Health Data Revolution

"In the next twelve months there is going to be the most dramatic democratization of access to health information that we've seen ever."

SiliconANGLE interviewed Farzad Mostashari, MD, the National Coordinator for Health IT at the 2013 MIT Chief Development Officer Information Quality Symposium which had the theme "Big Data Demands Good Data." Dr. Mostashari gave a nice overview of the EHR incentive program and what is meaningful about meaningful use. There was also a recognition of the need for advanced analytics that leverage increasingly large sets of high quality data to help ensure that care outcomes, costs, and quality of service delivered are trending in the right direction.They had a wide ranging discussion from health reform to healthcare technology, and it is well worth time to watch.



In healthcare we talk a lot about quality data - data about healthcare quality - but there has been a great deal of discussion, now that we are beginning to aggregate massive health data sets, about data quality - the quality of the data. They have held these CDOIQ Symposiums since 2006, and I am glad this one is now on my radar. You can also watch a bunch of other fascinating interviews and conversations on the SiliconANGLE YouTube page from this conference and many other excellent gatherings.

Health Data Searcher Beware!

Patients who search on free health-related websites for information related to a medical condition may have the health information they provide leaked to third party tracking entities through code on those websites, according to a research letter by Marco D. Huesch, M.B.B.S., Ph.D., of the University of Southern California, Los Angeles. The research letter was recently published in JAMA Internal Medicine entitled "Privacy Threats When Seeking Online Health Information" and looked at how 20 health-related websites track visitors, ranging from the sites of the National Institutes of Health to the health news section of The New York Times online. Thirteen of the sites had at least one potentially worrisome tracker, according to the analysis performed by Dr. Huesch.

He also found evidence that health search terms he tried — herpes, cancer and depression — were shared by seven sites with outside companies. According to the paper:

"A patient who searches on a “free” health-related website for information related to “herpes” should be able to assume that the inquiry is anonymous. If not anonymous, the information knowingly or unknowingly disclosed by the patient should not be divulged to others.
Unfortunately, neither assumption may be true. Anonymity is threatened by the visible Internet address of the patient’s computer or the often unique configuration of the patient’s web browser. Confidentiality is threatened by the leakage of information to third parties through code on websites (eg, iframes, conversion pixels, social media plug-ins) or implanted on patients’ computers (eg, cookies, beacons)."

Dr. Huesch says that he was inspired to investigate this area by the archive of coverage on the topic by The Wall Street Journal on how the technology and market for your online information work. The most recent piece in this series is on Facebook privacy settings and some of the risks associated with "Graph Search." This entire series is very good and worth the read.

The research paper states:

"My findings suggest that patients and physicians who are concerned about the privacy of information about their health-related searches may prefer to search through government websites or those of professional societies. Alternatively, individuals can use privacy tools that are available free of charge when searching and browsing online. Examples are DoNotTrackMe and Ghostery. Use of these tools created some inconveniences but generally did not affect the functionality of the websites I examined."

The tool Dr. Huesch used for his research Ghostery has been noted to have some problems however. The MIT Technology Review posted an article last month which points out that Ghostery is owned by a company that uses the data it collects from its users to help advertisers target their ads better. It seems that few of those who advocate Ghostery, including Dr. Huesch, as a way to avoid the online ad industry realize that the company behind it, Evidon, is in fact part of that industry. Evidon helps companies that want to improve their use of tracking code by selling them data collected from the 8 million Ghostery users who have enabled the tool's data sharing feature.

The paper states:

"Many third parties use the information they collect only to target advertising (eg, DoubleClick). However, nearly 300 third parties use the information to track consumers, delivering advertising related more directly to the user’s known or inferred interests, demographics, and prior online behavior.
These weaknesses in privacy practices have been detailed in the news media. The Federal Trade Commission has called for consumer privacy legislation. Online privacy guidelines for searches on health topics have been published. 6 But privacy threats are poorly understood because of the technical nature of online data collection and aggregation."

The paper does not suggest any direct damage from the tracking but does note the potential: "The ramifications could span embarrassment, discrimination in the labor market, or the deliberate decision by marketers not to offer or advertise particular goods and services to an individual, based solely on the companies’ privately gathered knowledge."

Tracking of Searches at 20 Health-Related Websites

The paper concludes that "failure to address these concerns may diminish trust in health-related websites and reduce the willingness of some people to access health-related information online. Until strong consumer privacy legislation is enacted, individuals should take care how much trust they place in their anonymity and the confidentiality of their information when online."

Turn the page

After eleven years working at Mid-Columbia Medical Center (MCMC) in The Dalles, Oregon, I have decided to take advantage of some new opportunities and move on from the organization. This was a very difficult decision to make because I truly love MCMC. In 1992 MCMC was the first hospital in the world to implement the Planetree concept of patient-centered care facility wide, and in 2007 MCMC was recognized as a "Designated Patient-Centered Hospital", only one of five such hospitals in the country.

I've written about Planetree before and have always been incredibly impressed with the organization. It is with great gratitude that I leave both MCMC and Planetree since my life life has been dramatically changed by being a part of these fine institutions, but I am sure that at some point in the future we will cross paths again. The heart of the organization is patient-centered and I will always support these principles.

I am leaving MCMC, but fortunately I don't have to leave The Dalles, and will continue work both locally, statewide, and nationally on healthcare transformation. I live in one of the most beautiful places in the country: the gorgeous Columbia River Gorge! I am very grateful that my new opportunities are not requiring me to relocate.

I am also very grateful to people at MCMC who have been instrumental in my success. Of course some of the most important are: my boss, the CIO Erick Larson, the Medical Director Judy Richardson, and also the CFO Don Arbon, as well as the CEO Duane Francis (who actually invented the position Health IT Evangelist and the article in Government Health IT magazine was subsequently cited on the ONC website Health IT Journey's page... it makes for an interesting read :). But most of all I am in debt to Elise Bailey, one of the many unsung heroes of our healthcare system, for her faith in me and her unwavering faith in the power of Jesus Christ to transform lives. She gave me the chance I needed and believed in me eleven years ago when few others would. I will always be very grateful.

But like all great chapters in life, it is time to turn the page and move into the next phase of the journey. I have created Advanced Health Information Exchange Resources (AHIER) and will be working on Outreach and Business Development for DirectTrust (among other things) under a cooperative agreement with the ONC to participate in the Exemplar HIE Governance Program. DirectTrust is partnering with ONC and other participants to develop and adopt policies, interoperability requirements and business practices that align with national priorities. The goal is to overcome some of the EHR interoperability challenges, reduce implementation costs, and assure the privacy and security of health information exchange. Much of this effort has sprung from the Scalable Trust Forum.

I also have some other consulting engagements lined up, and I will continue to tweet, blog, and write about health IT and the technology infrastructure that supports new payment and care delivery models. One of the first things I am going to do is slowly transform this blog into more of hybrid blog/website. I will continue with somewhat of a focus and EHR and HIE, but also begin moving into the area of analytics. I once said "Big data is the next big thing in health IT," and now that we have begun aggregating this massive data set, the next wave beginning to crest is analytics. So watch for some posts focused on business intelligence and analytics capabilities, as I continue to cover the digitization of healthcare.

EHR Vendor Market Share

The latest SK&A "Physician Office Usage of Electronic Health Records Software" report shows continued growth in EHR software adoption, with 50% adoption in medical offices. In addition to reported trends by specialty, office size, application and ownership, this latest edition ranks EHR vendors by market share (see table below). You can register for a number of their reports for free here: http://www.skainfo.com/reports

SK&A was awarded a contract by the U.S. Department of Health and Human Services (HHS), Office of the National Coordinator for Health IT (ONC), to provide ongoing survey information about the adoption, usage and planned usage of electronic health records (EHR) by physicians in U.S. medical offices. The SK&;A OneKey database of 251,000 medical offices and over 700,000 physicians is delivered to ONC quarterly.

SK&A's Research Center in Irvine, Calif., conducts telephone interviews with office managers and physicians in all 50 states and the District of Columbia. Every month, the researchers survey and verify information at more than 40,000 sites. Medical offices are asked about their intent to purchase an EHR and about their timeframe, decision factors (such as price and functionality), and awareness of government incentives for adopting EHR technology.

EHR Vendor Market Share by Practice Size Rank Vendor Name Number of Physicians in Practice 1 to 3 4 to 10 11 to 25 26 to 40 41+ Overall 1 Allscripts 10.0% 13.2% 11.6% 10.7% 7.1% 10.6% 2 eClinicalworks Logan Solutions 11.0% 8.6% 5.5% 3.4% 0.0% 10.5% 3 Epic Systems Corporation 8.1% 17.0% 30.1% 33.5% 51.0% 10.3% 4 NextGen Healthcare 5.3% 9.3% 9.9% 5.3% 6.1% 6.1% 5 Practice Fusion 7.1% 1.0% 0.1% 0.0% 0.0% 5.8% 6 General Electric Healthcare IT 3.3% 7.2% 8.0% 11.2% 10.2% 4.1% 7 McKesson Provider Technologies 3.8% 2.7% 3.0% 5.8% 4.1% 3.6% 8 Cerner Corporation 3.1% 4.6% 8.0% 11.2% 10.2% 3.5% 9 AmazingCharts.com, Inc. 3.2% 0.5% 0.0% 0.0% 0.0% 2.7% 10 athenahealth, Inc 2.5% 1.6% 0.4% 0.0% 0.0% 2.3% 11 Greenway Medical Technologies, Inc. 1.7% 3.9% 2.3% 0.0% 2.0% 2.0% 12 MedPlus, A Quest Diagnostics Co. 2.3% 0.5% 0.1% 0.0% 0.0% 1.9% 13 e-MDs, Inc. 2.1% 1.5% 0.4% 1.0% 0.0% 1.9% 14 MEDITECH, Inc. 1.5% 2.8% 4.6% 6.3% 1.0% 1.8% 15 Vitera Healthcare Solutions 1.4% 2.1% 1.1% 0.5% 0.0% 1.6% 16 Community Computer Service Inc. 1.1% 1.9% 0.9% 0.0% 0.0% 1.2% 17 BioMedix Vascular Solutions 1.3% 0.3% 0.0% 0.0% 0.0% 1.1% 18 Office Ally 1.3% 0.2% 0.0% 0.0% 0.0% 1.1% 19 SOAPware, Inc. 1.1% 0.2% 0.0% 0.0% 0.0% 0.9% 20 NexTech Systems, Inc. 0.9% 0.3% 0.1% 0.0% 0.0% 0.8% 21 All Others Vendors (422) 27.8% 20.7% 14.0% 11.2% 8.2% 26.3% Grand Total 100% 100% 100% 100% 100% 100%

Source: SK&A, A Cegedim Company, May 2013.