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.
FHIR’s culmination
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.
Tom Leary
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.
Jeff Coughlin
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.
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.
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.
