Great assesment and article, sfisher.  Building the exchanges seems to be everyone's goals, but the ability to make it work and truly interface with other systems will be the true test.  Otherwise, we are building Towers of Babel.

I fully agree with your assessment that fraud exists in the delivery system as well as with the recipients.  I believe there is both tremendous waste and intentional fraud in the overall system.

DHagar

I think, too, that when most people think of "fraud," they mean the individual who's scamming the system to get freebies. What I believe is actually more common are healthcare facilities that scam the system on a much larger scale.

I think these systems will help curtail fraud. In Florida they finally implemented a simple step: a database for controlled substances, after the Sunshine State became known for its pill mills. In part because of that database (accessible by pharmacists and physicians) and, of course, a crackdown on doctor shopping (tracked by this database), along with criminal prosecutions of pill-pushing doctors and fraudulent "patients," the number of deaths by prescription drugs has dropped significantly in FL - and fast. So while that's not traditional Medicaid fraud, it does enter into fraud in some ways because some folk who went in for these powerful drugs claimed "back and neck" injuries, and scammed the system for medical non-treatments as well as medications they didn't need.

Flexibility and openness, because they're trying to coordinate 50 different systems. Honestly, I can't imagine how they're doing it. So they're going to basically need a pretty open and forgiving API on the federal side.

Thanks Sharon for your brillant responses. If I may ask one more question: what in your view do you think are the critical software requirements for implementing Health Information Exchange?

Gimmie a link and I'll look at it, thanks.

"Dunbrack, the author of both reports, noted that two years ago HIE executives were focused on connecting the ecosystem and making plans to transmit data between health organizations to qualify for Meaningful Use incentives. Today the focus has shifted to harnessing the data into "actionable information" that supports "accountable care organizations (ACOs) and coordinated care initiatives."

Hi Sharon,

What do you make of these Top 8 HIE Vendors and what's your assessment ofthe HIE vendor market?

Well, people are people. They will try to game any system, regardless of what technology is used to implement it. I don't know why Obamacare would be any different. On the other hand, Obamacare has already saved $1.5 billion. So we shall see.

As far as what changes might happen if Republicans take over the Senate, if both houses are controlled by Republicans, they could conceivably vote to overturn Obamacare -- though whether the House could overturn a veto is another question. But they would have to deal with the poltiical fallout from people who like having their pre-existing conditions and their adult children covered. There are some signs that the pragmatic Republicans are starting to regain control over the ideological ones, but who knows.

"After that, we can see if the Senate turns Republican; if not, it should be good for at least two more years. Recall that it's survived something like 33 Congressional votes."

So what happens if the Senate turns Republicanin two years time? Will it set backwards the gains that have been in developing these softwares?

"I recently did an article about how new ways of doing computer-based Medicare billing are resulting in huge new costs, because providers are simply cutting and pasting information from one form to another to make it look like the examinations that they performed on each visit look more extensive than they really were."

So on that same reasoning, we shouldnot expect much from these Health Information Exchange Softwares to be ofany significant help in curtailing fraud or excessive cost?