Brendan, repeating the comment I posted in LinkedIn, but don't feel obliged to post your response in both places...
thank you for this analysis, and links to resources.
You didn't open a can of worms all the way re secondary uses, but I will.
Your recommendation is for Carequality to prohibit "secondary uses" by "on-ramps". Shouldn't that prohibition extend to HINs/HIEs/QHINS? I have a problem with any entity sitting in the middle of an end-to-end data transaction conditioning service on a license grant (or reservation of rights) to reuse data transacted through their service 'for any lawful purpose'.
1. "These events occurred because fraud and abuse are happening because the status quo of the networks only working for Treatment leads to the worst possible incentives."
2. Highlights the David Brailer quote I still use from Dr. Bob Wachter's book - The Digital Doctor:
Dr. Bob Wachter: I asked Brailer an unfair question: Given his well-known skepticism about too muscular a federal role, if he had still been ONC director in 2008, would he have turned down the $30 billion?
Dr. David Brailer: No, but I would have spent the money on standards, interoperability, a ‘Geek Squad’ to help with training and implementation, and creating a cloud-based ‘medical Internet.’ I never would have spent money on direct subsidies to providers. We’ve built the Frankenstein I was most afraid of.
Everything we've done since are really technical hacks designed to avoid the regulations (with teeth - not just a "coalition of the willing") that are needed for patient SAFETY, quality and equality. Revenue and profits still rule - and that (sadly) applies just as much to interoperability as it does to the larger EHR world. “Plus ça change, plus c'est la même chose” - Jean-Baptiste Alphonse Karr 1849
Likely the best analysis of the Particle Health-Epic disaster. Thank you, Brendan! Do you think we should go directly to Epic to find the root of the problem? After all, Judy Faulkner fiercely opposed (and eventually succeeded in removing) interoperability in the HITECH Act of 2009, selfishly aiming to preserve Epic's interests.
Great article Brendan! The big thing I always struggle with regarding network participants only supporting treatment PoU - isn't this naked info blocking? It certainly fits the basic definition - "Information blocking is a practice by an "actor" that is likely to interfere with the access, exchange, or use of electronic health information (EHI), except as required by law or specified in an information blocking exception" and it's hard to see how any of the exceptions apply.
Great summary. Thank you for sharing. Regarding your comment about developing working pathways for other PoU queries it should be acknowledged that last year Carequality adopted a new ‘Care Coordination’ purpose of use to support a narrow set of Operations use cases. However despite enthusiasm in the workgroup drafting the new PoU the CQ implementer community has largely not vigorously explored opportunities to begin real world pilots and adoption. What started as a good faith effort to unlock some degree of Operations exchange and to have payers more actively participating within the CQ framework has unfortunately not gained steam. Admittedly there are some questions still to resolve with the Care Coordination purpose of use but that is exactly why real world testing is so important. The broad range of interests, perspectives and concerns about Operations exchange has created this quagmire of reasons for different actors to not engage. In my personal opinion the best thing to do in a situation with this many competing sources is to just take step one. That first step might not work, it could be in the wrong direction. But at least you’d now know which direction to not step and can regroup to plan out the next step. To me the CQ care coordination PoU is no different. There might be real, insurmountable obstacles to broad adoption. But if a few implanted would just try then we’d at least learn what doesn’t work. There is great value from that when untangling a knot as complex as this.
Brendan, repeating the comment I posted in LinkedIn, but don't feel obliged to post your response in both places...
thank you for this analysis, and links to resources.
You didn't open a can of worms all the way re secondary uses, but I will.
Your recommendation is for Carequality to prohibit "secondary uses" by "on-ramps". Shouldn't that prohibition extend to HINs/HIEs/QHINS? I have a problem with any entity sitting in the middle of an end-to-end data transaction conditioning service on a license grant (or reservation of rights) to reuse data transacted through their service 'for any lawful purpose'.
Great summary - with 2 takeaways:
1. "These events occurred because fraud and abuse are happening because the status quo of the networks only working for Treatment leads to the worst possible incentives."
2. Highlights the David Brailer quote I still use from Dr. Bob Wachter's book - The Digital Doctor:
Dr. Bob Wachter: I asked Brailer an unfair question: Given his well-known skepticism about too muscular a federal role, if he had still been ONC director in 2008, would he have turned down the $30 billion?
Dr. David Brailer: No, but I would have spent the money on standards, interoperability, a ‘Geek Squad’ to help with training and implementation, and creating a cloud-based ‘medical Internet.’ I never would have spent money on direct subsidies to providers. We’ve built the Frankenstein I was most afraid of.
Everything we've done since are really technical hacks designed to avoid the regulations (with teeth - not just a "coalition of the willing") that are needed for patient SAFETY, quality and equality. Revenue and profits still rule - and that (sadly) applies just as much to interoperability as it does to the larger EHR world. “Plus ça change, plus c'est la même chose” - Jean-Baptiste Alphonse Karr 1849
Likely the best analysis of the Particle Health-Epic disaster. Thank you, Brendan! Do you think we should go directly to Epic to find the root of the problem? After all, Judy Faulkner fiercely opposed (and eventually succeeded in removing) interoperability in the HITECH Act of 2009, selfishly aiming to preserve Epic's interests.
Great article Brendan! The big thing I always struggle with regarding network participants only supporting treatment PoU - isn't this naked info blocking? It certainly fits the basic definition - "Information blocking is a practice by an "actor" that is likely to interfere with the access, exchange, or use of electronic health information (EHI), except as required by law or specified in an information blocking exception" and it's hard to see how any of the exceptions apply.
Thank you Brendan for such an excellent, thoughtful, and balanced article. I learned a lot -- which is probably the highest compliment.
Great summary. Thank you for sharing. Regarding your comment about developing working pathways for other PoU queries it should be acknowledged that last year Carequality adopted a new ‘Care Coordination’ purpose of use to support a narrow set of Operations use cases. However despite enthusiasm in the workgroup drafting the new PoU the CQ implementer community has largely not vigorously explored opportunities to begin real world pilots and adoption. What started as a good faith effort to unlock some degree of Operations exchange and to have payers more actively participating within the CQ framework has unfortunately not gained steam. Admittedly there are some questions still to resolve with the Care Coordination purpose of use but that is exactly why real world testing is so important. The broad range of interests, perspectives and concerns about Operations exchange has created this quagmire of reasons for different actors to not engage. In my personal opinion the best thing to do in a situation with this many competing sources is to just take step one. That first step might not work, it could be in the wrong direction. But at least you’d now know which direction to not step and can regroup to plan out the next step. To me the CQ care coordination PoU is no different. There might be real, insurmountable obstacles to broad adoption. But if a few implanted would just try then we’d at least learn what doesn’t work. There is great value from that when untangling a knot as complex as this.