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HIMSS: Software Bugs, Shifting Alliances Unsettling for Healthcare CIOs

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   March 04, 2014


Some revelations made at the HIMSS 2014 conference illustrate how difficult this period of transition is for healthcare executives charged with bringing compliant, interconnected electronic health records systems online at their organizations.

On the last day of the event, CMS announced it would grant more hardship exemptions to those who cannot meet their end-of-2014 attestation dates for Meaningful Use Stage 2. The announcement was a clear victory for CHIME, the College of Healthcare Information Management Executives, whose leaders had lobbied hard along with the American College of Physicians for some leeway during a difficult year. More on that in a future column.

Earlier at HIMSS, the CommonWell Alliance demonstrated its patient ID service operating across different vendors' electronic health record software on the show floor, and arranged for some of its pilot sites to meet with the media. But this was a lower-key event than I would have imagined a year ago. Still, the announcement of a major commitment to the work of the alliance by Tenet Healthcare was evidence of some solid momentum.

Seemingly in response, Epic and a number of partners active in the Care Connectivity Consortium, including government-assisted Healtheway, announced Carequality, a collaborative bringing together EHR vendors, HIE vendors, care providers, and IT organizations together to address the remaining challenges involved in inter-network exchange.


Meet Carequality
Carequality's goal, announced also in low-key fashion at the very start of last week, is to facilitate agreement on a common national-level set of requirements that will enable providers to access patient data from other groups as easily and securely as today's bank customers connect to disparate banks and user accounts on the ATM network.

The following 26 organizations have signed up as founding members: California Association of Health Information Exchanges, CareEvolution, Community Health Information Collaborative, CVS MinuteClinic, eClinicalWorks, Epic, Greenway Health, HIElix, Hyland Software, ICA, Intermountain Healthcare, InterSystems, Kaiser Permanente, lifeIMAGE, MDI Achieve, Medfusion, Medicity, MedVirginia, Mirth, Netsmart, New York eHealth Collaborative, Optum, Orion Health, Santa Cruz Health Information Exchange, Surescripts, and Walgreens.

At HIMSS, I approached CommonWell leader and RelayHealth vice president of strategy Arien Malec for a comment on Carequality, and he seemed fairly certain that there can be a meeting of the minds between CommonWell and Carequality at the appropriate time.

What About Deliverables?
Setting an April 1 deadline to become a founding member, Carequality was a bit vague on deliverables, saying it was just beginning its activities on a common interoperability framework. But it seems that in this pivotal year where healthcare interoperability has to take more definite shape, stakeholders are certainly filling their calendars with commitments to once again see if work by committee can trump the forces of free-market competition.


In its lengthy announcement, an additional 16 organizations have also expressed support for the Carequality vision and mission:, Alaska eHealth, Care Connectivity Consortium (CCC), etHIN, GE Healthcare, Guthrie Health, Healthbridge, HEALTHeLINK, Marshfield Clinic, Medical University of South Carolina, MEDITECH, Michigan Health Information Network, National Association for Trusted Exchange (NATE), OCHIN, Premier Family Physicians and RSNA.

I also spent time last week with Jacob Reider, MD, chief medical officer of the Office of the National Coordinator for Health Information Technology. Here too, the choices facing healthcare vendors and customers alike seem to be proliferating. A new 2015 Edition Proposed Rule, published in last Wednesday's Federal Register, is sowing its own seeds of confusion.

The 2015 Proposed Rule serves a lot of different purposes, but practically speaking, it has no impact on providers' efforts to achieve Meaningful Use Stage 2 attestation this year. It has some important objectives, nonetheless, including bringing long-term post-acute care providers into voluntary compliance with the Meaningful Use standards, although with no incentive money to accompany it.

ONC 'Not Working On' National Patient ID
One big takeaway from my conversation last week with Dr. Reider was to understand the limits of both Meaningful Use software certification, and ONC's recent effort to help providers in the tricky area of patient identity.


In our conversation, Reider indicated that nothing ONC has recently undertaken amounts to any progress toward a national patient identifier.

"ONC is not working on national patient ID," Reider says. "ONC is working on understanding best practices regarding patient matching. They're two different topics. One topic, national patient ID, is a proposed solution. Other countries have employed that solution. That solution does not address all of the challenges of patient matching. Even in countries where there is a national patient ID, matching this patient to this record is still something that's necessary."

Instead, ONC's work is already producing a set of best practices for patient matching. It's still up to non-governmental U.S. organizations, such as CommonWell, to champion their own patient ID proposals, perhaps using ONC's work to get there a little faster.

No Software Without Bugs
The limits of ONC's software certification may be one of my biggest causes for concern given something I heard multiple times at HIMSS—that certified Meaningful Use Stage 2 software is currently riddled with bugs keeping implementations from proceeding smoothly.

"There is no such thing as software without bugs. No such thing," Reider says. "That's not a secret. The question is, how serious are those bugs? The certification program isn't a thorough, deep quality assurance process."


Reider likens ONC certification to getting a car "smogged" to ensure that emissions are below a set level. "At the end of that analysis, the machine says 'yes, this passes,'" he says. "But it's not testing whether the windows go up and down properly. It's not testing whether the seats go backwards and forwards, or whether the radio works perfectly."

Some critics say ONC should test the software more than it does. Some say it should test less. "We're in the middle of that," Reider says.

It's also true that healthcare providers are caught in the middle, in this most difficult of years, squeezed by the golden handcuffs of incentive programs now entering the penalty phase, squeezed by vendors distracted from eliminating bugs in their software by the need to choose partners in elaborate jockeying to appear to be more interoperable than the next company.

Let's hope the next HIMSS conference doesn't leave us with quite so much confusion and uncertainty.


Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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