Tag: FHIR

How USCDI Is Reshaping Data Quality and Access In The Healthcare Industry 

Angela Kennedy

By Angela Kennedy, director of strategic operations, medical specialty societies, IQVIA.

In 2016, the 21st Century Cures Act (Cures Act) resulted in new regulations that fundamentally changed the way deidentified patient data is accessed and utilized. However, data quality and interoperability between the various healthcare stakeholders has been a major hurdle.

When it comes to implementing the Cures Act, the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) each must administer the law’s requirements. Therefore, each agency has released a final rule over their respective jurisdiction.

Information blocking is a primary focus of the ONC final rule, which also requires that developers certified by the ONC Health IT Certification Program must have standardized Application Programming Interfaces (APIs) and implement Fast Healthcare Interoperability Resources (FHIR) technology, enabling individuals to access structured electronic health information securely and easily.

These advancements will only make information sharing easier. The CMS Interoperability and Patient Access final rule also focuses on API interoperability, requiring federal payers to make provider directory information publicly available. Specifically, it encourages interoperability and patient access to health information.

In a major step to ensure open sharing of information, the ONC introduced the US Core Data for Interoperability (USCDI). Since ONC is the certifying body for EHRs, providers must be prepared to transition to a new “Cures Edition” version of its software before the end of 2022.

What is USCDI?

USCDI encompasses a standard for data creation, a set of defined data classes and elements that Electronic Health Record (EHR) vendors must be able to provide. This creates an expectation for open and free access to healthcare data by industry stakeholders, including physicians, insurers, labs, registries, and the patients themselves. CMS requires that payers share the USCDI data they maintain with patients via the Patient Access API and with other payers via the Payer-to-Payer Data Exchange.

While some organizations have used APIs to aid the exchange of data, experts in the healthcare industry have been aware that for a truly free and open data exchange to work, modern technology and standards need to be put in place. This is where FHIR comes in.

What is FHIR?

FHIR is based on a new iteration of Representational State Transfer (REST) designs, which uses HTTP to enable the exchange of information between applications. That means if two applications adhere to the standards outlined for REST technologies, it makes it easier for two applications to exchange and manage healthcare data regardless of how it is stored. Not only do these applications now speak the same language, but FHIR has also created categories for certain healthcare interactions to further refine the data exchange by making it easily identifiable within each system.

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HL7 Launches FAST FHIR Accelerator To Jumpstart FHIR-Based Interoperability Solutions

New HL7 FHIR Accelerator Project Aims to Improve ...Health Level Seven International (HL7) announces the Office of the National Coordinator for Health Information Technology’s (ONC’s) FHIR at Scale Taskforce (FAST) will transition into an HL7 FHIR Accelerator.

The FAST project was originally founded to identify Fast Healthcare Interoperability Resources (FHIR) scalability barriers and define a common set of infrastructure standards for scalable FHIR solutions. As an Accelerator, FAST will continue its work under the purview of HL7 with a broad range of stakeholders informing and participating in the initiative.

“As a widely adopted standard supported by many of the most notable stakeholders in the health IT community, FHIR is making rapid, real-world progress toward addressing the biggest challenges of health data interoperability,” said HL7 International chief executive officer Charles Jaffe, M.D., Ph.D. “The FAST Accelerator will bring us closer to defining a consistent and scalable approach to deploying FHIR across high-value use cases and disseminating these best practices to the industry.”

FAST will complement and support the work of HL7’s other accelerators.  While groups such as Vulcan, the Da Vinci Project, and CodeX develop standards to support specific functional use cases, FAST focuses on scalability approaches that implementers can leverage across use cases to simplify deployment and use of FHIR in disparate environments.

In early 2022, FAST formed a cross-stakeholder team to begin the transition from an ONC-convened initiative to an HL7 FHIR Accelerator. The team has been working to develop a framework for the accelerator’s scope of work, governance principles, and operating and funding models.

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What Health IT In the Cloud Means To Providers

John Kelly

By John Kelly, chief technology officer, PatientKeeper, Inc.

If there’s a topic in healthcare IT that has absorbed more ink over the past decade than “interoperability,” I can’t imagine what it would be. (Well, going back to 2009, “meaningful use” may rank a close second.)

The federal government has taken a significant interest in advancing health IT interoperability. For instance, Title IV of the 21st Century Cures Act is all about it, and in 2020 ONC promulgated rules designed to push the industry along to make interoperability a practical reality. One specific way is through an application programming interface (API) approach that “supports health care providers’ independence to choose the ‘provider-facing’ third-party services they want to use to interact with the certified API technology they have acquired.”

But, generally speaking, government mandates have paved a slow and bumpy road to any health IT goal.  They focus on rules and regulations rather than incentives (admittedly, meaningful use was a different case).  And thus far, that has been the fate of interoperability.

The metaphor our parent company, Commure, uses to describe healthcare today is a city without roads. We built the “city” of healthcare, populated with over 3,000 healthcare IT companies, without considering the pathways that would connect them. Healthcare lacks the proper infrastructure and connectivity to collect and serve up data in ways that will meaningfully transform the way care is accessed, coordinated, delivered, and experienced.

I believe healthcare IT is, at long last, on the cusp of finally realizing the much-hyped, yet elusive promise of true interoperability. Why now? Because of the cloud, and cloud vendors’ embrace of open standards in their APIs, notably FHIR.

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HL7 Launches Helios FHIR Accelerator For Public Health

A new initiative launched by Health Level Seven International (HL7) and jointly supported by the Centers for Disease Control and Prevention (CDC) and the Office of the National Coordinator for Health IT (ONC) seeks to use widely recognized data exchange standards to help advance public health. The effort, called Helios, intends to strengthen the capacity and streamline data sharing across all levels of public health using the HL7 Fast Healthcare Interoperability (FHIR) standard.

“Public health has risen in urgency and importance over the last 18 months,” said the ONC’s National Coordinator for Health IT Micky Tripathi, Ph.D., M.P.P., “FHIR accelerators have had great success in engaging implementers as early as possible to help identify and overcome longstanding barriers to interoperability. The Helios alliance is a market-based implementation collaboration that will help to ensure FHIR development is coordinated and focused on real world public health needs.”

The initiative is the latest to use HL7’s FHIR Accelerator program, which seeks to speed the development and availability of FHIR to deliver better data that leads to better health outcomes. The Helios alliance represents an ambitious new use of the FHIR Accelerator Program, pulling together a diverse group of state, tribal, local, territorial, and Federal public health agencies, private and philanthropic sector partners, and other groups interested in the equitable and effective use of data for the advancement of public health.

“Helios is expected to become an integral component of the HL7 FHIR Accelerator Program and comprise a cornerstone to the newly announced HL7 Implementation Division,” said Charles Jaffe, M.D., Ph.D., the CEO of Health Level Seven International. “The Helios Public Health Accelerator will provide a critical step toward the direct access to data needed for public health.”

As the FHIR standard matures, there is a clear path to utilize FHIR and other existing standards to execute the interoperable exchange of data for public health. Helios members will help demonstrate the utility of FHIR and ensure public health needs are at the forefront as FHIR-based implementations evolve and rollout nationwide.

As the FHIR standard matures, there is a clear path to utilize FHIR and other existing standards to execute the interoperable exchange of data for public health. Helios members will help demonstrate the utility of FHIR and ensure public health needs are at the forefront as FHIR-based implementations evolve and rollout nationwide.

“Standardizing and automating our data flows will help us accelerate data into action,” said Daniel Jernigan, M.D., M.P.H., CDC’s deputy director for public health science and surveillance. “Organizing in this way will help ensure FHIR-based solutions are integrated, aligned, and are a complement to everything else that’s going on in the public health community.”

Organizers of Helios are encouraging other entities to participate in the effort. More information about Helios and the project’s goals can be found on HL7’s website, www.hl7.org/helios/.

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Innovation Options For Healthcare IT leaders

Jörg Schwarz

By Jörg Schwarz, director of strategy and solutions, Infor Interoperability

The COVID-19 pandemic has served as an innovation catalyst for many healthcare delivery organizations. Within a short period of time, health systems had to find ways to perform tasks they previously did not execute, such as scheduling thousands of vaccination appointments online with people that are not regular patients and delivering healthcare visits between patients and doctors electronically.

Let’s pause for a moment and acknowledge what a great achievement this burst of innovation and implementation was in an industry that chronically underfunds IT and rolls-out projects over years, not months.

However, this accelerated innovation can also present a problem – there is no going back. Patients expect online services. Patients want to book appointments like they book services for their car or food delivery: online. Patients want the option to have phone or video visits instead of waiting weeks for face-to-face visits. There is a myriad of options for new applications that promise remote patient monitoring or improved diagnostics, workflows, etc. How can a CIO in Healthcare possibly cater to all the demands for innovation when they must shell out the majority of their budget to maintain a behemoth EHR Mega suite from one of the three main vendors in the U.S. at the same time?

Fortunately, there are interoperability standards that enable just this – connecting new applications that augment the functionality of core systems and let information flow between all of them. HL7 v2 was designed for this and has been around since the 1990s. It was developed along with other EDI standards, such as X11, in an age when files where exchanges in batches or real-time when a connection was available – in other words, before the Internet age. While HL7 v2 is focused on transacting clinical data, X11 was developed to transact claims.

Much has changed in the world since the 1990s, and HL7 v2 is still the reliable de-facto standard that our healthcare system and interoperability across providers runs on in 2021. But it is not a great standard in the age of web services and mobile applications. To ensure interoperability flourishes in today’s digital age, we now have HL7 FHIR (Fast Healthcare Interoperability Resources). Many of the new and promising applications that allow innovative functions and workflows are based on FHIR. The introduction of FHIR creates the following set of questions for a CIO at a healthcare delivery organization that is considering his or her innovation agenda:

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HHS STAR HIE Program Funds 5 Organizations To Improve Interoperability

Image result for u.s. department of health and human services logoThe U.S. Department of Health and Human Services (HHS) announces that five cooperative agreements to health information exchange organizations (HIEs) to help support state and local public health agencies in their efforts to respond to public health emergencies, including disasters and pandemics such as COVID-19.

The HHS Office of the National Coordinator for Health Information Technology (ONC) is administering $2.5 million in funding from the Coronavirus Aid, Relief, and Economic Security Acts (CARES Act) signed by President Trump on March 27, 2020.

The funding will support local health information exchanges (HIEs) under the Strengthening the Technical Advancement and Readiness of Public Health Agencies via Health Information Exchange (STAR HIE) Program.

Each of the five recipients will work to improve HIE services so that public health agencies can better access, share, and use health information during public health emergencies. These efforts will also support communities that are disproportionately impacted by COVID-19.

“Health information exchanges have long served important roles in their states and regions by helping health data flow to treat patients,” said Don Rucker, MD, national coordinator for health information technology. “These STAR HIEs will help public health officials make real-time decisions during emergencies like fires, floods, and now, the COVID-19 pandemic.’

The five HIEs, each awarded two-year cooperative agreements, are:

Georgia Health Information Network, Inc. (GaHIN)

Georgia Health Information Network will support the Georgia Department of Public Health and Georgia Department of Community Health to better access, share, and use electronic health information, especially data from populations underserved and/or disproportionately affected by the COVID-19 pandemic. This will include increasing the reporting to a state-wide COVID-19 registry and expanding public health reporting and data enrichment for providers not connected to GaHIN.

Health Current (Arizona)

Health Current (Arizona) will support the Arizona Department of Health Services by improving the timeliness, accuracy, and completeness of hospital reporting of key COVID-19 healthcare data, including facility hospitalization metrics, personal protective equipment (PPE) inventories, and ventilator inventory and utilization. Health Current will also seek to reduce hospitals and health system burden related to state and federal reporting requirements by using the HIE as a data intermediary.

HealthShare Exchange of Southeastern Pennsylvania (HSX)

HealthShare Exchange will modernize the region’s pandemic response with the use of automated application programming interfaces (APIs), supporting the Philadelphia Department of Public Health and the Pennsylvania Department of Health. HSX will also facilitate public health agency use of the Delaware Valley COVID-19 Registry, and create new clinical data connections based on public health agency priorities.

Kansas Health Information Network, Inc. (KHIN) d/b/a KONZA

The Kansas Health Information Network’s KONZA team will expand the number of providers participating in the HIE, enhance lab data that is already being exchanged and combining it with existing HIE data for public health reporting, and add additional information to its real-time alerting platform for the Kansas Department of Health and Environment.

Texas Health Services Authority

The Texas Health Services Authority, in partnership with Healthcare Access San Antonio (HASA, a regional HIE covering multiple regions in Texas), a local hospital partner, and Audacious Inquiry (Ai), will conduct a proof-of-concept pilot to demonstrate real-time, automated exchange of hospital capacity and other situational awareness data through APIs using HL7 Fast Healthcare Interoperability Resources (FHIR). This improved reporting will support the Texas Department of State Health Services.

These five awards represent a range of activities across different geographic regions of the country. The cooperative agreements will include cross-recipient collaboration to leverage their collective expertise and ensure the sharing of implementation experience gained from the program. This will bolster the likelihood of success and enable better replicability of the projects throughout the country.

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HL7 Starts Project Vulcan FHIR Accelerator Program

Image result for hl7 logoA new initiative launched by Health Level Seven International (HL7) seeks to use its widely recognized data exchange standards to help health care researchers more effectively acquire, exchange and use data in translational and clinical research.

The effort, called Vulcan, intends to use a model for collaboration among diverse stakeholders in the translational and clinical research community to define a common set of standards that can be implemented internationally, built on current agreements to use the HL7 Fast Healthcare Interoperability (FHIR) standard to facilitate data exchange.

“Improving data sharing can bring significant benefits to medical research, which is often a time-intensive and costly process that unnecessarily delays progress in discovering treatments for medical conditions because researchers are unable to share critical information,” said HL7 International CEO Charles Jaffe, M.D., Ph.D. “Project Vulcan aims to develop common solutions to help partners overcome these challenges.”

The initiative is the latest to use HL7’s FHIR Accelerator Program, which seeks to expand the FHIR standard and enhance market adoption through a programmatic approach that diverse stakeholders can use. The Accelerator Program aims to motivate and support market collaborations, seeking to speed the availability of FHIR to tackle important interoperability needs. Project Vulcan represents an ambitious new use of the FHIR Accelerator Program, pulling together a diverse multi-stakeholder group that includes government and regulatory agencies, standards development organizations, academic sites, technology vendors and patients.

With the advent of FHIR there is a clear path to utilize FHIR and other existing standards to execute the interoperable exchange of data for clinical research.

“Using FHIR to assist translational and clinical research is a natural extension for the standard,” said Rob Goodwin, co-chair of Vulcan and Vice President of Pfizer’s Global Product Development Operations Center of Excellence.

“Delivering a new therapy to market now takes 10 to 15 years at an average cost of $2.6 billion,” said Goodwin, who’s also on the TransCelerate Clinical Oversight Committee of TransCelerate BioPharma, a non-profit organization that works across the biopharmaceutical research and development community to improve the delivery of new medicines.

“The most powerful way to make research faster and less expensive is to bridge clinical care and clinical research, while keeping patient safety and compliance in mind,” said Amy (Nordo) Cramer, Vulcan co-chair and Pfizer Global Product Development Strategic Partnerships. Cramer continued, “Vulcan’s contributions in using FHIR to streamline data collection and submission, protocol representation, clinical trial setup and management, and for other data-intensive purposes will be a game changer for clinical research.”

Organizers of Vulcan are encouraging other entities to participate in the effort. More information about Vulcan and the project’s goals can be found on its website, www.hl7.org/vulcan.

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Healthcare’s Most Innovative Companies of 2020: Innovaccer

Innovaccer - WikipediaInnovaccer is a healthcare technology company pioneering the Data Activation Platform that’s helping the industry realize the promise of value-based care.

Innovaccer’s integration & analysis engine activates healthcare data, cleaning, aggregating and delivering insights at the moment of care. This revolutionary technology streams analytics with custom insights and dashboards, automates workflows, provides real-time decisions for care teams, and point-of-care alerts—actionable intelligence without leaving the EHR experience.

Innovaccer is based in San Francisco with offices across the United States and Asia.

What is the single-most innovative technology you are currently delivering to health systems or medical groups?

Innovaccer is a leading healthcare technology company that deploys its FHIR-enabled Data Activation Platform to help the healthcare industry realize the promise of value-based care. The name “Innovaccer,” is, in fact, a play on the words “innovation” and accelerator.”

Innovaccer leverages AI and predictive analytics to generate insights that help healthcare organizations achieve better clinical outcomes. The FHIR-enabled Data Activation Platform is built on a Hadoop-based Big Data repository with a scalable architecture that allows the integration of disparate sources of data without having to write code. Its agile and modular structure can ingest structured, semi-structured, unstructured data, pool it as a single source of truth, and work on a central HL7 FHIR-based data schema.

How is your product or service innovating the work being done in the organization to provide care or make systems run smoother?

Innovaccer’s smart FHIR-enabled Data Activation Platform has intelligent workflows powered by unified patient records, advanced analytics and true interoperability, enabling collaborative healthcare. Innovaccer brings the data and all healthcare stakeholders together and empowers them with complete patient information to help them care as one.

Today, Innovaccer’s COVID-19 Management System uses AI to optimize the provider response to the disease, allowing medical facilities to reduce assessment time and prioritize patients with a high-risk profile for the next steps of care.

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Solving Today’s Interoperability Gaps

By Drew Ivan, EVP of Product and Strategy, Rhapsody  and Corepoint Health.

Healthcare is home to some of the most mind-blowing technological advances when it comes to diagnostics and therapies. At the same time, the healthcare system is responsible for many of the most head-scratching operational difficulties related to standard IT processes, such as those involved with moving data from one system or site to another. The same industry that successfully deploys remote-controlled surgery robots to heal a patient also struggles to send a discharge summary to a physical therapist for the same patient.

How can we explain this apparent paradox?

A Model of Interoperability

The simple answer is that interoperability in healthcare is a journey, not a destination. The question “why haven’t we solved interoperability?” assumes that interoperability is a one-time problem, when in fact the systems, standards, and data flows that constitute interoperability are constantly changing as the underlying patterns of treatment and reimbursement change.

Interoperability today spans more systems and settings than ever before, and “interoperability” means different things to different audiences, so it’s worth taking a moment to ponder the modern interoperability landscape. The following model is an expansion of one suggested by the National Academy of Medicine[1].

In the center, provider, or organizational, interoperability indicates data flows within a single organization, typically a hospital or hospital system. This has historically been dominated by HL7 v2 transmitted over a TCP connection on a private network, although other standards and technologies are also used.

At the top, community, regional, and national cross-organizational Interoperability refers to communication of healthcare data across different organizations, for example ACOs, HIEs, and provider-to-payer data flows. In this part of the model, we often see IHE style integrations that exchange entire patient records in a single, secure transaction over a public network.

At the bottom, the Internet of Medical Things (IoMT) is divided into two parts: medical device interoperability, which concerns devices used in a clinical setting, and consumer device interoperability – commercially available devices marketed directly to consumers, such as fitness devices and in-home monitors.

On the left, healthcare IT vendors need to enable their products to interoperate at different levels of the interoperability model, depending on which markets they serve. For example, an EHR vendor will need its product to send and receive HL7 v2 messages in order to participate in the organizational interoperability space.

On the right, we are seeing an increased demand for patient or consumer access to their data, whether it is from a fitness device, a hospital’s EHR, or a payer’s disease management system. Integration in this box is often accomplished using APIs, including FHIR.

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More Health Systems Are Catching FHIR

By Patricia Hyle, vice president of product commercialization, StayWell.

Patricia Hyle
Patricia Hyle

Fast Healthcare Interoperability Resources or FHIR was introduced in 2014 as a data standard for electronic health records to adopt, enabling improved access in sharing health data. The move was predicated by new standards set for the with the passing of the Affordable Care Act in 2015 but supports the standard framework for EHR systems to ensure patient information be accessible in an effort to deliver quality care.

FHIR aims to simplify implementation without sacrificing information integrity. It leverages existing patient models to provide a consistent, easy to implement, and rigorous mechanism for exchanging data between EHR applications. This move gained ground when it earned support and adoption from Epic and Cerner, two of the largest EHR systems in the industry. With more than 80 percent of hospitals and health systems now using EHRs on the FHIR platform, it has become the standard for EHR vendors to meet ONC certification criteria.

Addition of apps to FHIR

Following the adoption of FHIR as the new universal standard operating platforms for EHR systems, the launch of SMART (Substitutable Medical Applications, Reusable Technologies) quickly followed to enable to launch of apps within the FHIR platform. When the two platforms came together it became known as SMART on FHIR, allowing software engineers and clinicians to create open-source tools for app developers.

With the addition of these plug-in apps, clinicians can pick and choose which apps they want to integrate into their EHR system. This allows apps to use the standard type of data to build profiles, deliver tools, create reminders, or share data within a fully connected set.

One example of this type of app on is Krames On FHIR. Launched in 2017, this app delivers recommended patient education materials based on inputs from the patient’s EHR record. The material also includes video resources, interactive tools, and health tips that can be sent directly to patients via the patient portal and provides a patient engagement dashboard that allows physicians to track engagement for greater treatment adherence.

Impact of consumer applications to FHIR

When SMART on FHIR initially launched, it was intended to be a set of app standards for developing apps within the closed FHIR network. The end user would be interfacing with an EHR system, and ideally the end user was a care provider or administrator in a health care setting. However, after a few years of use, more users and developers saw the potential use of extending limited access to the network to the patient.

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