Interoperability ‘not the goal’ Connectivity between healthcare providers has been a sharp focus for IT initiatives since 2004, and the concept has assumed many forms An idea can change a lot over eight years and while the intent of interoperability remains essentially the same, its application has split off in various directions since 2004, when the Bush administration called for establishment of electronic health records, universal connectivity between healthcare providers and named David Brailer, MD, as national health information technology coordinator. EHRs remain a work in progress, though Brailer is long gone from his post and interoperability has meandered down divergent paths of connectivity. Over that time, new initiatives have sprung up as well, such as meaningful use, accountable care organizations and ICD-10 conversion.
The lofty regional health information organization concept originally proposed has been largely scaled down to smaller health information exchanges. Patching archaic gaps. Ideo’s Fix For The Upcoming Health-Care Enrollment Blitz. Paperwork is a pain, and largely becoming a thing of the past. With the passage (and upholding) of the Affordable Care Act, almost 40 million Americans are anticipated to go online for health care needs come January 2014.
The California Health Care Foundation, along with a coalition of nine public and private organizations, enlisted Ideo to create an exchange--or online interface--that will simplify the intimidating, overwhelming, and labyrinthine process of exploring options and signing up. As ever, Ideo applied its signature human-centered approach to Enroll UX 2014. The team talked to people on all sides of the federal poverty line to “establish empathy” for those who will be bringing their disparate backgrounds to the table. “Those at different points on the income spectrum have had different experiences because of what they’ve been eligible for,” project leader Christian Palino tells Co.Design. “Going out into the world helped us to synthesize and develop our design principles.” HL7 standards set free. 6 September 2012 Chris Thorne Health Level Seven International has announced that it is going to make its standards for the electronic exchange of health information free from 2013.
HL7 is a series of common standards and guidelines created by volunteers that enable computers to talk to other computers and share healthcare information. At the moment, only members of HL7 International are able to access the standards and the organisation has annual membership fees for suppliers from US $1,260 to $19,635. However, the standards and other select pieces of intellectual property will now be made available to the international healthcare community free of charge following a period of what HL7 describes as “careful analysis”, which is expected to take several months. “I’m delighted as it’s been a kind of stink that has been happening around health informatics for over the past ten years. "It’s going to benefit small developers and individuals as they don’t need to pay to join the club.
Computer Assisted Coding. In the past, I've highlighted candidates such as "analytics", "HIE", and "gamification" for the hottest technology concepts of the year, the "Plastics" of 2012. Recently, I've seen a new strong contender - "Computer Assisted Coding" With ICD10 looming on the horizon, companies such as m-Modal, Dolbey, 3M, and Optum are offering applications that process the structured and unstructured data associated with an inpatient hospitalization or outpatient encounter into suggested ICD9 or ICD10 codes. Using linguists, informaticians, natural language processing experts, and proprietary algorithms, each company promises to increase the efficiency of coders, provide a audit trail of the logic used to code each case (very useful if CMS/RAC asks for justification), and more accurately code case complexity. Workflow is a tricky question. Suppose that a patient visits an emergency department after a finger injury.
ICD-10 has spooked the industry with tales of 50% loss in coder productivity. Metadata in an HIE. Last week, the Technology Workgroup of the Massachusetts State HIE Advisory Committee was asked to address an interesting policy and technology question. When a payload of data (a clinical summary, a public health transaction, a lab result) is sent from provider to provider, what data should be included in the electronic envelope used in the sending process?
Massachusetts uses the Direct protocol so the payload is encrypted during transport. The Healthcare Information Services Provider (HISP) cannot read the contents of the message. All routing information i.e. who is the sender, who is the receiver, when was it sent, are there special privacy restrictions etc. must be placed as metadata in an electronic envelope around the payload. Most metadata is not very controversial. However, for auditing purposes, it could be important to send patient identifiers in the envelope. However, there are downsides. How could this be a problematic? What if the audit trail is itself is breached? Hunkered Down on HIE. Been pretty quiet here on the Chilmark Research site for the simple reason – we are doing one heck of a lot of research which you’ll be seeing the results of in the not so distant future.
Primary among those research efforts is the update to the 2010 HIE Market Report. The last report was extremely successful and highly regarded among those in the know. For example, a CEO from one of the top HIE vendors told us: By far, Chilmark Research has done the best research on the increasingly critical HIE market – no one else has come close to providing the in-depth research that is contained in the 2010 HIE Market Report. And it is not just the HIE vendors who appreciated the report as we sold quite a few to healthcare organizations who have been using the report to assist them in their strategic decisions and ultimately vendor selection process.
But the HIE market is evolving quite quickly and thus the need to provide a refresh of the report. “The more things change, the more they stay the same.” Managing Distributed Authentication. As the nation begins its pilots of pioneer Accountable Care Organizations and shares more data for care coordination and population management, IT departments will be asked to make clinical records available to increasing numbers of loosely affiliated clinicians and staff. The challenge will be managing the authentication and authorization of a diverse population of legitimate users. BIDMC stakeholders met this week to discuss best practices for managing distributed authentication while protecting privacy. We suggested three approaches: 1. Use well defined rules to approve new accounts for external organizations in addition to implementing robust audit systems for monitoring account use As clinical relationships become increasingly complex, it is no longer sufficient to use staff/credentialing privileges as the gating factor for creating accounts with clinical access rights. 2. 3.
Approaches 1+2 work well for clinician access to provider portals. Common Terminology Services. The HIT Standards Committee has tirelessly focused on content, vocabulary and transport standards. When it comes to vocabularies, they've tried to do three things 1. Select one vocabulary per domain of medicine (problems, medications, laboratories, demographic elements, structured data questionnaires etc.), which they've achieved n the 2014 edition of the standards and certification NPRM recommendations. 2. Recommend that the National Library of Medicine is the optimal organization for doing content review of value sets, offering feedback to value set and measure developers. 3. For #3, we'll need a body of standards to enable the sharing of value sets. What is CTS? It is the work of some 20 years, merging early terminology services work (Pathak, et al; LexGRID, JAMIA) and the 3M/Intermountain work into the LexGrid environment .
What does it do? The core principle is that we should not have different ways (Custom programming, REST protocols, SPARQL queries , etc) of accessing terminologies. LexGrid - EVS - LexEVS. What is the LexGrid? LexGrid (Lexical Grid) provides support for a distributed network of lexical resources such as terminologies and ontologies via standards-based tools, storage formats, and access/update mechanisms. The Lexical Grid Vision is for a distributed network of terminological resources. Currently, there are many terminologies and ontologies in existence. Just about every terminology has its own format, its own set of tools, and its own update mechanisms.
The only thing that most of these pieces have in common with each other is their incompatibility. This makes it very hard to use these resources to their full potential. We have designed the Lexical Grid as a way to bridge terminologies and ontologies with a common set of tools, formats and update mechanisms. Accessible through a set of common APIsjoined through shared indicesonline accessibledownloadableloosely coupledlocally extendableglobally revisedavailable in web-space on web-timecross-linked Documentation and Training.
The State HIE Privacy and Security Program Information Notice. On March 22, ONC issued important privacy and security guidance to State Designated Entities. It addresses concerns from State leaders and other stakeholders that health information exchange efforts have been hampered and slowed by the lack of consistent approaches to core privacy and security issues. The Program Information Notice (PIN) provides clear national guidance. It covers eight Core Domains 1. Individual access 2. Here's a summary of the highlights: Access and Correction Where HIE entities store, assemble or aggregate individually identifiable health information (IIHI), such as longitudinal patient records with data from multiple providers, HIE entities should make concrete plans to give patients electronic access to their compiled IIHI and develop clearly defined processes (1) for individuals to request corrections to their IIHI and (2) to resolve disputes about information accuracy and document when requests are denied.
In my view, these are very reasonable principles. HIE as a verb: ONC wants to move quickly on data exchange. Satisfying Patient-Consumer Principles For Health Information Exchange: Evidence From California Case Studies. Obtaining Providers’ ‘Buy-In’ And Establishing Effective Means Of Information Exchange Will Be Critical To HITECH’s Success. Simulation Suggests That Medical Group Mergers Won’t Undermine The Potential Utility Of Health Information Exchanges. + Author Affiliations ↵*Corresponding author Federal and state agencies are investing substantial resources in the creation of community health information exchanges, which are consortia that enable independent health care organizations to exchange clinical data. However, under pressure to form accountable care organizations, medical groups may merge and support private health information exchanges. Such activity could reduce the potential utility of community exchanges—that is, the exchanges’ capacity to share patient data across hospitals and physician practices that are independent.
Simulations of care transitions based on data from ten Massachusetts communities suggest that there would have to be many such mergers to undermine the potential utility of health information exchanges. Siemens Jumps into HIE Waters. Acquisition fever has set in and they’re dropping like flies, independent HIE vendors that is. Earlier today, Siemens announced its intent to acquire enterprise HIE vendor MobileMD. So in little over a year we have seen IBM snag Initiate, Axolotl fall into the hands of Ingenix/United Health Group (Ingenix is now known as OptumInsight), Medicity tie the knot with Aetna, Harris pick-up Dept of Defense clinician portal darling Carefx and Wellogic, a damsel in distress, being rescued by Alere.
Elsevier also announce an intent to acquire dbMotion for a whooping $310M, but nothing came of that other than a substantiation of the rumor that dbMotion was being shopped. That does not leave many small, independent HIE vendors that have some traction left in the market. Following is our list of such vendors and what might become of them: Care Evolution: Privately owned and self-funded, founder has every intent to stay independent. Getting back to the Siemens/MobileMD deal… Siemens has chosen to buy. Interoperability should be top priority for NHS, report says. The Interoperability Toolkit (ITK), a set of standards and guidelines intended to help the NHS across England to connect health IT systems, is touted as an important resource in bringing about interoperability in the region. A new report co-authored by Paul Cooper, IMS MAXIMS Head of Research, titled We Should Talk: Interoperability and the NHS, delves into this topic.
The report recognizes the benefits of the ITK, such as its ability to ensure results at a local level. But it recommends that more needs to be done to engage suppliers and that many people still need to be persuaded to accept interoperability. “An efficient healthcare system, which delivers the best for patients and makes effective use of resources, can only exist if data can be shared within and between organisations," Cooper noted. "The good news is that these problems can be overcome and that everyone within the healthcare IT sector accepts that interoperability is the way forward.
The full report can be found here. 5 keys to getting your HIE capabilities up and running. Another Shade of Blue Button. The Blue Button idea is simple - a large visible button on payer, provider, lab, or pharmacy websites enables patients to download their records in plain text. The Veterans Administration has used it extensively. The Office of Personnel Management asked all health insurance carriers in the Federal Employees Health Benefit Program (FEHBP) to add Blue Button functions to personal health record systems. OPM administers health benefit programs for the civilian sector of the federal government, including all executive agencies, Members of Congress and their staffs, and the federal judiciary on their websites.
The Blue Button is one of several models of health information exchange being implemented. I've summarized HIE models as: View - a website or web service enables authorized patients, providers or payers to view data in plain text or HTML. Push - an EHR sends data to another EHR via the Direct standard. Here's how it works: 1. Interoperability: One Key To Saving U.S. Healthcare - Healthcare - Interoperability. It's not the entire solution, but without well-designed, interoperable systems, our healthcare industry can't climb out of its current hole. During this week's Health Information and Management Systems Society (HIMSS) conference in Las Vegas, I sat down with Dr. Rasu Shrestha, medical director of interoperability and imaging informatics at University of Pittsburgh Medical Center (UPMC), to discuss the role of interoperability in hospital and community practice.
By the end of the conversation, I felt genuinely optimistic, for the first time in a long time, about the future of U.S. healthcare. I've been a skeptic about IT's ability to fix healthcare since I first signed on as the editor of InformationWeek Healthcare. Over the years, I've known too many medical leaders who were infatuated with medical technology and willing to adopt the latest innovation even before there was sufficient proof that it actually cuts costs and saves lives. More Insights. HIE Consent Policy. Blue Button — Home. Another Shade of Blue Button. HL7, IHTSDO Expand Collaborative Efforts | News | Healthcare Informatics. EFMI Web Portal - Intersectoral Medical Data Exchange Based on ISO EN 13606. Health Information Exchanges Cross Interoperability Milestone - Healthcare - Interoperability. Direct Project - Overview. Just in time for HIMSS: new HealthVault features! - Family Health Guy. Microsoft's HealthVault gets encrypted e-mailing | Microsoft.
IHE open source | Download IHE open source software for free. Clinithink Ltd. Doctors, Patients Can Spur HIE Progress, Feds Say - Healthcare - Interoperability.