Political Connections and Health Care Data

Interoperability -- the ability of health information systems in different organizations to "talk" with each other -- is crucial to the future of health care.  By tapping into "big data" to learn more from existing information, we will make health care more effective and less expensive. By allowing patients to carry their health information across provider lines as easily as we want them to carry their health insurance across state lines, we will empower patients. In fact, one of the stated goals written into the Recovery Act was the development of "software that improves interoperability and connectivity among health information systems."

But one politically connected left-wing company, Epic Systems, could destroy this health care progress.

With over $19 billion in stimulus money being dedicated to health IT, the selection of members to occupy the Health Information Technology Policy Committee was a crucial one for the Obama administration. And a platform of interoperability isn't exclusive to the Obama camp. Democrats, Republicans, and industry experts alike recognize the importance of interoperability.

So why, despite their public support for interoperability, did the administration appoint to the HHS board Epic Systems CEO, Judy Faulkner, who opposes the broad consensus position on interoperability?

As Lachlan Markey pointed out in the Washington Examiner, "Epic employees are massive Democratic donors."

Unfortunately, those political donations may have caused the administration to overlook things like Faulkner's 2009 comments to Bloomberg News claiming that sharing Electronic Health Records (EHR) "doesn't work when you mix and match vendors."  She added, "It has to be one system, or it can be dangerous for patients."

 Tariq Chaudhry, a consultant for American Soft Solutions Corp. says, "Judith Faulkner's version of interoperability reveals a clear effort to establish (a) monopoly for Epic." 

He also believes that after working with Epic for a couple of years, there is little to indicate that their software is unique in the industry. 

"I have not seen anything specific to Epic, not found elsewhere that could set (them) apart from other competing EHR/EMR systems," Chaudhry explains.

In fairness, the entire industry is, according to Otech President Herman Oosterwijk, "15 years behind in interoperability compared with PACS systems". PACS (Picture Archiving and Communication System) is a technology that allows medical images and reports to be stored and transferred electronically. 

Oosterwijk, who has worked with the U.S. Department of Veterans Affairs and the U.S. Department of Defense, believes that "none of the EHR systems are truly open."  He adds, "I can connect a PACS workstation to pretty much any PACS system and query and retrieve images.  Compare this with an EMR where we, at best, can get a HL7 feed and/or CDA summary documents out."

Andrew Needleman, the President of Claricode Inc., acknowledges difficulty with the implementation of interoperable EHR systems.

Due to the amount and complexity of data being transmitted between systems, even systems that attempt to be interoperable run into issues when they send data to other systems.

Expanding on the complexity problem, Needleman says:

For healthcare data, even the demographic data to determine if you are talking about the same patient is complex.  Then, you add things like medications with dosages, different forms, such as capsules, liquid suspensions for injections, tablets, inhalers, etc.  And then you need to include observations, doctor's orders, lab requests and results, admissions and discharges, billing information, vital signs, etc.

Despite the existing standards ... [i]t's not an easy task."

Rob Quinn, a partner at APP Design, a software development company, says the office of Health and Human Services "is trying hard to get vendors to communicate via standards."  Though, he doubts many health IT companies like Epic will comply.

"There's simply too much money to be made in locking in their clients," Quinn admits. 

In the end, Needleman isn't sure if the appointment of Faulkner crosses ethics boundaries, but says a conflict of interest may be unavoidable.

I think that it would be extremely difficult to appoint someone who was knowledgeable enough about the industry, was willing to serve, and didn't have an interest in the outcome of the regulations.

Needleman has a point about the difficulty of finding somebody without any conflict of interest.  But it seems like the administration, at a minimum, should have appointed somebody whose business was not antithetical to an interoperable future.  Unfortunately, as an iWatchNews investigation pointed out in Politico, the administration has appointed hundreds of big donors to "plum government jobs and advisory posts..."

The appointment of Faulkner poses a significant challenge for the Obama administration; her opposition to interoperability creates difficulty for the advancement of the health IT industry.  The market should decide whether Epic Systems approach to Health IT should be rewarded or deprecated, but - in the interests of interoperability and political integrity - HHS should immediately ask Judy Faulkner to step down from her role on the HHS Health IT Policy Commitee.

Rusty can be contacted on Twitter @rustyweiss74.

Interoperability -- the ability of health information systems in different organizations to "talk" with each other -- is crucial to the future of health care.  By tapping into "big data" to learn more from existing information, we will make health care more effective and less expensive. By allowing patients to carry their health information across provider lines as easily as we want them to carry their health insurance across state lines, we will empower patients. In fact, one of the stated goals written into the Recovery Act was the development of "software that improves interoperability and connectivity among health information systems."

But one politically connected left-wing company, Epic Systems, could destroy this health care progress.

With over $19 billion in stimulus money being dedicated to health IT, the selection of members to occupy the Health Information Technology Policy Committee was a crucial one for the Obama administration. And a platform of interoperability isn't exclusive to the Obama camp. Democrats, Republicans, and industry experts alike recognize the importance of interoperability.

So why, despite their public support for interoperability, did the administration appoint to the HHS board Epic Systems CEO, Judy Faulkner, who opposes the broad consensus position on interoperability?

As Lachlan Markey pointed out in the Washington Examiner, "Epic employees are massive Democratic donors."

Unfortunately, those political donations may have caused the administration to overlook things like Faulkner's 2009 comments to Bloomberg News claiming that sharing Electronic Health Records (EHR) "doesn't work when you mix and match vendors."  She added, "It has to be one system, or it can be dangerous for patients."

 Tariq Chaudhry, a consultant for American Soft Solutions Corp. says, "Judith Faulkner's version of interoperability reveals a clear effort to establish (a) monopoly for Epic." 

He also believes that after working with Epic for a couple of years, there is little to indicate that their software is unique in the industry. 

"I have not seen anything specific to Epic, not found elsewhere that could set (them) apart from other competing EHR/EMR systems," Chaudhry explains.

In fairness, the entire industry is, according to Otech President Herman Oosterwijk, "15 years behind in interoperability compared with PACS systems". PACS (Picture Archiving and Communication System) is a technology that allows medical images and reports to be stored and transferred electronically. 

Oosterwijk, who has worked with the U.S. Department of Veterans Affairs and the U.S. Department of Defense, believes that "none of the EHR systems are truly open."  He adds, "I can connect a PACS workstation to pretty much any PACS system and query and retrieve images.  Compare this with an EMR where we, at best, can get a HL7 feed and/or CDA summary documents out."

Andrew Needleman, the President of Claricode Inc., acknowledges difficulty with the implementation of interoperable EHR systems.

Due to the amount and complexity of data being transmitted between systems, even systems that attempt to be interoperable run into issues when they send data to other systems.

Expanding on the complexity problem, Needleman says:

For healthcare data, even the demographic data to determine if you are talking about the same patient is complex.  Then, you add things like medications with dosages, different forms, such as capsules, liquid suspensions for injections, tablets, inhalers, etc.  And then you need to include observations, doctor's orders, lab requests and results, admissions and discharges, billing information, vital signs, etc.

Despite the existing standards ... [i]t's not an easy task."

Rob Quinn, a partner at APP Design, a software development company, says the office of Health and Human Services "is trying hard to get vendors to communicate via standards."  Though, he doubts many health IT companies like Epic will comply.

"There's simply too much money to be made in locking in their clients," Quinn admits. 

In the end, Needleman isn't sure if the appointment of Faulkner crosses ethics boundaries, but says a conflict of interest may be unavoidable.

I think that it would be extremely difficult to appoint someone who was knowledgeable enough about the industry, was willing to serve, and didn't have an interest in the outcome of the regulations.

Needleman has a point about the difficulty of finding somebody without any conflict of interest.  But it seems like the administration, at a minimum, should have appointed somebody whose business was not antithetical to an interoperable future.  Unfortunately, as an iWatchNews investigation pointed out in Politico, the administration has appointed hundreds of big donors to "plum government jobs and advisory posts..."

The appointment of Faulkner poses a significant challenge for the Obama administration; her opposition to interoperability creates difficulty for the advancement of the health IT industry.  The market should decide whether Epic Systems approach to Health IT should be rewarded or deprecated, but - in the interests of interoperability and political integrity - HHS should immediately ask Judy Faulkner to step down from her role on the HHS Health IT Policy Commitee.

Rusty can be contacted on Twitter @rustyweiss74.