Has anyone ever anywhere suggested a line item opt out?
Yes - Canada has the Personal Health Information Protection Act (PHIPA) which has what is referred to as the concept of "Lock box." The idea is that you may direct a healthcare provider to not disclose certain data about you. When sharing data, the provider is allowed to disclose that there is additional "lock box" data.
That's great for a data/transmission standard, but another big problem is proprietary databases. Every application has it's own "under-the-hood" storage structure. Imagine if there was a standardized database structure, don't you think that would go a long way towards better interoperability and communication?
No, I don't think a common data storage schema would promote better interoperability. I think a correct data exchange standard will promote this, and vendors will implement data storage and business logic independently.
The problem is that HL7 v 2.x is too "loose" of a standard. It's not particularly descriptive, and both vendors and healthcare organizations have had to stretch the HL7 protocol in order to make it useful.
HL7 3.0 and the RIM have gone a long way towards fixing many of the problems with 2.x. However, 3.0 is not ratified, and there is not straightforward mapping between 2.x and 3.0. This makes it a challenge for vendors and healthcare organizations to leverage 3.0.
HIT is a conservative, slow moving vertical. We'll see gradual movement towards better interop on the wire, and we'll go from there. The RDBMS (or, in some cases OODBMS) is not the place to tackle this issue.
-jd
You're only half right. The problem is that HIT vendors are generally well behind the times, slow to innovate and closed and proprietary as all get out. You think MS is bad? You haven't seen highyway robbery until you've seen the shit in a box most HIT vendors push.
While there is certainly long history behind this statement (and some truth), it's not so black and white. Innovation works great when you are landing new client deals - flashy and shiny sells.
However, many clinicians (and dare I say physicians in particular) while normally highly intelligent, are actually very "challenged" users of technology. Changes that are straightforward in the business world are a complete no-go in HIT. Many large healthcare entities will actually draw into contractual language the amount of technical and GUI changes that may occur in a software release or update.
For the most part, it is not vendor resistance to change, but an entire vertical that is very conservative. If it was otherwise, conservative vendors would die very quickly in a Darwinian manner as more responsive companies stepped up to bat.
In short, it's a symbiotic client/vendor relationship that inhibits change.
-jd
I've seen PHR to EMR interoperability, but very little EMR to EMR. The Social Security Administration is also doing an enormous amount of work to leverage the NHIN to pass CDA content for disability eligibility, but that's a payor/eligibility type relationship, kinda sorta.
RHIOs were supposed to be the "grass roots" mechanism to get this going, but while there have been some marginally successful RHIOs, most of them are funded by grant money. Without a mechanism to monetize this data exchange, there's little incentive (and action) in EMR to EMR interop.
Again, CCHIT and changes to STARK will inject incentives into adoption of this technology, and you'll see a lot of gears turning in this space.
-jd
For one, the creation of a single standard document for representing a medical history would go a long way towards enabling applications across the medical spectrum to coexist.
This document type does exist. Please review the emerging HL7 v3 documentation. Pay particular attention to CDA/CCD.
The bottom line is that once there is convergence around interoperability, which proprietary EMR solution a Healthcare Organization utilizes matter much less less. Prior to CCHIT and changes in STARK, vendors had little incentive to develop interoperable solutions - vendor lock-in is part of the HIT business model.
For once, the government is actually driving positive change into an industry. Through provider-based incentives (carrot vs. the stick), HCOs (Healthcare Organizations) will have positive incentive to implement interoperable solutions.
It's a facinating time in HIT, and I'm frankly enjoying being on the vendor side of right. I expect fundamental change over the next 5-7 years in HIT, unlike anything we've seen in the last 15. Great stuff, really.
-jd
If you want to put yourself on the map, publish your own map.
