Direct HISP - HIE the Verb

What happens when you version the standards for P2P exchange? One of the key value propositions of "HIE the noun", for example an Enterprise Service Bus (ESB) based regional patient-centric exchange, is that it abstracts between data providers and data consumers. Thus, if a new standard comes along, some can implement it and some can hold off. The HIE provides the abstraction between the two. There is no tight-coupling between trading partners. In the "we will all do the same thing peer to peer" model, doesn't it break when something new comes along? Otherwise, every P2P end-point needs to support every standard that emerges as they emerge and until everyone has it implemented, the world is frozen. That sounds an awful lot like where HIT is with ICD10 right now. Most systems seem to have tightly coupled to the ICD9 codes rather than having an abstraction in their system between internal coding and the outward facing standard codes, now they have trouble upg...

In " Ryba's 16 rules of effective HIE " published in Government Health IT, I recently wrote about what I believe to be the rules that can be used to define an HIE that is reusable across all use cases. I don't get into what technical implementation it supports or even what type of healthcare information is being exchanged. However, if your HIE complies with these rules, I believe you have a "fully effective" HIE. That said, if it does not, it may or may not be adequately effective for where the world is today. The point is, these rules are what I think exchanges, public or private, should comply with, or at least should be able to comply with, from a functional perspective. How soon you will need to meet all of them will probably be determined by market forces or government mandates in your area. While I left technology out of the rules, if you follow any of my previous writings, you know I of course believe that a services oriented architecture and enter...

There have been a lot of varied models of care management for many years now that are described by terms like Health Homes, Patient Centric Medical Homes, Primary Care, Managed Care, Accountable Care, etc. One thing I have noticed is that the industry seems to skim over the fact that this cannot be a patchwork quilt of care. It needs to be a woven fabric of care that can be cut and sewn into varied models through mass customization. We cannot expect that a provider is going to function differently if the patient in front of them is enrolled in a particular program or not. That certainly isn't going to create administrative efficiencies; quite the opposite. If they have to capture different information, provide different information, or provide different treatment based on how care is paid for; they will certainly be less efficient due to administrative burdens. Therefore, the customization needs to happen in the background as part of the ACO business processes.   Business proce...