By Scott E. Rupp, publisher, Electronic Health Reporter.
The healthcare technology world is ablaze, on FHIR. New proposed standards for interoperability are being established to allow health systems the ability to share information and facilitate patient access to data. Specifically, in large part through a structure known as FHIR.
This “FHIR” the market is speaking of is Fast Healthcare Interoperability Resources, an interoperability standard for electronic exchange of healthcare information. FHIR was developed by Health Level Seven International (HL7), a not-for-profit that develops and provides frameworks and standards for the sharing, integration and retrieval of clinical health data and other electronic health information.
FHIR emerged in 2014 as a draft standard for trial use to enable health IT developers to more quickly and easily build applications for EHRs and to exchange and retrieve data faster from applications. FHIR soon received support from EHR vendors like Epic, Cerner and AthenaHealth. Shortly thereafter, the Argonaut Project emerged to move FHIR forward, and in February 2017, FHIR became a full data exchange standard.
FHIR is interoperability
FHIR is built on the concept of interoperability and modular components that can be assembled into working systems to try to resolve clinical, administrative and infrastructural problems in healthcare.
FHIR provides software development resources and tools for administrative concepts, such as patients, providers, organizations and devices, as well as a variety of clinical concepts including problems, medications, diagnostics, care plans and financial issues, among others. FHIR is designed specifically for the web and provides resources and foundations based on XML, JSON, HTTP, Atom and OAuth structures.
FHIR can be used in mobile phone applications, cloud communications, EHR-based data sharing and among institutional healthcare providers.
According to HL7, FHIR aims to simplify implementation without sacrificing information integrity. FHIR “leverages existing logical and theoretical models to provide a consistent, easy to implement and rigorous mechanism for exchanging data between healthcare applications. FHIR has built-in mechanisms for traceability to the HL7 RIM and other important content models. This ensures alignment to HL7’s previously defined patterns and best practices without requiring the implementer to have intimate knowledge of the RIM or any HL7 v3 derivations.”
Health sector buy-in
The healthcare sector has clearly bought into FHIR, primarily because of interoperability challenges.
“Sharing data between different health systems has required significant investment of IT resources on one-off projects,” said Nilesh Chandra, healthcare expert at PA Consulting. “As the needs for data sharing have increased, hospital IT departments have been swamped with demand for all of this custom integration.
“FHIR and similar standards are an attempt at standardizing data integration, to make it easier to connect EHR systems and easily extract or upload data into them, based on reusable IT components,” added Chandra. “That said, FHIR is an important step in the right direction, but is not the panacea for all health IT integration issues.”
FHIR uses a set of commonly used medical ideas termed as “resources.” The resources are used across many different types of companies and organizations, but can all mean the same thing. An example would be blood pressure readings, or an MRI scan. Those resources are held in EHRs, smartphones, health information exchange databases and so on. FHIR also allows for the mining of those elements since they are tagged in a similar way in the FHIR standard.
“The complex part is done by individual systems that don’t have the same operating system,” said Jason Reed, PharmD blog founder. “Because they can pull that tag then they pull it and exchange it with other entities. They only show the tag and not the other code or structures they had to use to get to that tag.”
While consolidated clinical document architecture allows a group of healthcare items to be sent together, this is essentially like sending an electronic PDF, Reed said. Other systems that have different operating systems can’t break that down unless they use the same operating system.
All of this is a culmination of the fact that digital health data can improve outcomes and lower costs, but the reality has been something less than ideal. For example, during the economic stimulus in 2009, systems were designed before modern web standards for storing and exchanging data were ubiquitous. The industry was caught in the middle of a technical revolution and spent its cash before the best new practices were available, said Nick Hatt, senior developer at Redox.
By Scott E. Rupp, publisher, Electronic Health Reporter.
On March 21 HIMSS representatives vice president of government affairs, Tom Leary, and senior director of federal and state affairs, Jeff Coughlin, hosted a roundtable with members of the media to peel back a few layers of the onion of the newly proposed ONC and HHS rules to explain some of the potential ramifications of the regulations should they be approved.
The CMS proposed regulation is attempting to advance interoperability from the patient perspective, by putting patients at the center of their health care and confirming that they can access their health information electronically without special effort.
ONC’s proposed regulation calls on the healthcare community to adopt standardized application programming interfaces (APIs) and presents seven reasonable and necessary conditions that do not constitute information blocking.
According to HIMSS’s assessment of both proposals there’s room for interpretation of each, but the organization has not yet fully formed a complete response to each as of this writing.
However, Leary said: “It’s important to emphasize that all sectors of the healthcare ecosystem are included here. The CMS rule focuses on payer world. The ONC rule touches on vendors and providers. All sectors really are touched on by these rules.”
With both, ONC and CMS is trying to use every lever available to it to push interoperability forward and is placing patients at center, Coughlin said. The healthcare sector got a taste of how CMS plans to empower patients through its recent MyHealthEData initiative, but the current proposal places more specifics around the intention of agency. Likewise, the ONC rule is attempting to define the value of the taxpayer’s investment in regard to the EHR incentives invested in the recent meaningful use program.
Key points of the rules
Some key points to consider from the rules: APIs have a role to play in future development of the sector and are seen as a real leveler of the playing field while providing patients more control of their information, Coughlin said.
HHS is focusing on transparency and pricing transparency. For example, there’s movement toward a possibly collecting charge master data from hospitals and, perhaps, publishing negotiated rates between hospitals and payers, which HHS is looking into.
What happens now that rules are out? According to HIMSS, education members is the first step to understanding it and responding to the federal bodies. “What we’ve done is focus on educating HIMSS members in briefings,” Coughlin said. “Trying to get early feedback and early impressions from members, convening weekly conference calls to address parts of the rule. Once we have critical mass then we work with executive leadership to make sure what we are hearing from membership to is reflected across the membership.”
Looking into the future?
For health systems, the broad exchange of data likely remains a concern. Data exchange within the ONC rule impacts providers and health systems in a number of ways, especially in regard to the costs of compliance to meet all of the proposed requirements.
HIMSS representatives are not currently casting a look into a crystal ball or if they are (they are), they’re not yet ready to tip their hand regarding what the organization intends to pursue through its messaging on behalf of its members.
“We’re not in a place to see where we are going to land,” Coughlin said. “We are hearing from our members about the complexities of rules and what’s included. It’s hard to overestimate how complex this is. ONC and CMS in designing broader exchange of information is something that speaks very well of them, but (this is) complex in interpretation and implementation.”
Information blocking exceptions, the default is broader sharing of information across the spectrum. More information has to be shared and expectations need to be defined, they said. From HIMSS’ perspective, compliance is the primary issue of its members. The question that needs answering is what kind of burden is being placed on health systems and providers. Leary is confident HIMSS will spend a good bit of ink in its response on citing potential concerns over information blocking and what that might mean.
“It will be helpful for the community to have examples and use cases for what’s included especially for exceptions for information blocking,” Coughlin said. “We need examples to clearly define the difference between health information exchange and health information network.”
Healthcare IT Leaders, an award-winning consulting and staff augmentation firm that connects hospitals and health systems with top healthcare IT talent, announces its picks for the Best Healthcare IT Blogs of 2014. The winning blogs were chosen for their timely content, insightful writing and subject matter expertise on topics important to the HIT industry.
Electronic Health Reporter was among one of 15 sites nominated, and selected, for the honor of best healthcare IT blogs of 2014.
“It’s exciting to see the healthcare IT industry unfold from so many perspectives,” said Alex Gramling, chief marketing officer for Healthcare IT Leaders. “The blogging of CIOs, physicians, consultants, tech journalists, industry experts and lawmakers, whether they’re behind the scenes or right there in the action, helps inform, educate and entertain all of us.”
Site nominations came from social media followers and readers of the Healthcare IT Leaders blog.
Healthcare IT Leaders matches skilled IT talent to contract and full-time HIT consulting jobs. Through its blog, the company provides content, infographics, and news updates as well as insights from its chief medical officer, Dr. Frank Speidel. In 2013, Healthcare IT Leaders was named by Staffing Industry Analysts as one of the Best Staffing Firms to Work For in the US.
Here’s the complete list of sites selected as this year’s best:
Guest post by Rishi Agrawal, MD, MPH, physician champion, La Rabida Children’s Hospital, Chicago, IL.
“Why do I have to click so many times to order something so simple?” a frustrated resident blurted out on her first day using our newly implemented CPOE system.
Having helped build order sets as a physician champion, the best I could tell her was that many aspects of the software were beyond my control, but that it will get faster and easier with familiarity. And it did, to a point. Within a few weeks of going live, we had more than 90 percent adoption of CPOE, a source of both relief and pride. But challenges remained.
Because I’m fascinated with the lack of information surrounding pricing of various electronic health records and because I admire the work of AmericanEHR Partners, I thought it relevant to shine a little light on another interesting piece of information from the organization.
As this seems to be the year of the big EHR switch, and because seemingly the folks at AmericanEHR hear as much as I do about the lack of transparency in the pricing structure of these solutions, I thought I’d publish some guidance for what to consider when making the transition to EHRs. In my research on the subject – I’m developing a piece on the subject of EHR pricing – I came across this piece, compiled by the AmericanEHR from the Maryland Health Care Commission.
Breaking news hits the wires from the College of Healthcare Information Management Executives (CHIME), which has responded to a recent query by a group of six Republican senators who are hell bent on slowing down the meaningful use program to ensure its operating efficiently and not just handing out money to everyone claiming they’ve met Stage 1 (and eventually the other stages).
What’s remarkable about the news, though, is that CHIME actually issues a letter calling for a one-year extension of meaningful use Stage 2. According to CHIME’s letter, as reported by Healthcare Informatics,
Guest post by Alex Horan is the senior product manager at CORE Security.
In 2012 we saw an increasing number of health breaches across the country – and across continents. We saw an employee’s lost laptop turn into a healthcare records breach of more than 2,000 sensitive medical records of Boston Children’s Hospital patients. We heard how one weak password allowed a hacker to access the Utah Department of Technology Services’ server and steal approximately 780,000 patients’ health and personal information. We even read about Russian hackers encrypting thousands of patient health records and holding the information for ransom for thousands of dollars.
Healthcare fraud or medical identity theft put both individuals and healthcare organizations at huge and severe risk. Since 2010, Ponemon Institute has annually benchmarked the progressing and evolving issues of patient privacy and security. The third annual study, released in December 2012, found that healthcare organizations still face an uphill battle in their efforts to stop and reduce the loss or theft of protected health information (PHI) and patient records. What’s more, data breaches can have severe economic consequences – and the repercussion costs are only climbing. The study estimates the average price tag for dealing with breaches has increased from $2.1 million in 2010 to $2.4 million in 2012. The report projects that the economic impact of continuous breaches and medical identity theft could be as high as $7 billion annually, for the healthcare industry alone.
Guest post by Ken Perez, Director of Healthcare Policy and Senior Vice President of Marketing, MedeAnalytics, Inc.
Recently, Mitch Seavey, 53, became the oldest winner of the Iditarod, the most famous dog sledding race in the world. At a distance of 1,600 kilometers, the Iditarod constitutes a race of supreme endurance. In dog sledding, the dogs that are chosen to lead the sled are usually the smartest, as well as the fastest, and they are appropriately called lead dogs.
The lead dogs in the realm of Medicare ACOs are the 32 pioneer ACOs, the selection of which was announced in December 2011 with great fanfare and optimism. With the greater risks (and rewards) of the pioneer ACO Model, the pioneers were widely considered the best and the brightest, the organizations most likely to succeed as ACOs.
As a service to readers of Electronic Health Reporter I decided to ask its readers which sessions they most wanted to see at HIMSS13. For the record, I have attended HIMSS more than once so I understand how overwhelming it can be. However, I also understand that there are plenty of great resources available to those in attendance regarding which events to attend. Certainly, what I offer here is by no means authoritative nor is it objective.
Thus, I leave it up to you to decide what you are going to do while in New Orleans. All I can say is thanks for reading. I hope this helps.
One of the must-attend sessions at HIMSS13 will be the Interoperability Showcase, held at ongoing times between March 4 through6. During this showcase, attendees will have the opportunity to see how their personal health data moves securely from system to system. For Nextrials, it’s an opportunity to demonstrate how its clinical trial data and management platform, Prism, intersects with platforms used in hospitals and clinics. This integration can not only improve patient care — it can give patients better access to participation in clinical trials, and help clinics and hospitals contribute to the advancement of medicine.
Roundtable 305 – Proprietary vs. Third-party vs. Standards-based Device Integration: An Update, Tuesday, March 5 at 2:15 p.m., Room 293. Joe Kiani, the chairman of the Masimo Foundation for Ethics, Innovation, and Competition in Healthcare and CEO of Masimo, and I’m alarmed that more than 200,000 patients die each year of preventable deaths in U.S. hospitals. At the recent Patient Safety, Science & Technology Summit, Kiani and friend Bill Clinton issued a goal for zero preventable deaths by 2020. Eight other medical device companies – including GE Healthcare, Drager, Sonosite and Zoll – also pledge to make their data available through open architecture systems. Many other hospitals since have followed with similar commitments. The roundtable’s objectives: “Discuss the advancements and achievements in medical device integration over the last year.” While many are talking about device interoperability and patient safety, the Masimo Foundation for Ethics, Innovation, and Competition in Healthcare are actually doing something about it.
Cheryl Bailey, CNO/VP of Patient Care Services at Cullman Regional, will share her firsthand accounts of using mobile health to improve patient care and show conference-goers how the hospital reduced re-admissions by 15 percent and increased HCAHPS scores by more than 60 percent within six months using Good to Go, a recently launched mobile health platform by ExperiaHealth. Bailey will be presenting at the Nursing Informatics Symposium where she is presenting: “Improving Patient Satisfaction & Reducing Re-admissions with Better Discharge Communication.”
Accenture’s Manuel Lowenhaupt, managing director of U.S. clinical services, Monday, March 4 at 9:45a.m. “Trending Health: Using Information Technology to Deliver Clinical Outcomes.” By implementing a new clinical operating model and engaging clinicians in transformational change, Trinity Health standardized care and improved quality and safety outcomes by using information technology.
Executive Breakfast Panel: Go Big (Data) or Go Home, Tuesday, March 5 at 7 a.m., Hilton Riverside. Three CEOs discuss how the marriage of medical and pharmacy data paired with intelligent analytics will reveal remarkable insights available to all from the cloud. Speak is Atigeo CEO Michael Sandoval.
Emdeon Speaking Session: The Future of Coding is NOW: Maximizing Coding Efficiency and Accuracy Using Big Data and Analytics, Tuesday, March 5 at 11 a.m. Atigeo Director of product management, Manjula Iyer.
“Beyond the Device: A Comprehensive Mobility Strategy” on March 5, as a kick start to addressing mobility needs as they relate to business strategy, security, and infrastructure, beyond the device.
“Leveraging Smartphones to Simplify Communication Across Multiple Systems” will be helpful for organizations planning to implement or already using smartphones to communicate.
Policy and monitoring play critical roles in your information management; you need to develop a governance strategy to drive consistency and adherence to your adopted standards. Governance is essential to ensure that the right decisions and actions in the management of healthcare data are continuously taken. “Healthcare Information Governance: Establishing the Framework for Enterprise Management of Information” on March 6.
Former President Bill Clinton’s keynote on Wednesday, March 6.
“ICD-10 and Administrative Simplification” session (Education Sessions 131) will address the role of ICD-10 in administrative simplification, and the overall objective to lower costs, create uniform electronic standards, and streamline exchanges between health care providers and payers.
Other sessions of note:
#4: The Ins and Outs of Meaningful Use: Understanding Stage 1 Changes & Stage 2 Requirements, featuring Robert Anthony, Policy Analyst, CMS, March 4, 2013, 9:45 – 10:45 a.m., New Orleans Theater C
#23: Stage 1: EHR Incentive Programs, March 4, 2013, 11 a.m. – noon, New Orleans Theater C
#62: Stage 2: EHR Incentive Programs, March 5, 2013, 9:45 – 10:45 a.m., New Orleans Theater C
#81: CMS Town Hall: CMS eHealth: Building the Future, March 5, 2013, 1 – 2 p.m., New Orleans Theater C
#131: ICD-10 and Administrative Simplification, March 6, 2013, 8:30 – 9:30 a.m., Room 294
#138: Views from the Administrator, featuring Marilyn Tavenner, Acting Administrator, Chief Operating Officer, CMS, March 6, 2013, 9:45 – 10:45 a.m., New Orleans Theater C
#178: CMS Quality Measurement, March 7, 2013, 11:15 a.m. – 12:15 p.m., New Orleans Theater C
When my wife forwarded me the following heartwarming link to a tender, but powerful presentation about leadership and teamwork, and later in the day I came across a piece titled “5 Facts that Top Teams Learn From Geese,” I figured it was some sort of sign so thought I’d share with the readers of Electronic Health Reporter.
The link to the presentation is here, and it’s worth a look. Even though it’s a slide show, I understand if you don’t have the time or the desire to follow a link. As such, I’ve included the piece, from HR Pulse (thanks to writer Charles Lubbe for compiling this post, his in full below).
Is it about health IT? No. But, it’s about leadership and taking common sense steps to help improve your teams and your organizations. These are simple tips that apply to every business and should be embraced by every leader — and, who doesn’t like an animal story?
Fact #1: As each bird flaps its wings, it creates a “current” that lifts the bird following it. By flying in a V formation, the whole flock adds 71 percent more flying range than if one bird flew alone.
Lesson learned: People who share a common direction and sense of community can get where they are going quicker and easier if they travel on the strength of one another. The clearer the vision or certainty of a team, the more courage they demonstrate in achieving their results and the less they concern themselves with individual effort.
Fact #2: Whenever a goose falls out of formation, it suddenly feels the drag and resistance of trying to fly alone and quickly gets back into formation to take advantage of the lifting power of the bird immediately in front of it.
Lesson learned: If we have as much sense as geese, we will stay in formation with those who are ahead of where we want to go and be willing to accept their help and give ours to others. Top teams encourage discipline and look forward to opportunities for positive criticism, ensuring that the entire team reaps the reward.
Fact #3: When the lead goose gets tired, it rotates back into the formation and another goose flies at the point position.
Lesson learned: It pays to take turns doing the hard tasks and sharing leadership. Teams that are focused on their vision understand situational leadership and don’t need to be micro managed.
Fact #4: The geese in formation honk from behind to encourage those up front to keep up their speed.
Lesson learned: We need to make sure our “honking” from behind is encouraging, and not something else. Teams that place a value on regular check in and feedback hold their shape.
Fact #5: When a goose gets sick, is wounded or shot down, two geese drop out of formation and follow it down to help and protect it. They stay with it until it is able to fly again, or dies. They then launch out on their own, with another formation, or they catch up with their flock.
Lesson learned: If we have as much sense as geese do, we too, will stand by each other in difficult times as well as when we are strong.
I’d love to know your thoughts and if you think the previous points are worth the read, and more importantly, if they are worth implementing.