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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Electronic Health Record – Foundation for Excellence

Excellence (ĕk‘sə-ləns) n.

  1. A special feature or quality that confers superiority
  2. The quality of being exceptionally good

I have mentioned this many times but it bears repeating with three recent news articles – the electronic health record itself is not a game changer but it is a powerful information gathering tool. However, by gathering information in a single collaborative place, EHR technology allows all clinical providers to measure, monitor, and begin to improve the way the provide care. It is this later part, which is part of the overall organizational transformation enabled by the technology (not solely because of it), that allows an organization to achieve the promised high performance results of an often painful EHR implementation.

  • Kaiser achieves top ranking among California HMO’s. I have mentioned Kaiser before. They are well positioned to be the national leader, eclipsing the VA, because they have continued to heavily invest in the technology while the VA has essentially lost their lead due to political infighting, inept leadership, and general lack of vision (contrast this with the Indian Health Service which ROCKS under Terry Cullen’s leadership). Watch for Kaiser to extend their leadership with how they engage their patients and extend the EHR from the enterprise to the home.
  • Midland Memorial recognized as an Info World Top 10 Projects. I obviously am pretty pleased with this recognition as Midland was our first commercial customer. The focus of this award is the intelligent use of the public domain VistA software to literally transform the organization. They have begun to reap the clinical benefits, and will continue to do so as the software marinates and permeates their ancillary services. They have also extended the software in new and exciting ways that should give the entire code base a new life that the VA had strangled out of it after years of neglect.
  • GE Health Care wants to invest $200M in National Health Record. We are all familiar with GE’s excellence in all the things it pursues including their famed Top 2 approach to every industry. Well, given that philosophy, they should bail out of HIT and reinvest in their market leading imaging technology. The GE Health Care unit has floundered, and beyond some big names (including Mayo, IHC, and Montefiore), it has essentially been a market loser. After their very promising beginning, with their $100M partnership announcement with Intermountain Health Care, they have floundered. Their Centricity product, plus the indigestion with the IDX acquisition, has proven to be as dysfocusing as dysfunctional to integrate. While I applaud the effort and the intention, making a $200M investment in a national project is but a PITTANCE (See Kaiser’s $10B investment in Epic). I hope they keep the promise of making the “open architecture” available so that others may learn and adopt code that may be produced by this effort.

I anticipate many more efforts, announcements, and projects like the above in the coming years. Particularly when we can agree on some standards of information sharing wherein all these disparate efforts can now work together. I also hope to see the ongoing collaboration requirements, ultimately yield to code sharing as part of their efforts so that all these individual investments might work toward a common goal – Excellence in Clinical Outcomes and Health Care Value (outcomes / price).

6 comments on “Electronic Health Record – Foundation for Excellence

  1. Very interesting post. I think the time is ripe for a serious look and investment in EHRs. Although healthcare is feeling the stress related to tightening financial budgets, the Jt. Commission recently published a whitepaper that provided insight and suggestions for “The Hospital of the Future.” Enabling technologies were discussed in the paper. Here’s a link if you’re interested in reading more…

  2. Of course, there are many points of disagreement on healthcare reform and numerous difficult decisions and compromises to be hammered out. But there’s also widespread agreement on at least two critical reform requirements.

    — Electronic health records (EHR). Bringing together the major medical systems has been a priority of current HHS Secretary Michael Leavitt, and will likely be backed by his probable successor Tom Daschle. EHR adoption is still low, so the opportunity is real and big.
    — Evidence-based medicine. Stakeholders agree that all efforts and systems should be based on sound medical science and published literature. The new systems need to assure and deliver quality, consistent care, incorporating the best diagnostic and quality care guidelines. These guidelines need to be available at the patient’s bedside as well as throughout payer and provider organizations.

    These two concepts give us a starting point for the emerging health reform compromise. I’m looking forward to seeing more points of agreement emerge as the reform conversation gains volume.


  3. Tim Cook says:

    Great post Scott.

    Both the VA and Kaiser have shown that a well governed common model is required to provide the interoperability results that they have achieved. That have each done this through a very expensive R&D process.

    I believe that this approach is essential for us to EVER have the NHIN. The practice of exchanging messages has worked to enable some level of interoperability. However, we know that there is a serious loss of semantic context in this process, not to mention the labor intensive effort of handcrafting so many messages between systems.

    Now; we could adopt the VA information model or we could adopt the Kasier information model. In each case, AFAIK, they do not openly publish formal definitions of the models nor do they demonstrate what the governance approach of these models are going forward. This would simply be sound engineering practices in any domain.

    Or; we could choose to embrace the openEHR specifications that have been developed over time and are proven in software. The openEHR concepts are difficult for some to grasp but they are are really very simple if you appraoch them with an open mind. The complexity of healthcare information is described in clinical knowledge models and not in the software itself. This leads to more flexible (ever changing healthcare) and more maintainable and future proof healthcare applications (not just EMRs).

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