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Brendan Keeler Profile picture
Brendan Keeler
@healthapiguy
interoperability practice lead at https://t.co/GFmkh2fU1I advisor flexpa, elion, revero, vitalize. formerly zus, redox, carequality advisory board, epic
Aug 27, 2024 • 67 tweets • 35 min read
a selection of my favorite hti-2 comments (will update as more come in)

make sure to comment!

rules of thumb:
1. do an attachment PDF
2. don't do anonymous, that's lame
3. only comment on parts you know about
4. cement your comment in real world experienceregulations.gov/commenton/HHS-… the individual comments are always funny. I'm really curious who these good samaritans are reading the rules despite not working in the industry - generally the company ones with attachments are meatier and actually in the weeds Image
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Jul 10, 2024 • 176 tweets • 39 min read
wake up babe, new interop and ehr certification rule just dropped

healthit.gov/topic/laws-reg… USCDI v4 by Jan 1, 2028.

previous thoughts here. not much to uscdi v4
Jan 21, 2023 • 12 tweets • 5 min read
wow, excellent writeup by @Particle_Health on Carequality, Commonwell, and networks. aside from the fairly constant self-backpatting, it's really accurate about the mechanics and state of affairs

some random thoughts

go.particlehealth.com/hubfs/Files/Ma… first section is an excellent primer
Jan 12, 2023 • 5 tweets • 2 min read
Cures FHIR APIs are live as of December! Most EHRs actually hit the deadline (at least one paper).

It can be hard to find the new APIs. Here's how I do it. 1. Navigate to Certified Health IT Product List (CHPL)

This is an unparalleled resource by the @ONC_HealthIT listing certified health IT products. If you're buying an EHR, this lists what ONC considers one. If it's not here, technically not an EHR

chpl.healthit.gov/#/search
Dec 12, 2022 • 19 tweets • 4 min read
I don't have answers about what the real intent here is and no one will until we see what Connection Hub really is next month

Some historic context is worth considering, however
digitalhealth.modernhealthcare.com/technology/epi… Prior to the advent of App Orchard, Epic integration largely consisted of:
1. HL7v2 interfaces
2. MU3 FHIR APIs
3. Random other IHE and connectivity methods

All of these were on open.epic.com

4. Proprietary "web services", documented for customers but not externally
Oct 8, 2022 • 13 tweets • 3 min read
One commonality im seeing across API companies is the consistent early launch (and generally inevitable failure) of chat based developer communities API companies want to be developer first. Part of that effort is that they want to have product led growth, with self service enablement. A developer should be able to go from problem to solution without sales or support, if they choose
Apr 20, 2022 • 15 tweets • 3 min read
some early morning thoughts about secondary and tertiary effects Cures

1. The October date this year is going to be an absolute, unmitigated clusterfuck Let's start with providers. If I'm a provider, I have dozens or hundreds of systems, not just my EHR. Only a handful of these systems are certified health IT (i.e. "Cures enabled"), represented by yellow boxes. Most are living a Cures-unaware life (black boxes) Image
Apr 10, 2022 • 7 tweets • 2 min read
The unbelievable selective mixture of epistemic and deontic modal verbs in this article is galaxy brain.

To comingle optimistic possibility (all the "can" and "could") with deterministic future ("will") is actually disingenuous writing Blockchain's impact on healthcare has not made progress since the Etwaru's comments. There's been negligible market adoption. We've seen no regulatory tailwinds.
Mar 20, 2022 • 13 tweets • 5 min read
A little over a year ago, I published an article on the future of EHRs, especially for digital health provider orgs. I proposed three paths forward but the main one people seemed to gravitate towards was the headless EHR.

Let's see how we've progressed

healthapiguy.substack.com/p/to-ehr-or-no… On the buy side of the house, I listed a few of the most common EHRs people purchase.

This list has definitely changed Image
Jan 11, 2022 • 14 tweets • 2 min read
There's often a lot of confusion about the big 3 of C named networks in healthcare interoperability: Care Everywhere, Carequality, and Commonwell.

So here's a breakdown Care Everywhere is the module in Epic for cross-organization exchange. The user interface offers the ability for providers to query for patient records as well as pushing records.
Jan 9, 2022 • 6 tweets • 1 min read
The blanket statement indictment of mental health startups missed the mark for me. "They're taking VC money looking for a return!"

virtual care practices don't have structurally different incentives than in-person

Let me introduce you to private equity, a hugely dominant force now in brick and mortar care
Aug 19, 2021 • 22 tweets • 7 min read
Let's talk a bit about pharmacy fulfillment, e-prescribing, and the state of affairs. It's a space that's existed for a (relatively) long time but there are a ton of exciting companies trying to work their way into the mix *Biblical voice*

In the beginning, there were paper prescriptions. Doctors wrote (scribbled) what medications a patient should take, how often, etc on a piece of paper (or expensive paper for regulated meds) and the patient took to the pharmacy of their choice
Aug 17, 2021 • 13 tweets • 3 min read
Since BTC and NFTs are dominating twitter this year, let's talk blockchain in healthcare.

Lots of memes and jokes, lots of generic "it doesn't work in healthcare", etc, but this is thread is the why. Architecture in general can be broken down into three main paradigms: centralized, distributed, and decentralized (contrary to my further simplification yesterday)
Aug 17, 2021 • 12 tweets • 3 min read
If centralizing patients' data from thousands of local records to ~80 aggregate hubs is good and the right way to enable access, lemme tell you about a crazy idea: 1 aggregate hub Drastically and tremendously oversimplified, there are only two perspectives for data exchange:

1. You dump all the data in one aggregate spot
2. You keep all nodes on a network decentralized but give the right tools to find and access
Aug 15, 2021 • 10 tweets • 5 min read
going digging trying to finish this article and continue to find gems:

the absolute bloodbath in this google group as Peter DeVault, @amalec, and go to town fighting for which standard to use for NHIN Direct (now @DirectTrustorg)

groups.google.com/g/nhindirect-d… @amalec's history of Direct a great source for what I'm looking for:
Jul 8, 2021 • 9 tweets • 2 min read
Fun fact: Patient auth for providers is a red herring. It's the payer member auth access that's going to be the Plaid for healthcare. Providers are the healthcare equivalent of retail and e-commerce. Fragmented with hundreds of thousands of organizations and also tons of disparate products
Feb 11, 2021 • 5 tweets • 3 min read
A quick and simplified guide to determining your product's healthcare data strategy.

If you are building in healthcare, you fall into three overlapping broad buckets Digital health consumer app - you're making something consumer-facing. You're not signing BAAs or selling to health systems, but maybe to payers or employers (big groups of consumers)

You should use patient authentication via SMART on FHIR. Aggregators like @Human_API can help