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.
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.
DirectTrust announces its Second Annual DirectTrust Summit, scheduled at the Washington Marriott Georgetown in Washington, DC, June 9-10, 2020. DirectTrust also announced its call for speaker proposals is now open to health information industry experts interested in speaking at the Summit.
DirectTrust is a nonprofit healthcare industry alliance created to advance the electronic sharing of protected health information (PHI) between provider organizations, and between providers and patients, for the purpose of improved transitions of care, care efficiency and coordination, patient satisfaction and reducing healthcare cost.
The DirectTrust Summit brings healthcare industry leaders together to share ideas and best practices around improving health information exchange and interoperability. In response to feedback from the inaugural summit this past June, the format for the Second Annual DirectTrust Summit has been expanded to include a full-day event on June 9 and a half-day of breakout sessions on June 10. Additionally, a virtual participation option via webcast is available for the full-day event and plenary sessions.
“We’re thrilled to announce the Second Annual DirectTrust Summit—and excited to be convening in Washington, DC,” said Scott Stuewe, DirectTrust president and CEO. “Our inaugural event in June was a terrific success, which is amply validated by the calls for more time and more sessions.
“As introduced, our intention with this Summit continues to be to look to the future; to build awareness and understanding of the many elements involved in and influencing the electronic sharing of health information, and to foster collaboration between DirectTrust members and DirectTrust members with non-members. Our goal is to help advance the industry’s progress toward achieving secure exchange among provider organizations, and between providers and patients nationwide,” Stuewe continued.
“With this in mind, we’re eager to learn about and share new and original applications of Direct Secure Messaging and interoperability, and invite industry experts to share their submissions on our Call for Proposals link,” concluded Stuewe.
This year’s Summit also adds a host committee responsible for evaluating speaker proposals and driving awareness of the event.
Members of the Host Committee were selected for their distinguished positions in healthcare interoperability. They include:
Jodi G. Daniel, JD, Partner, Crowell & Moring;
Leslie Kelly Hall, Founder, Engaging Patient Strategies and Consulting Executive, LifeWIRE Group;
David Kibbe, MD, MBA, Principal, The Kibbe Group;
Steven Lane, MD, MPH, FAAFP, Clinical Informatics Director, Privacy, Information Security, and Interoperability as well as a family medicine physician with Sutter Health;
Micky Tripathi, President and CEO, Massachusetts eHealth Collaborative
The Summit is open to both DirectTrust members and non-members. Additional information about the Summit—including Registration, Early Bird pricing, and Call for Speaker Proposals—may be found at bit.ly/DTSummit2020.
By Eric Hamborg, co-founder and chief commercial officer, MOBE.
Last month, I was honored to join some of the country’s most elite healthcare executives at the Health Care Executive Group Annual Forum – a closed-door forum to engage in in-depth discussions about challenges and opportunities facing the healthcare industry today. It’s an event I look forward to every year as we discuss pressing issues and how we can better collaborate across the industry to drive meaningful change and innovation.
Each year, the event culminates with a Top 10 list of challenges, issues and opportunities that HCEG members and forum attendees are expecting to confront in the coming year. Over 100 execs from the country’s leading healthcare organizations all worked together to develop this predictive list – debating, ranking and voting on 25 topics compiled from webinars, round tables and the 2019 Industry Pulse Survey.
As a co-founder of MOBE, I could relate to many of the Top 10 issues – they’re the challenges we grapple with every day as we bridge the gap between lifestyle choices and medical care in order to support individuals in achieving their best health outcomes. While the full list included several important topics, there were a couple that continually came up in my conversations with other executives at HCEG, and seem to be particularly important as we consider the needs of today’s healthcare consumer and the industry’s future:
Cost and Transparency
Healthcare costs continue to soar and consume 15% to 20% of the U.S. GDP, so it’s not surprising to see “Cost & Transparency” ranked first on the Top 10 list for 2020. Anytime we discuss challenges or innovation in the healthcare space, cost will remain central to the conversation.
The U.S. has the highest unit costs for nearly all services and procedures – yet we’re not even in the top 10 countries for health outcomes. Why the disconnect? This is the point where healthcare executives, news outlets, and politicians might start pointing fingers at each other. However, HCEG proved to be a venue for diverse thoughts and provoking conversations, arriving together at the core of our most imperative issues and what it will take to pursue progress. In all of my conversations, one word continually came up: transparency.
Although transparency alone won’t solve our cost problems, it’s a key part of the solution. At MOBE, we’ve found this can be particularly powerful for individuals in a hidden population with high-deductible plans, who make up 15% to 20% of the healthcare spend within our clients’ commercially insured populations. Promoting transparency from all corners of the industry will help to equip the consumer with the information they need to make better healthcare decisions.
Holistic Individual Health
Most exciting to my colleagues and me was seeing holistic individual health make it on the top 10 – an encouraging signal that we are on the right path here at MOBE. Throughout the forum, healthcare executives repeated the need for identifying, addressing, and improving an individual’s overall well-being in order to promote a frictionless and connected healthcare experience.
CAQH CORE and Health Level Seven International (HL7) announce a collaboration to address long-standing healthcare industry challenges by accelerating automation and improving interoperability between administrative and clinical systems. This is the first time these two organizations, which conduct complementary work to improve the electronic exchange of data across the healthcare industry, have collaborated on solutions to specific technical and administrative burdens.
“Our collaboration will help move the healthcare industry towards greater automation and streamlined business processes,” said April Todd, senior vice president, CAQH. “We are delighted to work with HL7 to address some of the biggest interoperability issues facing the industry.”
The two organizations will initially collaborate in three areas:
Prior Authorization: Currently, the prior authorization process is a labor intensive, time consuming, and costly administrative burden for providers and payers. It also frustrates patients and, in some cases, delays care. HL7 and CAQH CORE will collaborate to move the industry towards end-to-end automation of the prior authorization process.
Exchange of Medical Documentation: According to the CAQH Index, 84 percent of attachments, or documents that prove medical necessity, are exchanged manually and often contain too much, too little, or the wrong type of information. This delays prior authorizations, hinders the transition to value-based payments, and costs plans and providers time and money. HL7 and CAQH CORE will work to align their respective efforts to support the electronic exchange of clinical information and medical documentation.
Value-Based Payments: The transition to value-based payment models has been slowed by a patchwork of administrative and technical approaches and work-arounds. HL7 and CAQH CORE will work together to address the interoperability challenges causing administrative burden for innovative payment models.
“HL7 and CAQH have made great strides to improve the exchange of information in the healthcare continuum,” said Charles Jaffe, MD, PhD, CEO, HL7 International. “Our collaboration will enable better alignment and accelerate progress toward interoperability between clinical and administrative systems.”
The American Health Information Management Association (AHIMA) sent a joint letter to Congressional leaders today voicing concerns that certain provisions of the Office of the National Coordinator for Health Information Technology’s (ONC’s) recent 21st Century Cures Act (Cures) proposed rule on information blocking jeopardizes goals to foster a healthcare system that is interoperable, patient-engaged and reduces burdens for those delivering care.
The letter, co-signed by seven organizations representing the nation’s clinicians, hospitals, health systems and experts in health informatics and health information management, outlines several recommendations aimed at furthering the objectives of Cures, while ensuring that the final regulations do not unreasonably increase provider burden or hinder patient care.
“We support the intent of the Cures Act to eradicate practices that unreasonably limit the access, exchange and use of electronic health information for authorized and permitted purposes that have frustrated care coordination and improvements in healthcare quality and efficiency,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “However, in light of the lessons learned from the meaningful use program, we believe it is crucial that we get this right. We look forward to discussing the details of these recommendations with congressional staff and ONC.”
Recommendations outlined in the letter include:
Additional rulemaking prior to finalization: ONC should seek further input from impacted stakeholders on issues including modifying the information blocking proposal to ensure that the requirements and exceptions are well-defined and understandable, and clinicians, hospitals and health information professionals are not inappropriately penalized if they are unable to provide a patient’s entire electronic health information through an application programming interface (API).
Enhanced privacy and security: The proposed rule does not sufficiently address Cures’ directives to protect patient data privacy and ensure health IT security. It is imperative that the Committee continues its oversight of privacy and security issues that fall outside of the Health Insurance Portability and Accountability Act (HIPAA) regulatory framework. This includes ensuring certified APIs include mechanisms to strengthen patients’ control over their data—including privacy notices, transparency statements and adherence to industry-recognized best practices.
Appropriate implementation timelines: ONC should establish reasonable timelines for any required use of certified health IT (CEHRT). Providers must be given sufficient time to deploy and test these systems, which must take into account competing regulatory mandates.
Revised enforcement: The U.S. Department of Health and Human Services should use discretion in its initial enforcement of the data blocking provisions of the regulation, prioritizing education and corrective action plans over monetary penalties.
For additional information on these recommendations, click here.
Signatories of the letter include:
American Health Information Management Association (AHIMA)
American Medical Association (AMA)
American Medical Informatics Association (AMIA)
College of Healthcare Information Management Executives (CHIME)
Federation of American Hospitals (FAH)
Medical Group Management Association (MGMA)
The American Medical Association (AMA) and six other organizations have asked two congressional committees to use their oversight of the 21st Century Cures Act to improve interoperability and empower patients with meaningful health information while ensuring data is safe and secure. The letter arrives as the administration is drawing up its plans to implement the law and adopt information blocking rules.
The AMA appreciates several of the administration’s proposals, particularly related to electronic health record (EHR) certification, EHR application programming interfaces (APIs), and modifying EHR vendor business practices and behaviors.
There are, however, numerous complex, counter-intuitive proposals that jeopardize the goals Congress outlined in the Cures Act. Concerningly, many of the administration’s proposals will dramatically affect patient privacy and safety as well as as data security. The proposals also will add to physician burden and burnout.
“The administration owes it to patients, physicians, Congress and our nation to listen and act on these concerns,” said Jesse M. Ehrenfeld, M.D., chair of the AMA’s Board of Trustees. “We still have a chance to get these policies right. It is possible to improve access to medical information while promoting privacy and transparency.”
For nearly a decade, Health Information Exchanges (HIEs) have been looking for their long-term sustainable business model. This is part of the journey toward the future state of the HIE, which will be a ubiquitous healthcare utility that makes data available to all stakeholders across the healthcare landscape. Today, their work and future plans are driven by a desire to support value-based care initiatives, enhance interoperability, and leverage and manage a wider scope of data.
Representing a broad swath of HIEs, a 2019 Survey on HIE Technology Priorities uncovered various key trends and changing priorities in the sector. To become a sustainable healthcare information provider, HIEs must understand and leverage data to gain insights that improve patient outcomes while containing costs. Additionally, other trends include joining national exchanges, introducing value-added capabilities, enhancing integration of clinical and claims data, and growing payer participation in HIEs.
Participation in various national initiatives is an important driver for HIEs as it requires successful HIEs be more active across traditional geographic and state boundaries. Mechanisms for participation include the Trusted Exchange Framework and Common Agreement (TEFCA), the national eHealth exchange, Direct Trust and Carequality. Participation in Patient Centered Data Home, an event notification service that includes HIEs across the U.S. led by the Strategic Health Information Exchange Consortium (SHIEC), had the highest level of interest across all surveyed HIEs.
Like a utility, the next generation HIE must fit into the growing “Network of Networks” ecosystem, providing shared services to multiple HIEs (e.g. EMPI/record locator, patient directory, provider directory, data aggregation). This also means bringing together disparate entities into a local HIE network connecting a variety of different end-points – including practices, hospitals, systems, labs, long-term care facilities and more – while simultaneously making the local information shareable with other regional and national HIE networks. HIEs will need to support population-based use-cases and assist safety-net providers and small, independent providers to access larger interoperability initiatives across the U.S., such as TEFCA and the e-Health Exchange.
Access to data and the interoperability of health information has the power to change the face of healthcare, according to Alexandra Mugge, deputy chief health informatics officer at the Centers for Medicare & Medicaid Services (CMS).
Addressing leaders in health information management (HIM) at the AHIMA19: Health Data and Information Conference, the American Health Information Management Association’s (AHIMA) annual conference, Mugge outlined CMS’ Interoperability and Patient Access Initiative efforts and what the agency will focus on next.
“We believe electronic data exchange is the future of healthcare, and interoperability is the foundation of value-based care,” Mugge said. “CMS is dedicated to advancing interoperability throughout healthcare.”
Emphasizing that the privacy and security of health records underpins all CMS activity on interoperability, Mugge pointed to several initiatives in 2019 aimed at improving data exchange among providers, payers and patients, including:
The CMS interoperability and patient access proposed rule addressing new policies to expand the exchange of information across all aspects of healthcare
The Office of the National Coordinator for Health Information Technology (ONC) 21st Century Cures Act proposed rule
The Blue Button 2.0 initiative, an application programming interface (API) containing four years of Medicare Part A, B and D data for 53 million Medicare beneficiaries that allows patient access to their health information.
Looking ahead to 2020, Mugge said CMS will focus on addressing challenges to patient matching, updating provider directories, expanding data elements to be standardized and incorporating behavioral and public health social determinants in healthcare.
HIM professionals are essential to ensuring access to health information where and when it is needed, Mugge said, adding that HIM professionals are responsible for shaping the data that ultimately comes together as a part of a patient’s complete healthcare picture.
“CMS is a valued contributor to our ongoing support of interoperability and its benefits to patients, providers and payers,” said Wylecia Wiggs Harris, AHIMA CEO, PhD, CAE. “AHIMA stands in alignment with the goals of interoperability in helping people to live healthier lives and creating access to health information that empowers people to impact health.”
The digitization and expansion of access to data and health information will continue to change healthcare, making this an exciting time in the industry, Mugge added.
“Patients are no longer passive participants in their care, they now have the ability to be empowered consumers of the healthcare industry through access to data that puts them in the driver’s seat to make the best and most informed decisions about their health,” Mugge said. “And providers who have historically been forced to work with incomplete information can now unlock large amounts of data about their patients that will improve care.”
Health Level Seven International (HL7), the global authority for interoperability in health information technology, and the American Academy of Family Physicians (AAFP), the only medical society devoted solely to primary care, are pleased to announce that the Gravity Project is now part of the HL7 FHIR Accelerator Program.
The Gravity Project aims to standardize medical codes to facilitate the use of social determinants of health-related data in patient care, care coordination between the health and human services sectors, population health management, value-based payment and clinical research. Social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.
The HL7 FHIR Accelerator Program is designed to assist implementers across the health care spectrum to create HL7 FHIR implementation guides and other products than can facilitate FHIR acceleration and adoption activities. Other projects within the Accelerator Program include Argonaut, Da Vinci and CARIN Alliance.
Why the Gravity Project? Unmet social needs including limited access to food, transportation and housing can negatively impact health outcomes. Research has demonstrated that addressing social and medical needs in tandem improves health outcomes and lowers costs.
“Progress in patient care and research has made significant strides with the emergence of the HL7 FHIR Accelerator Program,” said HL7 International CEO Charles Jaffe, MD, PhD. “By incorporating the social determinants of health care into our decision process, the Gravity Project will help to transform care delivery and health analytics.”
In this context of mounting interest around collecting and using SDoH data in healthcare settings, new challenges have emerged related to the capacity of existing medical terminology standards to effectively capture, use and exchange the necessary data.
The Social Interventions Research and Evaluation Network (SIREN) at the Center for Health and Community, University of California, San Francisco, was an early catalyst of the Gravity Project, convening a diverse group of stakeholders as early as November 2017 to develop a strategy for achieving consensus-based comprehensive coding standards for SDOH data capture in EHR systems.
“With funding from the Robert Wood Johnson Foundation and in partnership with EMI Advisors LLC, SIREN is pleased to be working with multiple stakeholders to meet the rapidly expanding market needs around SDOH data documentation and interoperability,” said SIREN Director and UCSF associate professor of Family and Community Medicine, Laura Gottlieb, MD, MPH. “Building on work originally supported by Kaiser Permanente and the Robert Wood Johnson Foundation, the Gravity Project’s new partnership with HL7 will strengthen the capacity for SDOH information exchange between stakeholders, including clinical providers, patients, community organizations and payers.”
The Gravity Project has established a public collaborative process initially focused on three domains: food security, housing stability and quality, and transportation access. The project is working to:
Develop use cases to support documentation for screening, diagnosis, treatment/intervention, and planning activities within EHR and related systems;
Identify common data elements and their associated value sets to support the uses cases;
Develop a consensus-based set of recommendations on how best to capture and group these data elements for interoperable electronic exchange and aggregation; and
Develop an HL7 Fast Health Interoperability Resource (FHIR) Implementation Guide based on the defined use cases and associated data sets.
“The AAFP is pleased to act as convener for the Gravity Project and support information interoperability efforts,” said Shawn Martin, senior vice president of advocacy, practice advancement and policy for the American Academy of Family Physicians. “Our vision is to transform health care by addressing the social determinants of health through efforts such as our innovative HealthLandscape geoanalytics platform and The EveryONE Project to help family physicians take action and confront health disparities head-on. The important work of the Gravity Project will advance data exchange and allow family physicians to better care for patients and communities.”
The Blue Cross Blue Shield Association (BCBSA) is an active member of HL7’s initiatives to advance interoperability, and has joined SIREN and AmeriHealth Caritas in co-sponsoring the Gravity Project launch. Additionally, both the BCBS System and AmeriHealth Caritas have several programs in place to address SDOH, including actively collecting SDOH health data, engaging community health workers, providing rides to doctor appointments, and delivering healthy, affordable meals to people’s homes.
“The social and environmental conditions in which we live, such as access to healthy food and housing or reliable transportation, are critical to our health,” said Dr. Trent Haywood, chief medical officer for BCBSA and president of the Blue Cross Blue Shield Institute. “The Gravity Project will help enable the data interoperability that allows the entire health care community to address barriers that limit the ability to achieve optimal health.”
The Gravity Project has convened more than 500 experts from across the nation including clinical and community-based provider groups and payers to health technology developers and standards stewards, to collaboratively develop recommendations for how best to capture data about food, housing, and transportation risks and needs, for interoperable electronic health information exchange.
“AmeriHealth Caritas has been actively collecting social determinants of health data from member households for the past two years to help us better address their needs,” said Andrea Gelzer, MD, senior vice president of medical affairs for AmeriHealth Caritas. “The Gravity Project affirms our collective belief that standardizing the ways in which we all collect data will enable providers, plans, and other supportive agencies to quickly and more strategically mobilize care for the populations we serve.”
Participation in the Gravity Project is open to all interested organizations and individuals.
“We are pleased to coordinate and facilitate an open, transparent, and virtual community via the HL7 suite of collaboration tools,” said Evelyn Gallego, MBA, MPH, CPHIMS, program manager for the Gravity Project, and EMI Advisors CEO. “We invite all interested parties to visit the HL7 Confluence page to learn more about the Gravity Project, including how to become a participant and/or a sponsor of this important endeavor.”
Brightree announces the results from its survey in post-acute care, revealing a significant gap between what referring providers and health systems want, and what home health and hospice providers are delivering, when it comes to interoperability.
The survey was conducted by Porter Research, and is the first to interview both home health and hospice providers (675 respondents) and their referral sources (440 respondents). It found that electronic referrals are high on the priority list:
70% of home health and hospice organizations reported an increase in the number of referral sources requesting referral data to be sent electronically over the past one to two years;
60% of referring providers said they would switch to a new post-acute care provider if that organization were able to accept electronic referrals; and
Only 4% of home health and hospice organizations reported they were able to accept electronic referrals from a referral source (electronic medical record) EMR system.
This lack of automation and reliance on manual labor takes a toll on post-acute providers’ bottom lines. According to the survey findings, almost two-thirds of home health and hospice organizations require several full-time equivalents (FTEs) each month tracking down data and documents they feel could be obtained with better integration in place.
“Interoperability is no longer an option, but an essential aspect of any home health and hospice business,” said Nick Knowlton, Brightree vice president of strategic initiatives. “We were pleased to find users of our Brightree home health and hospice solution were among respondents reporting the highest ability to receive electronic referrals properly, but there’s still tremendous opportunity to continue bridging the gap.”
Many post-acute care providers are considering interoperability a business necessity. According to the survey:
30% of home health and hospice organizations said they are planning to expand their efforts into interoperability this year; and
31% claim they would even switch electronic health record (EHR) systems if they found one that could better support their interoperability needs.