Feature Articles

Dutch Parliament: Vendor Dependence Too High a Cost

The Dutch government’s lack of vendor independence is too high a cost for society, the Dutch Parliament concludes. The government should enforce its policy on open standards in ICT procurement and should also devise exit strategies - to reduce its dependence on ICT suppliers. This week Tuesday, the parliament adopted a resolution criticizing the government for having no open source ambition. The resolution was adopted with 136 votes in favour and 14 against. The parliament calls upon the government to make sure that in any new ICT project, the specifications give open source a fair chance. When proprietary software is selected, this needs to be explained, the parliament stipulates. “(the) dependence on a limited number of large software vendors (is) too strong”, the resolutions says, adding that this can lead to software costs that are too high for society.

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Is Machine Interoperability the Next Unusable Level of Meaningful Use?

As the HIMSS15 extravaganza is getting under way, and every EHR vendor flush with cash from the Meaningful Use bonanza is preparing to take its unusable product to the next level, machine interoperability is shaping up to be the belle of the ball. A simple minded person may be tempted to wonder why people who, for decades, manufactured and sold EHRs that don’t talk to each other, are all of a sudden possessed by interoperability fever. The answer is deceptively simple. After exhausting the artificially created market for EHRs, these powerful captains of industry figured out that extracting rents for machine interoperability is the next big thing.

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openEHR: A Game Changer Comes of Age

I’ve been watching openEHR over more than fifteen years and have always been impressed by its potential to enable us to do things differently, but it’s been a slow burn, with limited take up, particularly in the United Kingdom (UK) where it was invented. However, recent developments mean that I think this is about to change and that openEHR is going to take off in a big way which is going to revolutionize how we think about and do digital health and increase the speed at which we can do it by at least two orders of magnitude. Why do I say this and what evidence is there to support my assertion?

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5 DIY Hardware Platforms for Physiological Computing

Physiological computing focuses on the use of biosignals for the development of interactive software and hardware systems capable of sensing, processing, reacting, and interfacing the digital and analog worlds. However, biosignals have specific requirements for which typical physical computing platforms are not particularly tuned. Until recently, many projects ended up hindered by high costs and limited access to suitable hardware materials. That scenario is different today, partially thanks to the following 5 DIY hardware platforms...

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Cloud-based EHR Interoperability Takes Front Stage

Because our industry is still in diapers, we focus on the lack of basic interoperability and ruminate on why EHR vendors struggle (aka, refuse) to share even basic patient data. But we must take heart, health IT friends, stiffen our upper lips and look to trends and examples that create optimism (i.e., help get us out of bed in the morning): 21st century interoperation is happening in health IT. In a recent interview with Healthcare Dive, Athenahealth CEO Jonathan Bush laid out a vision for how the cloud is the disruptive technology to bring healthcare into the Internet age. He describes “level three interoperation,” where two cloud-based systems connect once and support multiple interoperations that accomplish more than just data sharing.

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Congressman Roe Reintroduces Bill To Create Joint Military EHR System

On Tuesday, Rep. Phil Roe (R-Tenn.) reintroduced legislation that calls for the development of an integrated electronic health record system for members of the military and veterans, Politico's "Morning eHealth" reports (Allen et al., "Morning eHealth," Politico, 3/25)...According to WBIR, the bill would establish a temporary panel to create criteria for the EHR system, which would then be created by a U.S.-based vendor. The vendor would receive a lump sum of $50 million to develop the system, as well as $25 million annually over five years to operate the system. Roe said a joint military and veterans EHR system would help to streamline the transfer of medical records between DOD and VA. In addition, Roe said the system could help ease coordination of benefits claims and care.

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‘Open Source, Open Science’ meeting report – March 2015

On March 19th and 20th, the Center for Open Science hosted a small meeting in Charlottesville, VA, convened by COS and co-organized by Kaitlin Thaney (Mozilla Science Lab) and Titus Brown (UC Davis). People working across the open science ecosystem attended, including publishers, infrastructure non-profits, public policy experts, community builders, and academics. Read More »

Halamka on MU3 Regs: The Good, The Bad, and the Ugly

On Friday March 20, CMS released the Electronic Health Record Incentive Program-Stage 3 and ONC released the 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Perhaps the most important statement in the entire 700+ pages is the following from the CMS rule:  "Stage 3 of meaningful use is expected to be the final stage and would incorporate portions of the prior stages into its requirements."

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Are Smartwatches Being Over-Hyped as Health Trackers?

I don't get smartwatches. Yes, I know; they're all the rage.  Apple unveiled its Apple Watch earlier this month, to generally good if not entirely ecstatic reviews.  Not to be outdone, Google announced a collaboration with TAG Heuer and Intel for a "Swiss Smartwatch."...I have to wonder why the focus on the wrist.  It isn't the ideal place to track, say, your heartbeat, your sleep, or your steps, and as a result fitness trackers have been faulted about their accuracy.  Cramming features into a smartphone makes some sense, because they have become so ubiquitous, but I'm not sure who is clamoring to add more features to a watch...

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Stage 3 Meaningful Use – Objectives and Measures Summary

Last Friday (3/20/15) the ONC released the proposed rule for Stage 3 Meaningful Use (MU3).  Whenever this type of document is released, I find it useful to summarize the objectives and measures from the background and details into a more concise format.  It was tedious work, but in the end it saves me paging through a 301 page document. I figured that if I found it useful, others might as well, so I posted the summary on the Clinical Architecture blog.  Our mission is to help evolve the clinical architecture of the healthcare industry.  A big part of that has to do with terminology, since terminologies are the language of healthcare solutions.  These Meaningful Use initiatives are fundamentally about how we share and use terminology.  Understanding the planned objectives and proposed measures allows us to provide feedback to the ONC and help our partners prepare for what is coming.

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Engineering OpenClinica’s Future

We believe all research participants—patients, clinicians, researchers, should have technology that meets the ‘anytime, anywhere’ expectations of a mobile, smartphone enabled world. Based on conversations with the OpenClinica community, many of you share this view as well. We are committed to making sure, at minimum, that OpenClinica’s patient engagement technology ‘just works’ in mobile, real world environments. Wherever possible, we will go beyond that and work to make the participant experience engaging, fun, and inspiring. As transformational as these patient engagement capabilities can be, what we’ve been working on is about more than that. This is about a foundation for the future of the OpenClinica project.

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How the American Health Care Business Turned Patients into Consumers

A clash of cultures is rapidly developing among those of us who see the mission of the health care system to be primarily the diagnosis and healing of illness and those who see it primarily as an opportunity to create personal wealth. The concept of health care primarily as a business is uniquely American, and it has gained ascendancy during the last few decades. While there have always been a few greedy doctors, businessmen-wealth-seekers — not doctors — now dominate the medical-industrial complex. 

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What the IoT can learn from the health care industry

After a short period of excitement and rosy prospects in the movement we’ve come to call the Internet of Things (IoT), designers are coming to realize that it will survive or implode around the twin issues of security and user control: a few electrical failures could scare people away for decades, while a nagging sense that someone is exploiting our data without our consent could sour our enthusiasm. Early indicators already point to a heightened level of scrutiny — Senator Ed Markey’s office, for example, recently put the automobile industry under the microscope for computer and network security. Read More »

Halamka Reports on the Progress on Interoperability Made by the HIT Standards Committee

The March 2015 HIT Standards Committee was one of the most impactful meetings we have ever had. No, it was not the release of Meaningful Use Stage 3 or the certification rule. It was the creation of a framework that will guide all of our work for the next several years - everything we need for a re-charted standards harmonization convening body as well as a detailed interoperability roadmap, complementing the 10 year general plan developed by ONC. Thanks to Arien Malec for yeoman’s work in both areas...

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FrontlineSMS, Human Usability, and the Missing Middle Mile

FrontlineSMS started in 2005 with what seemed like a simple, clear ambition: make a tool that makes it easy for offline communities to communicate. The goal wasn’t innovation or profit, it was simply to get a useful tool into the hands of as many people as possible...Looking back, it feels naive to think that it could ever be simple—that delivering usable, open source, multi-channel tools that drive measurable, positive outcomes through text messaging could have ever felt inevitable. Nine years and many iterations (and tens of thousands of users) later, though, we’re more successful than ever—and mostly for unexpected reasons...

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