Feature Articles

ONC Releases 2018 HITECH Report

In early January the Office of the National Coordinator for Health Information Technology (ONC) issued its annual report to Congress for 2018 on the adoption of electronic health records (EHR) and interoperability. This report is required under the HITECH Act and is further informed by requirements of the later 21st Century Cures Act...One thing that I think is notable was a short discussion about barriers to interoperability that we have heard before. The report identifies three types: technical barriers, financial barriers, and trust barriers. Within trust barriers the report mentions legal incentives to keep data from moving (I guess that would have better been phrased as legal disincentives to sharing), but this misses the point: It is the patchwork of inconsistent and incompatible State and local laws and regulations - not intentional information blocking - that presents a bigger challenge and barrier.

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In God We Trust, All Others (Don't) Pay Cash

I was intrigued by a recent Wall Street Journal article about how some retail establishments won't accept cash as a form of payment, citing Drybar, Sweetgreen, and at least one Starbucks location. Cashless is touted as faster, safer, easier to administer, and in line with most customers' preference. Indeed, a new study from the Pew Research Center found that 29% of all U.S. adults don't use cash at all in their typical week, up from 24% in 2015. The higher the household income, the less cash was used. Alistair Johnson writes in Forbes that, hey, if we're going to a cashless society, we should make it a cardless one as well, not simply replace our cash with those pieces of plastic we use for debit/credit. I think he's on to something there, and both discussions made me think about how we change the constructs of our everyday lives -- including in healthcare.

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Open Source Space Academy Opens in Nairobi

Nairobi's Tunapanda Institute has been using open source tools to provide technology, design, and business training in East Africa since its inception in 2013. Next year the school will launch a "space academy" to inspire young people to think about some of the most critical challenges facing humanity on this planet and beyond. Tunapanda's founders believe that everyone should have the opportunity to help shape the future, and in order for that to happen there must be learning materials and tools that are open, shareable, and unrestricted so that anyone, no matter their financial or educational background, can learn and be inspired.

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Why Data Scientists Love Kubernetes

Let's start with an uncontroversial point: Software developers and system operators love Kubernetes as a way to deploy and manage applications in Linux containers. Linux containers provide the foundation for reproducible builds and deployments, but Kubernetes and its ecosystem provide essential features that make containers great for running real applications...What you may not know is that Kubernetes also provides an unbeatable combination of features for working data scientists. The same features that streamline the software development workflow also support a data science workflow! To see why, let's first see what a data scientist's job looks like...

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HHS Releases Landmark Report: Reforming America's Healthcare System

On December 3, 2018, the Department of Health and Human Services (HHS) released an extensive, 120-page report on the administration's proposals to reform the healthcare system. The report, titled Reforming America's Healthcare System Through Choice and Competition, is divided into four major sections. The report that government policy of the last few years has suppressed competition, increased prices for healthcare, and limited choices for consumers. Though rich in detail as it tries to prove each of these points, the more than fifty recommendations are often broad and aspirational rather than practical. Since I am not a health economist, I will leave the market issues to others to discuss (many of the ideas in this report have been vetted and discussed by others previously). But there are two sections of the report which make direct mention of Health IT.

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2019 Forecast: Amara's Law

I have two predictions for 2019. One is that at the end of 2019 our healthcare system will still look a lot like it looks now. Oh, sure, we'll see some cool new technologies, some innovative start-ups, some surprising corporate pairings, some moves by Big Tech, and some promising clinical findings. But our healthcare system moves slowly, and many in it have strongly vested interests in the status quo. The second prediction is that, more than ever, Amara's Law still prevails. In case you don't know this "law," it is attributed to Roy Amara, who was President of the Institute for the Future, among other things, and goes like this...

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A Public Health Perspective on ONC's Strategy to Reduce Burden on Physicians

On November 28, 2018, the Office of the National Coordinator for Health Information Technology (ONC) released a draft Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs for public comment. The strategy aims to reduce the time and effort and improve the functionality of electronic health records (EHRs) for clinicians, hospitals, and other healthcare organizations. This strategy was developed primarily through the efforts of ONC-convened workgroups in response to requirements laid out by Congress in the 21st Century Cures Act (Section 13103). The report itself does not identify who exactly served on these workgroups and what organizations were represented.

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Creating EHRs that Doctors Don't Hate

It may be difficult to recall now, what with the ongoing Cerner deployment and recent challenges that had little to do with technology, but there was a time when the Department of Veterans Affairs was considered the gold standard for healthcare IT. VA was out front with the initial development in the 1970s of the VistA system, which would come to be widely recognized and frequently honored. Indeed, when VA was overhauled in the 1990s, VistA was the primary tool that enabled the success of new policies. Without question, much of the effectiveness and durability of VA's VistA can be attributed to the way it was developed, specifically to the collaboration between technologists and clinicians that defined the process.

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The risks and rewards of IoT in healthcare

The Internet of Things (IoT) is taking the industries of the world by storm, and the healthcare sector is no exception. With 101 million IoT devices worldwide, the healthcare industry is becoming more connected by the day, and this figure is expected to increase by over 62% by 2020. As is always the case with new technology, the growing presence of IoT in the healthcare industry poses several threats to both patients and providers - but do the rewards outweigh the risks? Firstly, let's explore some of the key benefits that IOT can bring to healthcare:

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How are Clinical Decision Support Artifacts Tested Today?

In October 2018 the Centers for Disease Control and Prevention (CDC) issued a Request for Information (RFI) for a Natural Test Collaborative (NTC). Through a series of questions, the RFI seeks opinions and information about "The development of a national testbed (notionally called the National Test Collaborative (NTC)) for real-world testing of health information technology (IT)" and "Approaches for creating a sustainable infrastructure" to achieve it. The scope of this RFI is daunting. It might be useful, rather than to try to tackle this whole topic broadly but superficially, to take just one Clinical Decision Support (CDS) domain and show as completely as possible how testing is currently done.

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The Microsoft Empire Strikes Back

It seems deeply ironic that a week after I wrote about how even giant companies eventually get surpassed, I'm writing about the resurgence of one such giant, Microsoft. Last week Microsoft won back the title of world's most valuable company (as measured by market cap), passing Apple. Apple had that distinction since 2012; Microsoft hasn't had it since 2002. Admittedly, Microsoft was only able to pass Apple because a recent tech stock downturn dropped Apple from its record trillion-dollar valuation, and, as of this writing, Apple has pulled back in front again, but the fact that it is a race again says a lot about Microsoft.

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Five Tech Trends Affecting Healthcare IT Today, and Tomorrow

Technology is evolving faster than ever before, and shows no sign of slowing down. Digital innovation has enhanced the way we operate in almost every aspect of modern life, but in the healthcare industry, technology is not only changing lives, it's saving them too. Outlined below are five technology trends that are taking hold of the healthcare IT industry today, and what developments we can expect to see over the course of 2019 and beyond.

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3 Emerging Tipping Points in Open Source

Over the last two decades, open source has been expanding into all aspects of technology-from software to hardware; from small, disruptive startups to large, boring enterprises; from open standards to open patents. As movements evolve, they reach tipping points-stages that move the model in new directions. Following are three things that I believe are now reaching a tipping point in open source. As the name suggests, the open source model has mainly been focused on the source code. On the surface, that's probably because open source communities are usually made up of developers working on the source code, and the tools used in open source projects, such as source control systems, issue trackers, mailing list names, chat channel names, etc., all assume that developers are the center of the universe.

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CDC Issues RFI for Real-world Testing of Health Information Technology

In October the Centers for Disease Control and Prevention (CDC) issued a Request for Information (RFI) for a Natural Test Collaborative (NTC). Through a series of questions, the RFI seeks opinions and information about "The development of a national testbed (notionally called the National Test Collaborative (NTC)) for real-world testing of health information technology (IT)" and "Approaches for creating a sustainable infrastructure" to achieve it. The scope of the questions is somewhat confusing and quite broad, starting with Clinical Decision Support (CDS) and electronic Clinical Quality Measures (eCQMs) but quickly expanding to Electronic Health Records (EHR) and interoperability (not precisely defined).

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The Big Get Bigger, Until They Don't

You may have missed it, but the Open Markets Institute released a report on what it calls "America's Concentration Crisis." The report begins bluntly: "Monopoly power is all around us: as consumers, business owners, employees, entrepreneurs, and citizens." As David Leonhardt wrote in his op-ed about the report, "The federal government, under presidents of both parties, has largely surrendered to monopoly power." Their associated data set details market concentration within 32 industries, several of which are health related. For example, in electronic health record systems, the top 3 firms account for 58% of the market, whereas in pharmacies/drugstores, the top 3 control 67% (and the top 2 alone have 61% share).

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