Last year, 2015, was a year of buildup, anticipation, and finally some bold moves to propel healthcare technologies forward, specifically regarding interoperability of data. The Office of the National Coordination, under the auspices of the department of Health and Human Services, released the long-awaited and much-debated meaningful use Stage 3 requirements in October. All the players in the health tech space were awaiting the final verdict on how Application Programming Interface (API) technology was placed into the regulations, and the wait was worth it, regardless of which side of the fence you were on. Before we get into the predictions, though, a little background knowledge about these technologies, and their benefits, will be helpful.
An API is a programmatic method that allows for the exchange of data with an application. Modern APIs are typically web-based and usually take advantage of XML or JSON formats. If you are reading this article, you almost inevitably have used apps that exchange data using an API. For example, an application for your smartphone that collects data from your Facebook account will use an API to obtain this data. Weather apps on phones also utilize an API to collect data.
Next let’s take a look at the history of interoperability of healthcare data. HL7 2.x is a long standing method to exchange healthcare data in a transactional model. The system is based on TCP/IP principles and typically operates with Lower Layer Protocol (LLP) which allows for rapid communication of small delimited messages. The standard defines both the communications protocol and the message content format. No doubt about it, HL7 2.x is incredibly effective for transactional processing of data, but it has been limited in two key areas:
A pioneering developer of a successful HL7 interface engine once said: “Once you have developed one HL7 interface … you have developed one HL7 interface.” The standard exists, but there is nowhere near enough conformity to allow this to be plug-and-play. For example, a patient’s ethnicity is supposed to be in a specific location and there is a defined industry standard list of values (code set) to represent ethnicity. In reality, the ethnicity field is not always populated and if it is, it rarely follows the defined code set.
HL7 is an unsolicited push method, which means when a connection is made, messages simply flow from one system to another. If you are attempting to build a collection of cumulative data over time, this is a mostly sufficient method, but what you cannot do is ask a question and receive a response. Although some query/response methods have existed for years, their adoption has been very sparse in the industry.
2016: Year of the Healthcare API
If you are a physician with an electronic health record (EHR) system and you accept Medicare patients, you likely have gone through the process of becoming meaningful use (MU) certified, which means you have purchased an EHR software solution certified by the ONC. This EHR must follow guidelines of technical features, and physicians must ensure they utilize those features in some manner. In October 2015, the ONC released MU Stage 3 criteria (optional requirement in 2017, mandatory in 2018) which includes this game changer: A patient has a right to their electronic health information via an API.
Guest post by Robert Williams, MBA/PMP, CEO, goPMO, Inc.
I continue to view 2016 as a shakeup year in healthcare IT. We’ve spent the last five plus years coming to grips with the new normal of meaningful use, HIPAA and EMR adoption, integrated with the desire to transform the healthcare business model from volume to value. After the billions of dollars spent on electronic health records and hospital/provider acquisitions we see our customers looking around and asking how have we really benefited and what is still left to accomplish.
All politics is local
Our healthcare providers are realizing their clinical applications, specifically EMR vendors, are not going to resolve interoperability by themselves. When the interoperability group, CommonWell formed in 2013 much of the market believed the combination of such significant players (Cerner, Allscripts, McKesson, Athenahealth and others) would utilize their strength to accelerate interoperability across systems. Almost three years late CommonWell only has a dozen pilot sites in operation.
Evolving HL7 standards and a whole generation of software applications are allowing individul hospitals to take the task of interoperability away from traditional clinical applications and creating connectivity themselves.
Black Book’s survey published last month, stated that three out of every four hospitals with more than 300 beds are outsourcing IT solutions. Hospitals have been traditionally understaffed to meet the onslaught of federal requirements. Can they evolve into product deployment organizations as well? Across all the expertise they need within the organization? Most are saying no and searching out specialty services organizations to supplement their existing expertise and staff.
Are you going to eat that?
Patient engagement is on fire right now at the federal level (thank you meaningful use Stage 3), in investment dollars and within the provider community. But to truly manage hospital re-admissions and select chronic diseases (diabetes, obesity and congestive heart failure for example) providers need data and trend analysis on daily consumer behavior. The rise of wearable technology and the ability to capture data/analyze data from them will be a major focus going forward. These technologies will likely help to make us healthier but with a bit of big brother side affect.
The College of Healthcare Information Management Executives released the following statement in support of embracing federal interoperability plans:
The federal government’s top health IT advisers recently made recommendations on how public and private stakeholders should progress toward interoperability in healthcare. Leaders from the College of Healthcare Information Management Executives (CHIME) and Health Level Seven International (HL7) embraced the recommendations of the JASON Task Force, calling them a significant step forward in achieving the promise of information technology in healthcare. CHIME and HL7 also highlighted the need to incorporate critical enhancements to standards currently under development for meaningful use Stage 3.
During a joint meeting of the Health IT Standards and Health IT Policy Committees, federal officials discussed new details regarding a national interoperability roadmap and outlined concrete recommendations meant to improve the appropriate access and use of health data. The JASON Task Force said that a solid foundation for interoperability should utilize public APIs, advance modern communications standards, such as HL7’s Fast Healthcare Interoperability Resources (FHIR), and use meaningful use Stage 3 as a pivot point to initiate this transition.
FHIR is a simple-to-use format that can improve interoperability for a range of technologies, including EHRs, patient-centric solutions and mobile applications. A next generation standards framework created by HL7, FHIR combines the best features of HL7’s Version 2, Version 3 and CDA product lines while leveraging the latest web standards and applying a tight focus on implementability.
“Today’s discussion and the recommendations of the JASON Task Force represent an evolution in thinking,” said CHIME president and CEO Russell P. Branzell, FCHIME, CHCIO. “The updated roadmap and the recommendations put forth by the JASON Task Force incorporate a tremendous amount of stakeholder input and articulate the challenges facing our industry much more completely than previous efforts.”
“The prioritization of standards-based interoperability and a commitment to long-term policymaking will enable healthcare to benefit from information technology in very tangible ways,” said Charles Jaffe, MD, PhD CEO of HL7.
CHIME and HL7 believe important recommendations were accepted by the full Health IT Standards and Health IT Policy Committees. HL7 and CHIME also support allowing time to make meaningful use Stage 3 more impactful with the inclusion of key standards that are still under development. “There remains a disconnect between artificial government timelines and the realities of standards and technology development,” Branzell said. “This highlights a principle concern with how health IT policy is created, adopted and implemented at the federal level.”
CHIME and HL7 are committed to collaboration in the advancement of health IT initiatives such as FHIR and support government efforts on the interoperability roadmap.
CHIME is an executive organization dedicated to serving chief information officers and other senior healthcare IT leaders. With more than 1,400 CIO members and more than 140 healthcare IT vendors and professional services firms, CHIME provides an interactive environment enabling senior professional and industry leaders to collaborate; exchange best practices; address professional development needs; and advocate the effective use of information management to improve the health and healthcare in the communities they serve.