3/5/13 Dan Munro/Mandi Bishop - Interoperability MandiBPro .

.@GailZahtz: 15 minutes- wrap up your desk &catch co-guests @danmunro and @MandiBPro talking #HIMSS13 hottest topic "interoperability" #CPHC CLAROSMedTech Too Much #E-Communication Swamping Doctors?: MedlinePlus http://t.co/K646k3kDsw #HIMSS13 #HITChicks #CPHC @MandiBPro @jennylaurello GailZahtz @sandyhubbard We're very lucky to have @MandiBPro live from #HIMSS13 and Forbes' editor @danmunro both at #CPHC on interoperability GailZahtz Guests @MandiBPro and @danmunro should be arriving momentarily. Background http://t.co/XHkYrEXj1i and feel free to start intros! #CPHC

Danmunro Good morning/afternoon/evening (time zone agnostic here) ;-) #CPHC sandyhubbard Love that! > RT @danmunro time zone agnostic here #CPHC GailZahtz And there is one of our celeb guests from Forbes @danmunro who is going to try to make interoperability understandable for all #CPHC MandiBPro #HIMSS13 #interoperability #CPHC: how do we take it from the showcase floor to widespread adoption? CHopeMurray ie beyond Verizon RT @MandiBPro: #HIMSS13 #interoperability #CPHC: how do we take it from the showcase floor to widespread adoption? #CPHC GailZahtz @danmunro We've been sharing your article http://t.co/XHkYrEXj1i Can you give high points in 140? #CPHC ElinSilveous Hi everyone. Looking forward to #CPHC Wish I was laughing and learning with you all at #HIMSS13 sandyhubbard Honored to have Forbes contributor @danmunro with us today at #CPHC. Lurkers, please participate, no matter your expertise, all are welcome! Primushscm @GailZahtz @danmunro @MandiBPro Great, would love to witness it #CPHC #HIMSS13 nursefriendly Hello Everyone, Andrew Lopez, RN from #NewJersey :) #cphc lindner_sarah Greetings! Just dug out of my driveway in MN... and just in time to join the conversation. Thanks for the invite, @GailZahtz #CPHC GailZahtz @lindner_sarah Thanks for joining us! Our driveway has a foot of snow! Today we have live from #HIMSS13 @mandibpro forbes @danmunro #CPHC MandiBPro And I have WiFi - I'm here! Yay! Sorry for the delay. #HIMSS13 challenges: water shut-down, no WiFi...#interoperability issues. ;) #CPHC MediaLabRat Jumping in, @gailzahtz thx for the reminder :)#cphc GailZahtz @MediaLabRat Glad you've jumped in, I knew interopeability would interest you! We have two great guests- feel free to directly Q&A #CPHC DrNanN Sorry I'm late. Overlapping meetings today #cphc

GailZahtz @DrNanN Glad you can make it! We are talking interoperability with live from #HIMSS13 @MandiBPro and forbes @danmunro All Q&A welcome #CPHC

Danmunro High points of interoperabilty ... big buzzword ... big hype ... hard to separate the hype from reality .. we'll try ... #CPHC GailZahtz @danmunro Which is hype which is reality? #CPHC Danmunro Interoperability is front-and-center this year at #HIMSS13. I'm not there - but the dual announcements yesterday support that view #CPHC GailZahtz Why is interoperability front and center at #HIMSS13 @MandiBPro @danmunro @sandyhubbard #CPHC Danmunro CommonWell (with Allscripts, Cerner, McKesson, Greenway and athenahealth) was first Verizon news came second ... #CPHC Danmunro Commonwell is a good example of the hype (right now). It's an annoucement. Nothing tangible. Even the website says so. #CPHC Docnieder @danmunro Think CommonWell will have any effect on pushing Epic to improve its interoperability? #cphc GailZahtz @docnieder Great to see you! And great question to @danmunro #CPHC GailZahtz @danmunro How is commonwell all hype? Who is actually doing it? #CPHC Danmunro From the website - Commonwell says "they are working toward a proof-of-concept" in 12-18mos. That's hype. "SHOW ME THE DATA!" #CPHC GailZahtz @danmunro Who is showing the data? #CPHC Danmunro In that sense - Verizon is up/running - but small footprint of actual use #CPHC GailZahtz @danmunro We shared http://t.co/XHkYrEXj1i on your article- is anyone making a bigger footprint than Verizon? #CPHC CHopeMurray @danmunro agree - if not data then show me the foundation pieces, structures, agreed components #CPHC sandyhubbard Yes, good faith that success is possible. RT @CHopeMurray if not data then show me foundation pieces, structures, agreed components #CPHC CHopeMurray @danmunro agree Commonwell is an announcement with ambitious intent but little information on the stages/steps to success #CPHC GailZahtz @CHopeMurray Where do you see information on the stages and steps to success? #CPHC Danmunro Verizon is *just* coming out of a few small Beta/trials - but the feedback from those is encouraging #CPHC CHopeMurray @danmunro would it be fair to call Verizon a walled garden, as you have to buy into their standards and conditions? #CPHC Danmunro @CHopeMurray No - Verizon is like GMail (today). The only "wall" to use the service - you have 2B a registered provider (DEA/NPI) #CPHC

GailZahtz For those new to #CPHC we have the audience ask questions directly to guests- today @MandiBPro and/or @danmunro to explain interoperability ElinSilveous Because it doesn't exist for many? ;) #CPHC @GailZahtz @MandiBPro @danmunro @sandyhubbard #HIMSS13 MandiBPro So, I'm live @ #HIMSS13 and have had opportunity to tour #Interoperability showcase & sit down w/ @ONC_Gov leaders. Impressed. A bit. #CPHC GailZahtz @MandiBPro What did you learn from @ONC_Gov and other showcase while you're there at #HIMSS13 #CPHC MandiBPro @GailZahtz #Interoperability seems the theme for #HIMSS13. Progress w/ #MeaningfulUse and @ONC_Gov initiatives meaningless w/out it. #CPHC MandiBPro Believe @ONC_Gov has visionary #interoperability initiatives; their pavilion w/ real-world e.g. across continuum of care impressive. #CPHC GailZahtz @MandiBPro @ONC_Gov We would love to learn more about what they are doing! And what was impressive. #CPHC MandiBPro @GailZahtz @ONC_Gov focused on structure of #data container for #interoperability 1st; now focused common #data structure, itself #CPHC GailZahtz @MandiBPro @ONC_Gov So we are talking the ability to silo the data and then how it's put out to the user? cc @MediaLabRat #CPHC CHopeMurray @GailZahtz if you dont interoperate you cant mesh, if you cant mesh you cant communicate nor collaborate #CPHC MandiBPro The ? I continue asking the #Interoperability showcase vendors is: how have you applied this use case to your product development? #CPHC GailZahtz @MandiBPro What are vendors saying about applying #interoperability #CPHC MandiBPro @GailZahtz The vendors AREN'T. That's saddening to me. Use case-specific applications for showcase, not included in SDLC for release. #CPHC GailZahtz @MandiBPro So are you saying the vendors are all show basically and no real data behind it? #CPHC MandiBPro @GailZahtz Yes, from what I've seen thus far. They have capability for showcase-specific e.g., but no general release e.g. on floor #CPHC Danmunro Verizon is what we call "loosely" coupled exchange. Commonwell is targeting a more "tightly" coupled exchange (of data) #CPHC MandiBPro @GailZahtz Doug Fridsma & I had extensive convo re: standard data capture initiative, taking #interoperability to atomic level. NEEDED #CPHC GailZahtz @MandiBPro Oh! Tell us more about this taking it to the atomic level. #CPHC

sandyhubbard Today's #CPHC discussion on #interoperability would be interesting to all who have dealt with data silos and proprietary systems. MandiBPro @sandyhubbard YES! Silo'd #health #data remains challenge. Vendors giving lipservice to #interoperability but I haven't seen openAPI. #CPHC GailZahtz Per @mandiBPro siloed health data is a challenge. Who is making strides out there? #interoperability #CPHC Danmunro There are dozens of "HIE" (Health Data Exchange) projects up/runnning - some public - some private - various stages of "deployment" #CPHC GailZahtz @danmunro What is the difference from a HIE versus talk today of interoperability? Examples of good ones in deployment? #CPHC Danmunro http://t.co/9zcSeHPGE6 Camden NJ is one example (picked at random) of wrking HIE #CPHC MandiBPro @danmunro Yes - there are quite a few examples of working #HIEs here, and their #interoperability implementation stories are inspiring #CPHC CLAROSMedTech @MandiBPro @danmunro #CPHC Interop will come from Communications Cos that have built the infrastructure for HIT. Re: http://t.co/lAXiKjWGFR GailZahtz @CLAROSMedTech Thanks for joining us! Glad you're jumping right in- as you see a lot to discuss and digest! #CPHC GailZahtz @MandiBPro So what are they saying they will do versus what we hope they could do? What's the word at #HIMSS13 from the public? #CPHC MandiBPro @GailZahtz There are 2 publics here: the vendor booth public, and the disruptor public. The tech exists; market needs to demand it. #CPHC Nursefriendly @MandiBPro I don't see how the "market" is going to demand it, when the profit greatly from the status quo. #cphc MandiBPro @nursefriendly Exactly. Market in my tweet = patients, providers, CONSUMERS of system...not the #EMR vendors #CPHC Nursefriendly @MandiBPro #cphc :) I don't see the "demanding" coming from the public at large MandiBPro @nursefriendly It should. Unless/until it does, or large IDNs refuse to partner w/ bullies, we're stuck w/ vendor-driven rules. #CPHC CHopeMurray @MandiBPro great pt- the significance of the Verizon approach is that they are offering both structured and unstructured information #CPHC Danmunro My view with the Verizon model is that it's the way the "web" works. Great BIG functionality to get adoption - then add features #CPHC Danmunro Verizon is the "lean" model - with MVP to start. Look at how LinkedIn evolved. That's the "right" model I see for HIE #CPHC Danmunro Verizon's other advantage - BIG domain experience in industrial-strength security and ID management #CPHC

GailZahtz @danmunro Are you thinking Verizon will be to interoperability what Epic became to EMR/EHR platforms? #CPHC Danmunro I believe Verizon is demonstrating an Epic exchange at HIMSS - as part of the interoperability showcase #CPHC Danmunro Another BIG advantage to Verizon? Vendor neutral. Not tied to any one data format #CPHC CHopeMurray +1 RT @danmunro: Verizons other advantage - BIG domain experience in industrial-strength security and ID management #CPHC sandyhubbard Important RT @danmunro Verizon's other advantage - BIG domain experience in industrial-strength security and ID management #CPHC danmunro Another (BIG) adv to Verizon - is *when* we get to "consumer engagement" with smartphones/tablets - they have big footprint there too #CPHC danmunro Verizon's BIG challenge - are they nimble enough to execute on this vision/strategy? They are a HUGE entity ... #CPHC CHopeMurray @sandyhubbard agree I liked @danmunro's explanation of standard proliferation, its too easy to generate a new one #CPHC GailZahtz I see a lot of lurkers and thank you for RT's - don't be shy- feel free to jump in- there are no stupid questions today! #CPHC CHopeMurray @sandyhubbard but history has shown us that it simple standards and critical mass tend to win the race, that's how we got the internet #CPHC Danmunro @CHopeMurray Correct - today it's *very* basic data exchange (email message with attachments) ... but extensible #CPHC nursefriendly @CHopeMurray #cphc With the Trillions of dollars riding on proprietary software design, we are talking some serious "critical mass" needed. Docnieder Agree MT @nursefriendly: @CHopeMurray #cphc w/Trillions of $s riding on proprietary software, we're talking some EPIC "critical mass" needs. Nursefriendly @CHopeMurray #cphc #Healthcare is much larger than Internet, Highly Regulated, Highly ForProfit. Don't see it as a fair comparison CHopeMurray @nursefriendly lol: requires historical context, at the time internet was being born, it was all highly proprietary, highly for profit #CPHC nursefriendly @CHopeMurray Who regulates the internet Colin? Who scrutinizes every change made to it's structure, function, operations? #cphc sandyhubbard @nursefriendly Right, internet sprang from govt and university exchange where collaboration not penalized as it is in big business. #CPHC nursefriendly @sandyhubbard Not to mention the Internet doesn't have #HIPAA restrictions :) #cphc CHopeMurray @nursefriendly Currently a no. of entities including NIST WWWC but this too is being hotly debated. Yet the internet is still humming #CPHC Nursefriendly @CHopeMurray #cphc Is the Internet subject to #HIPAA rules which scrutinize every communication, piece of data transmitted?

CHopeMurray @nursefriendly parts of it are, but I take your point. Having said that, not all medical information is HIPPA constrained (eg CRM) #CPHC Nursefriendly @sandyhubbard @CHopeMurray Yes, when in doubt, assume #HIPAA applies and handle the data accordingly. #cphc GailZahtz @bacigalupe @teaminspire @ChronicPainGPS Great to see you all! Thanks for joining us. It's a big issue, but our guests are great #CPHC GailZahtz @MandiBPro @danmunro Could the two of you discuss difference between what you read, versus see, versus feedback? #CPHC MandiBPro Doug Fridsma differentiated b/w high jump and long jump: the high jump = 100% data liquidity. The long jump = incremental progress #CPHC CHopeMurray @MandiBPro tech exists, to a point (still missing extensive management capabilities) but major gap is matching purpose, process + data #CPHC MandiBPro @CHopeMurray YES. The universal change challenge triad still barrier to #interoperability: people, process, technology. #CPHC Sandyhubbard Fascinating! RT RT @CHopeMurray major gap is matching purpose, process + data #CPHC GailZahtz @CLAROSMedTech Please feel free to talk within #CPHC about what you've been doing and how you see it different- we are open to all! lindner_sarah How do we achieve interoperability when the health system is so uncoordinated? If we build it, will they come? #CPHC MandiBPro @lindner_sarah The field of dreams model for clinical standards does still play a role, and we're not seeing the adoption rates needed #CPHC CHopeMurray @danmunro both email message + attachments tend to be unstructured, does Verizon offer data analytics in their cloud to interpret it? #CPHC CHopeMurray @danmunro it is a start, which gets you into a protected environment, but what about some of the challenges of email environments? #CPHC Danmunro @CHopeMurray what email challenges? It's asynchronous communications ... #CPHC CHopeMurray @danmunro for example accidental or malicious use of messages (delete, modify, copy) #CPHC CHopeMurray @danmunro then of course there are the challenges of communication - ie shared definitions, semantic variances, contextual alignment #CPHC Danmunro @CHopeMurray ... it is a "walled" garden in that sense - but Verizon knows big datacenter operations (in real time) #CPHC MandiBPro @CHopeMurray YES! That's been my focus while I'm here. Semantic diff continues to represent an ENORMOUS challenge to #interoperability #CPHC

GailZahtz @MandiBPro @CHopeMurray Can you explain what you've learned at #HIMSS13 about the challenges of semantic differences? #CPHC Danmunro @CHopeMurray ... you're talking tighter data exchange. That's on the roadmap via API's that "map" the different EHR's #CPHC CHopeMurray @danmunro yes it is tighter, but not structured data tight. #CPHC CHopeMurray @danmunro yes they have that advantage, it will certainly be more scalable than most. Be interested in their international partners #CPHC GailZahtz @NatriceR Don't worry- I don't have a CLUE about the topic- that's why we have expertsjump in, basic questions welcome! #CPHC MandiBPro Funny, Dan & I coming at this from alternative views: my focus being data standards, Dan looking at the larger communication #CPHC GailZahtz @MandiBPro This is why it's so great to have you BOTH- this big topic, having you and @danmunro viewpoints different helps all! #CPHC GailZahtz TODAY definitely going to require some great distilling. We are getting fast and furious great answers from @danmunro and @MandiBPro #CPHC MandiBPro @danmunro Yes, they are - it's an impressive display @ #interoperability showcase. I'll take video for you folks later today. #CPHC Sandyhubbard Yay - maybe something for CarpoolTV! :) RT @MandiBPro I'll take video for you folks later today.#CPHC DrNanN @MandiBPro Is anyone looking at ease of use? Will help adoptibility #cphc Docnieder Ease of use! Now there's a thought. RT @DrNanN: @MandiBPro Is anyone looking at ease of use? Will help adoptibility #cphc #EHRBacklash Danmunro @DrNanN Verizon has the edge on ease-of-use because it's email. Everyone knows/understands how to use it - today - right now #CPHC GailZahtz @docnieder @DrNanN @MandiBPro Agree 100% WHERE are people with ease of use? Will this be another EPIC fail on workdays? #CPHC @danmunro MandiBPro @DrNanN #EHR vendors focused on ease of use and clinical workflows to incorporate #meaningfuluse standards, but not #HIE connectivity #CPHC GailZahtz @MandiBPro @DrNanN Do you really believe #EHR vendors are concerned with ease of use? My experience has not been that. #CPHC MandiBPro @GailZahtz @DrNanN The #EMR vendors I met w/ yesterday are making effort to include provider focus groups in development...trying. #CPHC GailZahtz @MandiBPro @DrNanN Who are the #EMR vendors using for focus groups? Do they really listen to them? #CPHC sandyhubbard @DrNanN I am surprised and pleased when anyone pays attention to ease of use. Big picture challenges often shove it off to the side. #CPHC

docnieder I see vendors focused on MU stnds, usability not so much. @MandiBPro: @DrNanN #CPHC CLAROSMedTech @GailZahtz #CPHC We have taken model from working with FEMA/Public Safety Interop & applied to HIT. Small Co's tho get run over Nuf said. GailZahtz @CLAROSMedTech You won't get run over in the Carpool! Please share with #CPHC links and whatever else! We want small company voices! CLAROSMedTech @danmunro #CPHC Lisbility, Privacy Issues and HIPAA compliance will soon bite the Telco Carriers. First class action suit. Crap hits the fan Danmunro @CLAROSMedTech ... but that's also why Verizon is the right candidate here. Deep $ pockets - so they're reputation is at stake #CPHC CLAROSMedTech @danmunro #CPHC PT can send/xchange info direct with Doc's any time. As soon as a third party transmits PT info. HIPAA, Privacy Act kick in. GailZahtz @danmunro @CLAROSMedTech Is there room for smaller companies? #CPHC Danmunro @GailZahtz there is ABSOLUTELY room for smaller companies - talked with a favorite one yesterday (loosely in this space) ;-) #CPHC Danmunro small companies are AGILE, NIMBLE - can move lightening quick. That's their advantage - but they don't have forever ;-) #CPHC GailZahtz ! RT @danmunro: small companies are AGILE, NIMBLE - can move lightening quick. That's their advantage -but they don't have forever ;-) #CPHC Danmunro Verizon announcment suggests the clock is ticking on the smaller companies! #CPHC GailZahtz @danmunro So can you address the differences between where a Verizon comes in and a smaller company? Do they work together? #CPHC Danmunro @CLAROSMedTech .. and it's a "private" secure network. They've sold this (or similar) solution to big Gov/Military etc.. #CPHC Danmunro @GailZahtz it's the classic startup/BigCo dilemma. Can the BigCo innovate & execute. Rich history of failure on the latter there #CPHC Danmunro Meanwhile - the little company is signing up market share with compelling innovation. Forecasting a winner is Vegas business #CPHC Danmunro In the end HIE's are BIG DATA. Companies that can work/handle/manage the risk/liability there have a different profile #CPHC nursefriendly @MandiBPro #cphc #Healthcare #Consumers are at a distinct disadvantage in dealing with their own health, how will they know to demand it? sandyhubbard @nursefriendly Great point, Andrew - they don't know what the possibilities are, what they could even ask for. #CPHC nursefriendly @sandyhubbard #cphc Not to make #consumers sound dumb, but when it comes to #HealthcareLiteracy few know what questions to ask.

nursefriendly @MandiBPro Are you talking a public education campaign, groundswell of activism, to prompt legislators to mandate "Interoperability? #cphc MandiBPro @nursefriendly Ah, Andrew, you're asking me to pontificate on how best to educate the masses on their rights? Come, now... ;) #CPHC MandiBPro @nursefriendly All of the above, Andrew. But given the accuracy of the earlier comment on lack of informed public on challenge- hard. #CPHC GailZahtz We still have people on the sidelines looking for basic explanations to catch up @danmunro and @MandiBPro Thanks! #CPHC CHopeMurray @nursefriendly as I said history has a precedent. apologies for geek talk but TCP/IP trumped vendor billions invested in OSI #CPHC GailZahtz @CHopeMurray What is OSI? THANKS #CPHC CHopeMurray @GailZahtz I did apologize, really - OSI is Open Systems Interconnect, which included an email standard X.400 trumped by SMTP #CPHC GailZahtz @CHopeMurray How does open systems interconnect play into the conversation? I am not afraid to ask the "stupid" questions here! #CPHC sandyhubbard That helps...a little! :) RT @CHopeMurray OSI is Open Systems Interconnect, which included an email standard X.400 trumped by SMTP #CPHC CLAROSMedTech @GailZahtz #CPHC See http://t.co/lAXiKjWGFR We've been at this longer than anyone else. Presented to our "friends" at Q-Comm. "No interest"~ GailZahtz @CLAROSMedTech Why do you think interest has been low? #CPHC MandiBPro @GailZahtz semantic challenges - disparate #data definitions for same field name/description - plague medicine, are huge challenge #CPHC GailZahtz @MandiBPro We in the Carpool are plagued by the issues of the data fields for research. Is this same issue? #CPHC MandiBPro @GailZahtz #Data #interoperability - each element means same to every stakeholder along continuum, from multiple sources #CPHC MandiBPro @GailZahtz Yes, on grand scale. #Interoperability b/w #EHR vendor/#HIE/clearinghouse/#payer requires #data standards #CPHC GailZahtz @MandiBPro Who is setting the guidelines of which element means the same? Who sits at the table? #CPHC GailZahtz @MandiBPro Who is setting the data standards? I read @danmunro article and seems many are competing not collaborating #CPHC lindner_sarah @MandiBPro @GailZahtz Data semantics are big issue. Not to mention strict HIPAA laws on what can & can't be shared b/w stakeholders. #CPHC CHopeMurray dont forget audit RT @MandiBPro: RT @lindner_sarah: Data semantics are big issue. strict HIPAA laws sharing b/w stakeholders. #CPHC CHopeMurray @sandyhubbard its the history of the internet - which needed those standard in place before we got to the browsers and web pages #CPHC

Primushscm @GailZahtz @danmunro @MandiBPro possible but not likely, #CPHC GailZahtz @primushscm @danmunro @MandiBPro What is possible but not likely? #CPHC GailZahtz @subatomicdoc @healthblawg we are chatting live from #HIMSS13 directly about this issue of interoperability- feel free to join #CPHC CHopeMurray @danmunro that leads to a table search on standard fields, + walled garden interpretation and resolution of conflicts - difficult #CPHC Danmunro @GailZahtz right now - there are 100 tables ;[-( CommonWell is a whole NEW table. That focus (tight exchange) is the long pole in tent #CPHC GailZahtz I am thrilled to watch the high level and basic conversations from both @danmunro and @MandiBPro on this big issue of interoperability #CPHC Danmunro @CHopeMurray correct. 12-18mos to first "proof-of-concept"! Don Berwick quote: "We're in Mann Gulch!" 4-alarm fire! #CPHC GailZahtz @danmunro @CHopeMurray Is 12-18 months to proof on concept fast enough? #CPHC Danmunro @GailZahtz 12-18mos to "proof-of-concept" is VAPORWARE! What they're saying is "we don't know." #CPHC CHopeMurray @GailZahtz @danmunro not for the whole caboodle, but basic parts should be demonstrable in that time frame #CPHC Danmunro @CHopeMurray 12-18 mos is really saying "we don't know - but we'll figure something out by then - stay tuned." Not an answer. #CPHC CHopeMurray @danmunro agree that they dont know, but it is good that we are opening the dialogues for better understanding on goals and objectives #CPHC GailZahtz @danmunro Is it the same as the 2 year race when people were trying to get the leader slot in EHR? Or is this different? #CPHC Danmunro @GailZahtz it's a different ballgame. Like trying to compare Football to Basketball. They both use one ball .. but .... #CPHC GailZahtz @danmunro Thank you for allowing simple questions too. I know our audience has very high level understanding, and some grasping #CPHC MandiBPro @GailZahtz Correct. #HIPAA trxs mandated & $-driven. #Clinical #data "guidelines" w/ competing orgs/codesets. @ONC_Gov pondering. #CPHC GailZahtz @MandiBPro @ONC_Gov Is there a deadline like there was for EHR penalties if not adopted? #CPHC MandiBPro @GailZahtz No - @ONC_Gov not yet willing to mandate #clinical #data standards, due to cost to implement & other factors. #CPHC GailZahtz @MandiBPro @ONC_Gov If clinical data standards aren't mandated- will people really follow? Was hard with EHR when $ was at stake. #CPHC

Danmunro @MandiBPro @ONC_Gov needs to step in here. Could - but probably won't. #CPHC MandiBPro @GailZahtz There's the quandary. Until #clinical #data tied to $ (reimbursement or incentives), standards unlikely 4 #interoperability #CPHC CHopeMurray @danmunro I was hoping that the WHO or UN should own this, I believe that there is a concerted effort by the EU, worth of tracking #CPHC Danmunro @CHopeMurray ... maybe - but I don't like the prospects for what happens in the mean time ... #CPHC GailZahtz @danmunro @CHopeMurray What DOES happen in the meantime? We can't wait for other data points when we're developing now EG #CPHC Danmunro @CHopeMurray WHO/EU - 180 degrees different. For one thing they all have "universal coverage." #CPHC CLAROSMedTech @CHopeMurray @danmunro International Interop standards need to be adopted/set by both WHO and ITU (Int'l Telco Union) Good call... #CPHC MandiBPro @sandyhubbard @ONC_Gov mandating #interoperability & #HIE adoption, and incenting foundation w/ #MeaningfulUse. But LOTS of exceptions #CPHC GailZahtz @CHopeMurray @danmunro Are organizations like our just starting to identify the data points at advantage to follow one or the other? #CPHC Primushscm @GailZahtz @danmunro @MandiBPro could be a great takeover, I see a vision powerful perfomance #cphc GailZahtz @primushscm @danmunro @MandiBPro Who can create the powerful vision? #CPHC MandiBPro Positive note: SO MANY #HIMSS13 #interoperability evangelists here working towards patient value @motorcycle_guy @fredtrotter #CPHC GailZahtz @MandiBPro Would love to hear about what @motorcycle_guy @fredtrotter are doing at #HIMSS13 to help push patient value! #CPHC MandiBPro @GailZahtz @fredtrotter @motorcycle_guy strutting their @ReginaHolliday #TheWalkingGallery jackets & hacking #interoperability myths #CPHC GailZahtz @MandiBPro @fredtrotter @motorcycle_guy LOL I saw their @ReginaHolliday jackets. Question is how does it affect today? #HIMSS13 #CPHC GailZahtz @MandiBPro definitely plays to why we need more patient advocates at conferences to represent the less vocal majority #CPHC cmaer .@GailZahtz @MandiBPro The challenge is that patient advocates don't always speak for all patients so hard to get right reps #CPHC GailZahtz Yes! @cmaer @MandiBPro sometimes it feels like the loudest voice wins. How do we give all patients a voice? We're trying at a new site #CPHC MandiBPro @GailZahtz @cmaer So true, in all things. Will continue to be a challenge for #healthcare - and life. #CPHC

GailZahtz @MandiBPro @cmaer I believe though that if we collaborate we can give all patients a voice- but where does that start and grow? #CPHC MandiBPro @GailZahtz They've been VERY vocally engaged on and off the #interoperability showcase floor, educating passers-by & #twitter folk #CPHC sandyhubbard That's what we like to hear RT @MandiBPro So many #interoperability evangelists here working towards PATIENT VALUE. #CPHC sandyhubbard From one who is grasping at these concepts, who ultimately decides how interoperability will happen, which technology, what timeline? #CPHC danmunro @danmunro I talked with @Farzad_ONC about this 2 years ago. Was not encouraged then or since. #CPHC MandiBPro @danmunro I know. It's frustrating for those of us in the trenches. Impacts everything from #ACO attribution to #informatics +... #CPHC sandyhubbard Absolutely RT @CHopeMurray It is good that we are opening the dialogues for better understanding on goals and objectives #CPHC nursefriendly @MandiBPro #cphc Yes, "stuck w/ vendor-driven rules" and #Fortune500, #ForProfit, Bottom Line, Investor priorities :( GailZahtz What can we do from here after #HIMSS13 and big announcements to help from the trenches? @MandiBPro @danmunro #CPHC Danmunro @GailZahtz We can ALL lobby @ONC_Gov to step-up/step-in ;-) They could change the landscape on this overnight - but won't #CPHC MandiBPro @GailZahtz Keep educating re: importance of #interoperability & evangelizing criticality of shared information for #patientengagement #CPHC CHopeMurray @danmunro you and me too.... but keeping it open and transparent brings focus and attention, better than it being worked covertly #CPHC sandyhubbard Elephant in the room RT @MandiBPro Until clinical data tied to $ (reimbursement/incentives), standards unlikely for interoperability. #CPHC CHopeMurray @Yesgsi @sandyhubbard agreed - but goals with criteria for success are as useful as good intentions #CPHC GailZahtz @CHopeMurray @danmunro @MandiBPro Is it stupid question to ask why this can't work like other CoP like driven technology initiatives? #CPHC Primushscm @GailZahtz @danmunro @MandiBPro Cannot be attributed to a specific tech, though Verizon seem to have something different #CPHC Danmunro @GailZahtz CoP? Sorry - don't know the acronym #CPHC

GailZahtz @danmunro Communities of Practice. In other parts of medicine, and in other countries, they work on these issues with CoPs. #CPHC Danmunro @GailZahtz the U.S. system is so different - we really have to think of ourselves as an Island when it comes to healthcare (sadly) #CPHC GailZahtz @danmunro Do we NEED to think of ourselves as an island or do we CHOOSE to? #CPHC Danmunro @GailZahtz ... at $3.5T / yr (18% of GDP) it's being decided for us ;-( Larger issues there around democracy and power #CPHC Danmunro ... and "patients" are also polarized around different beliefs - so Gov't can skate around the issues ... #CPHC lindner_sarah @MandiBPro @sandyhubbard Fyi, MN Council of Health Plans recently petitioned the State to amend HIPAA laws to allow for data sharing. #CPHC MandiBPro @lindner_sarah #HIPAA will have to evolve as communication standards evolve, in support of #patientengagement and #interoperability #CPHC CLAROSMedTech @GailZahtz @CHopeMurray @danmunro @MandiBPro #CPHC too many cooks. HIMSS, CONNECT, AHRQ, NIH, ONC, et al - not on same page/protecting turf Bacigalupe Arriving too late for #CPHC Carpool chat Health education and advocacy for all GailZahtz @MyRecordVault @mandibpro We are trying to talk patient engagement- hope you will join us- many voices needed!! #CPHC MandiBPro #Interoperability and #MeaningfulUse initiatives SHOULD generate standard #data which #patients can use to advocate for THEMSELVES. #CPHC lindner_sarah @MandiBPro @danmunro What is the role of health literacy in interoperability? How do we help the patient understand? #CPHC GailZahtz Perhaps a big step would be to include patients in the data standards? Crazy talk? @cmaer @danmunro @MandiBPro #CPHC Danmunro @NatriceR I think patients involved in standard setting would be crazy - yes. Like asking us (as consumers) if IPV6 is good (4 web) #CPHC NatriceR @danmunro can u explain what IPV6 is? #CPHC Danmunro @NatriceR IPV6 is Internet Protocol version #6. It's the primary building block of the web - from which everything else just works #CPHC NatriceR @danmunro thanks for your reply...appreciate learning at least one new thing today:) #cphc GailZahtz @danmunro @NatriceR What about patients being able to provide data points that are important to them? #CPHC CHopeMurray @danmunro agree on defining the standards, but at least they could contribute to the requirements and giving feedback #CPHC

CLAROSMedTech #CPHC Until we take Politics out of the equation, HIE's/Interoperability/Health Informatics/Analytics & true HIT data mgmt will never happen Danmunro The ACA is a good example here. Legislation "around the edges." Very little real/big change and limited "strategic" vision (if any) #CPHC sandyhubbard @CHopeMurray @nursefriendly People are so fearful that they constrain all patient information, even that which can be shared. #CPHC CHopeMurray @sandyhubbard great point, I've seen that in action. But I've also seen HIPPA regulated orgs simplify things by not including key data #CPHC MandiBPro Ladies and gentlemen, I have thoroughly enjoyed #interoperabilty LIVE from #HIMSS13 - but I must run to the next session & keep faith! #CPHC GailZahtz Thank you so much! @MandiBPro We look forward to seeing all of your thoughts and favorites in your new Big Data CoP! Enjoy #HIMSS13 #CPHC CLAROSMedTech Thanks for the #CPHC chat folks. Enjoy HIMSS NOLA - got to get back to posting PSA's and doing some real good. ~MP Danmunro Thanks for the chat! Hope I answered at least some questions! ;[-) #CPHC CHopeMurray @danmunro thanks for the input and discussion, hopefully to be continued..... #CPHC LAlupusLady #CPHC I am in a waiting room. GailZahtz @LAlupusLady you will see there was so much information from @danmunro and @MandiBPro Your thoughts from waiting room welcome #CPHC GailZahtz @danmunro TY so much for your insight! Was great to see you take your article http://t.co/XHkYrEXj1i and answer questions directly! #CPHC sandyhubbard @GailZahtz We've been chatting for an hour. If people want to continue to talk, that's cool. How about a wrap up comments and thanks? #CPHC GailZahtz As everyone runs off- feel free to post a final question left unanswered or a take away! #CPHC GailZahtz @lindner_sarah So glad you could join. You'll see how we can go from mental health advocacy one week to interoperability another! #CPHC Nursefriendly #Thankyou both for coming today :) @MandiBPro @danmunro & @GailZahtz for hosting :) #cphc