessons.  Sometimes he refers to himself in the third person.  As a one-time X12-er, and a strong believer in the win-win proposition of collaborative engagement, I loved every page of it.  But I thought it might be a little over the top in terms of his claims about the economic impact of EDI. 

Until I read that passage in the Economist this morning.

All of Us Is Smarter Than Any of Us
See, solving the problems that HIT can solve is not about developing products, or portals, or PHRs.  It's about everyone coming to the table and agreeing to do things the same way.  That means everybody gives up a bit of control, and they trim their wish lists and moderate their customer promises.  They disclose innovations rather than keeping trade secrets.  They dream about data flowing freely rather than getting bottled up in repositories or being forced through proprietary switches.

We don't need another Bill solution.  We need a Melinda solution.

WEDI, NCHICA to Map HIT Regulatory Timeline

Those of us who work in healthcare IT have this mental cascade of imperatives: regulations, new versions of standards, Medicare mandates and more.  It stretches back in time and on forward into seeming infinity, a dizzying ladder of challenges with strings of letters and numbers indicating the rungs: IPPS, HIPAA, TCS, 4010A1, NPI, ICD-10, 5010, AHIC, ad infinitum.

The trouble is, we are supposed to be familiar with all of them; what's more, we frequently get assigned to implementing multiple initiatives at the same time.  Worse, we are often called upon to implement one intiative (say, the National Provider Identifier Final Rule) when the feds have left out a necessary pre-requisite (like NPI Data Dissemination).  When it happens, we say, "What were they thinking?"  But a more important response is to try to prevent it from happening again, as when a number of standards development volunteers contacted congressional staff to let them know they can't implement the ICD-10 coding system until they've adopted a version of the claim standard (X12 v. 5010, for instance) that supports it.

A new collaboration between the North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA) and the Workgroup for Electronic Data Interchange (WEDI) will serve to connect the dots for regulators, standards developers and industry implementers alike.  It's not a simple calendar, but instead a map that includes dependencies, timelines and comment periods.  Way cool, and way overdue.

Read more about it online at Carolina Newswire and FCW.

HITSP Hits Harmonization

The American National Standards Institute (ANSI) has been awarded the contract to lead the harmonization effort in healthcare IT, along with partners Healthcare Information and Management Systems Society (HIMSS), the Advanced Technology Institute (ATI) and Booz Allen Hamilton.  The contract is one of three awarded by HHS under the sponsorship of David Brailer's Office of National Health Information Technology Coordinator.  The contract goes under the moniker ONCHIT1.

The first order of business is the development of a body to be known as the Healthcare Information Technology Standards Panel or HITSP.  Perhaps in anticipation of winning the contract, ANSI claims that this panel already includes 100 members.  A core group of 18 organizations will constitute the Standards Harmonization Collaborative.

American Health Information Community Commissioners and Curiosities

David Brailer's ONCHIT office just released the names of the 16 Commissioners appointed to American Health Information Community ("The Community" according to the release, or "AHIC" according to everyone else).

• Scott P. Serota, President and CEO, Blue Cross Blue Shield Association
• Douglas E. Henley, M.D., Executive Vice President, American Academy of Family Physicians
• Lillee Smith Gelinas, R.N., Chief Nursing Officer, VHA Inc.
• Charles N. Kahn III, President, Federation of American Hospitals
• Nancy Davenport-Ennis, CEO, National Patient Advocate Foundation
• Steven S Reinemund, CEO and Chairman, PepsiCo
• Kevin D. Hutchinson, CEO, SureScripts
• Craig R. Barrett, Chairman, Intel Corporation
• E. Mitchell Roob, Secretary, Indiana Family and Social Services Administration
• Mark B. McClellan, M.D., Administrator, Centers for Medicare & Medicaid Services
• Julie Louise Gerberding, M.D., Director, Centers for Disease Control and Prevention
• Jonathan B. Perlin, M.D., Under Secretary for Health, Department of Veterans Affairs
• William Winkenwerder Jr., M.D., Assistant Secretary of Defense, Department of Defense
• Mark J. Warshawsky, Assistant Secretary for Economic Policy, Department of Treasury
• Linda M. Springer, Director, Office of Personnel Management
• Michelle O’Neill, Acting Under Secretary for Technology, Department of Commerce

ICD-10 vs. Regulatory Inertia

Congressional HIT advocate Nancy Johnson (R-CT) has drafted legislation that would require a conversion to The International Statistical Classification of Diseases and Related Health Problems Revision 10 (ICD-10) coding for diagnosis and procedure information in electronic healthcare transactions by October, 2006.  What's the problem?  The electronic transactions mandated by HIPAA won't support ICD-10.  What's more, even the most optimistic estimates see adoption of the new 5010 transactions (most of which are still in draft) no earlier than 2009, with a two year implementation window extending to 2011 or later.

Underappreciated HIT Challenge #2 - Alphabet Soup

In HIT (that's "Healthcare Information Technology") we swim in alphabet soup.  We start with the SDOs ("Standards Development Organizations"), some of which are DSMOs ("Designated Standards Maintentance Organizations") as designated by HIPAA (you get the picture).  It seems like each week brings a new, critical TRA ("Three Letter Acronym") which you must immediately incorporate into your vocabulary. 

One of my favorite bits of jargon is "Mynorca" (the expansion of an acronym into its component words).

"Mynorca" is "acronym" spelled backwards.

As difficult as it is to decode the organizational abbreviations into words, getting the products of these organizations (and the people who create them) to work together is a much more significant challenge.  The buzzword here is "harmonization."  Lucky for you, this one is not an acronym.  But while harmonization is getting a fair bit of play in the HIT community -- and even a federal project to boost the effort -- it remains a murky conundrum.