“What can we say about the IT policy direction of the US right now?
1. There seems to be great consensus that all stakeholders need to focus on enhancing interoperability technology and policy in support of care coordination, population health, precision medicine, patient/family engagement, and research.
2. There is also a consensus that usability of the IT tools in the marketplace needs to be enhanced. Although the major EHR vendors are working on usability improvements, I believe the greatest agility will come from startup community via apps that get/put data with EHRs using APIs based on evolving FHIR standards. Here’s my sense of each vendor’s approach
Epic – will support open source FHIR APIs at no cost for the use cases prioritized by the Argonaut working group and HL7. Will also support proprietary Epic APIs for Epic licensees.
Cerner – similar to Epic with additional SMART on FHIR support
Meditech – will support open source FHIR APIs and give encourage developers to work with customers to leverage the SQL-based Meditech data repository at each customer site.
Athena – will support open source FHIR APIs at no cost but give much more sophisticated workflow integration through the more disruption please program, which involves revenue sharing with developers.
eCW – the department of justice settle should lead to additional eCW support for standards based data exchange …
It will be a great time for entrepreneurs, providers, and patients, all of whom are fatigued after years of Meaningful Use, ICD10, and accelerating numbers of quality measures. As a CIO, I’m looking forward to doing what my customers want me to do instead of being told what I must do.”
In the foregoing excerpt from the July 6, 2017, post to his blog Life as a Healthcare CIO, (http://bit.ly/1MEsYL2), John D. Halamka, MD (Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician) summarizes and speculates on health information technology (IT) for providers in this year and into the future. However, “It will be a great time for entrepreneurs, providers, and patients …” only if healthcare provider subject matter experts can obtain a “hands on” position with state-of-the-art IT to obtain customized cognitive support for medical practice and healthcare delivery without having to compromise with the multitude of electronic health record (EHR, a.k.a. hospital information systems or HIS) users and awaiting the independent software vendors’ next releases.
(N.B. — It is this vision of hands-on computer use by physicians that gave rise to the Massachusetts General Hospital (MGH) Utility Multi-Programming System (MUMPS), from which the first commercial HIS/EHR named MEDITECH was derived, created by Neil Papalardo and a couple of other IT innovators in the Laboratory of Computer Sciences at MGH directed by G. Octo Barnett, MD, to run on the now defunct Digital Equipment Corporation (DEC) PDP-7 computer. Some physicians who had the vision to embrace MUMPS, both the interpretive programming language and the system that included its own database construct, went on to cooperate with developers/programmers and to pave the way for clinical computing, the most renown example of which is the USA Veterans Administration’s VistA clinical information system, re www.worldvista.org).
An IT solution compliant with The Cloud Healthcare Appliance Real-Time Solution as a Service (CHARTSaaS) reference architecture (RA) will facilitate the HIT direction envisioned by Dr. Halamka by enabling healthcare provider subject matter experts to create IT applications a.k.a. “apps” for cognitive support with little or no expert help from IT staff. Such apps can automate such problematic and error-prone use cases as differential diagnosis, treatment planning and alarm/alert fatigue mitigation; and they can leverage the application programming interface (API) approach to interoperability now being offered by the EHR independent software vendors. Please validate my CHARTSaaS RA proposition to your own satisfaction by reading the white paper at http://bit.ly/2vmK1Rx, viewing the tutorials posted on YouTube (http://bit.ly/2sVajvS and https://www.youtube.com/watch?v=f5OtbCCDNLs) and also by reviewing the details of CHARTSaaS™ and the CHARTSaaS RA™ in these presentations:
Healthcare providers will benefit significantly from appreciating and then applying a CHARTSaaS RA-compliant IT solution. To do so will mitigate medical mistakes (currently the third leading cause of patient deaths. per Makaray and Daniel (http://bit.ly/1rtW6Sa); thereby minimizing patient adverse events and optimizing clinical case outcomes while maximizing the cost-effectiveness of care and treatment, and also accelerating the accrual and facilitating the application of medical knowledge.