Thursday, April 28, 2011

Maybe There Are Some Lessons Here for Australia. Very Interesting Point of View!

The following interesting blog post appeared a few days ago.

Through the Lens of Disruptive Innovation: Why Direct is a Hit and PCAST is an Outcast

Posted by Vince Kuraitis on

Regular readers know that I find Professor Clay Christensen’s theory of disruptive innovation to be a useful lens to explain industry evolution. Let’s look at two recent health IT initiatives and see why one is working and the other is stalled.

Characterizing the Direct Project — why it’s working:

  1. A low-end industry disruption. The Direct Project takes transactions that are routine but inefficient — fax, telephone, mail exchanges between health care providers — and specifies standardized, Internet based technologies to conduct them electronically.
  2. Incremental change — a few specified transactions.
  3. Bottom up — ONC hired a capable project manager (Arien Malec) who choreographed a small team of volunteers working under short deadlines.
  4. Implementing “better, faster, cheaper” technology on the fly (i.e., Internet transactions replace fax, phone).
  5. Under the radar — invoking little response from incumbents. Direct was seen as focusing on transactions that were peripheral to the core EHR.

The rest of the blog including the reasons why the PCAST proposals are failing are here:

The post refers to two articles:

The first is here:

Direct Project Rapidly Advancing Health IT Interoperability

More than 60 healthcare and health IT organizations are supporting the federal government's push for authenticated, encrypted health information to be shared with trusted recipients over the Internet.

By Nicole Lewis, InformationWeek

March 30, 2011


If the Direct Project's objectives continue to be advanced at a fast clip, widespread adoption of universal addressing and access to secure direct messaging of health information could soon be provided to healthcare stakeholders that serve up to 160 million Americans.

Those are the latest figures from officials at the Direct Project, a program that began one year ago to specify a secure, scalable, standards-based way for healthcare participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.

To keep healthcare stakeholders abreast of the latest development, the Direct Project announced March 22 that over 60 healthcare and health IT organizations, including many state-based and private-sector health information exchanges (HIEs), leading IT vendors, and several leading integrated delivery systems, have planned support for the Direct Project.

One of the vendors supporting the Direct Project is Allscripts Healthcare Solutions, a health IT provider. As part of the Direct Project, Allscripts has partnered with Albany, N.Y.-based Albany Medical Center to transform disconnected paper processes into connected, electronic transactions that improve physician collaboration and make healthcare interoperability a reality. As a result of the project, the hospital's discharge summaries will soon be routed to the patient's primary care provider via an automated exchange over the Internet. The primary care provider will also be able to refer patients to specialists and receive results back upon completion of those consultations.

The second is here

Monday, April 18, 2011

ONC Work Group Says PCAST Suggestions Not Feasible Now

Recommendations made by the President's Council of Advisors on Science and Technology to create a "universal exchange language" by 2013 are not feasible, according to a work group composed of members from the Health IT Policy and Standards committees, Health Data Management reports (Goedert, Health Data Management, 4/15).

PCAST Report Recommendations

Released in December 2010, the PCAST report recommended the development and use of a universal exchange language to promote health data exchange and increase the privacy and security of information. The language would separate data into units that have a "metadata tag" with directions for how to use the data. The report said a common language framework would assist in the adoption of electronic health record systems.

The report also recommended that CMS and the Office of the National Coordinator for Health IT establish a national infrastructure for patient data (iHealthBeat, 4/4).

Read more:

You can read about the theory here:

As I see it success follows doing things in simple, smart and incremental ways taking on one problem at a time. This seems to work.

Going complex, large scale and requiring major re-tooling often goes badly.

I leave it to the reader to apply these ideas to e-Health in Australia.


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