Sunday, November 18, 2007

Recent Developments

Quote of the Day:
We are always getting ready to live, but never living.
--Ralph Waldo Emerson


Health Train Express has recently become acquainted with a Canadian solution to RHIOs search for the "ultimate" application for their interconnectivity needs.  It bypasses the problems of "governance issues" and the thorny issues of "who owns what".

Many of these issues ignore the primacy of information transfer, efficiency, accuracy, and quality of healthcare delivery in this country.  In addition to that concern, it is not necessary to re-invent a "wheel" that already exists.

What we need has been well established by many consortiums, RHIOs and health information exchanges.  Do we all need all of it? The answer is profoundly "NO".

What about those providers who do not have broadband internet connectivity?

There are many pieces in the mix for a RHIO or Health Information Exchange.  Some of these are already provided by proprietary systems, such as clinical laboratories, hospital portals, secure messaging systems, Hospital PAC systems,etc.

The California Regional Health Information Organization provides a well structured outline and roadmap for developing governance; and also a library,   HIE toolkit  of documents for RFIs, RFPs, and other essentials for vendors, hospitals, providers and IT departments.

Monday, November 12, 2007


Groups To Launch No-Cost EHR Interoperability Testing Software

A no-cost, open-source software tool for testing the interoperability of electronic health record systems will be available to vendors March 21, 2008, Government Health IT reports.
The tool, which is being jointly developed by the Certification Commission for Healthcare IT and Mitre, will allow vendors to ensure that their EHR systems can exchange information on patients treated by more than one provider.
The tool, called LAIKA, also will initially support testing of the Health Level 7/ASTM Continuity of Care Document, a core set of patient information including:

  • Name;
  • Address;
  • Health problems; and
  • Medications (Ferris, Government Health IT, 11/9).

Mark Leavitt, chair of CCHIT, said, "This project is an important first step in our journey toward testing and certifying the interoperability of health IT systems" (Merrill, Healthcare IT News, 11/9).
CCHIT and Mitre have undertaken this open-source project without government support, Government Health IT reports.
Developers will demonstrate the tool at the Feb. 12, 2008, CCHIT meeting (Government Health IT, 11/9).

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Sunday, November 11, 2007

RPM or Remote Patient Monitoring

Microsoft has launched it's Health Vault application.

With this announcement comes a large list of positive and negative reactions in the marketplace.  The most positive aspects are the "commodization" and accessibility of these devices to consumers at affordable prices.


RPM data can and should enter the consumer electronics mainstream.  In addition, RPM data should be viewed as just one more type of medical data, similar to lab data, pharmacy data, physician notes, etc., that is equally plug and play.

But...There are Tradeoffs

Depending on whether you are a user or a seller of RPM, you probably reacted differently when reading Bill Crounse's casual reference to devices and services becoming "commoditized".  Regardless of your reaction, he's right.  HV will hasten the already occurring commoditization of RPM devices.

When the RPM market started, many of the devices were priced in the $6-8 K range.  Today prices have dropped to $1-2 K, and will go lower. 

We have all heard stories where RPM devices eventually would become consumer purchases made at Best Buy and Circuit City, and that prices would be in the range of other consumer technology purchases.  That day will arrive in 2008 when Continua Alliance compliant offerings begin hitting the street.

The RPM market is moving from

  • High unit prices rooted in the industry's early focus on medical device markets and business models
  • Proprietary devices, proprietary IT,  non-interoperable data
  • Low unit volume, moderate margins per unit
  • Competition based on the vendor lock-in through high changing costs


  • Low unit prices as the technology evolves toward consumer markets and consumer business models
  • Intereroperable devices, common IT platforms, and interoperable data
  • High unit volume, low margins per unit
  • Competition based on value and service

Where exactly commoditization and HV come together is not clear. The efforts of Continua will bring to market multi vendor interoperability, true plug and play connectivity. Microsoft can deliver plug and play interoperability with your personal computer, but little else.


What do you think?