By Dr. Chris Hobson, chief medical officer, Orion Health.
Dr. Chris Hobson
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.
Rhapsody, a global leader in healthcare data interoperability, today announced that the company will merge with Corepoint Health, the supplier of the Best in KLAS healthcare integration platform. The transaction will bring together two companies at the forefront of interoperability and create a dynamic combination of technology, talent, services, and trusted customer relationships to address the most complex healthcare interoperability challenges.
Both
companies will continue to support and advance their respective solutions,
while the combined entity will also devote its expanded resources to addressing
the growing need for interoperability among regional, national and
international healthcare providers and vendors.
“Corepoint’s platform offers incredibly fast, turn-key operations for provider organizations, HIEs and OEM partners, all with industry leading customer satisfaction. Complementing this with Rhapsody’s fully customizable and multi-platform capabilities creates great synergies for our current and future customers,” said Erkan Akyuz, president and CEO, Rhapsody. “Both entities share great technical depth and breadth and both have maintained long-standing customer relationships, which together yields a broader foundation on which to build the future of interoperability in healthcare. Together, we can better support our customers to fulfill all of their changing and future needs.”
Available on premises and as a cloud-based service, the Rhapsody and Corepoint interoperability platforms offer comprehensive routing and transformation functionality for every operating environment, offering highly differentiated features, applications and end customer focuses. The two platforms also support commonly used messaging standards and protocols such as FHIR, HL7 V2, CCD/C-CDA and DICOM.
These integration engines are among the most secure technology platforms in the healthcare industry, with customer bases that include the entire healthcare ecosystem and across the globe, including provider organizations, technology vendors, HIEs and public health systems.
“We are entering a new era in healthcare where the emphasis will be on expanding ecosystems and establishing new data trading partner relationships to optimize clinical and operational workflows. These initiatives will be powered by interoperability and data management: healthcare organizations that can excel in these areas will have a significant competitive advantage,” said Sean Cassidy, CEO of Corepoint Health.
“The combination of Rhapsody and Corepoint enables our customers to continue to get tremendous value out of the products and services they love, while having the confidence that their interoperability partner is heavily invested in helping them confront the challenges they will face in the future,” Cassidy added.
Rhapsody announces that the company will merge with Corepoint Health, the supplier of the Best in KLAS healthcare integration platform. The transaction will bring together two companies at the forefront of interoperability and create a dynamic combination of technology, talent, services, and trusted customer relationships to address the most complex healthcare interoperability challenges.
Both
companies will continue to support and advance their respective solutions,
while the combined entity will also devote its expanded resources to addressing
the growing need for interoperability among regional, national and
international healthcare providers and vendors.
“Corepoint’s platform offers incredibly fast, turn-key operations for provider organizations, HIEs and OEM partners, all with industry leading customer satisfaction. Complementing this with Rhapsody’s fully customizable and multi-platform capabilities creates great synergies for our current and future customers,” said Erkan Akyuz, president and CEO, Rhapsody. “Both entities share great technical depth and breadth and both have maintained long-standing customer relationships, which together yields a broader foundation on which to build the future of interoperability in healthcare. Together, we can better support our customers to fulfill all of their changing and future needs.”
Available on premises and as a cloud-based service, the Rhapsody and Corepoint interoperability platforms offer comprehensive routing and transformation functionality for every operating environment, offering highly differentiated features, applications and end customer focuses.
The two platforms also support commonly used messaging standards and protocols such as FHIR, HL7 V2, CCD/C-CDA and DICOM. These integration engines are among the most secure technology platforms in the healthcare industry, with customer bases that include the entire healthcare ecosystem and across the globe, including provider organizations, technology vendors, HIEs and public health systems.
“We are entering a new era in
healthcare where the emphasis will be on expanding ecosystems and establishing
new data trading partner relationships to optimize clinical and operational
workflows. These initiatives will be powered by interoperability and data
management: healthcare organizations that can excel in these areas will have a
significant competitive advantage,” said Sean Cassidy, CEO of Corepoint Health.
“The combination of Rhapsody and Corepoint enables our customers to continue to
get tremendous value out of the products and services they love, while having
the confidence that their interoperability partner is heavily invested in
helping them confront the challenges they will face in the future.”
“We move decisively when perfect opportunities present themselves,” said Philippe Houssiau, operating partner at Hg. “The opportunity to bring Corepoint and Rhapsody together was incredibly compelling. Our investments in these two phenomenal companies demonstrate how excited we are about the future of interoperability. Rhapsody is off to an amazing start as an independent company: joining forces with Corepoint will enable the combined team to accelerate the delivery of FHIR-based services, cloud-based integration solutions and support for regional and national interoperability frameworks.”
By Susan DeCathelineau, vice president of global healthcare sales and services, Hyland Healthcare.
Susan DeCathelineau
Healthcare interoperability continues to be a critical topic facing healthcare technology leaders. There’s no question that achieving true healthcare interoperability is key to moving the industry forward by enabling the type of information exchange that can streamline workflows, inform clinical decision making and enable precision medicine.
However, much of the current interoperability discussion is focused on ensuring core systems, i.e. Electronic Medical Records (EMRs) are compatible with one another. Yet there is one issue that is largely overlooked: the crucial role of integrating structured data with unstructured patient information.
For example, EMRs are designed to capture and manage structured patient data, and they do that job well. That is to say, they capture content using controlled vocabulary rather than narrative text. But the lack of structured data and standardization in the healthcare industry today creates major issues when sharing EMR content within and across healthcare organizations.
EMRs are not built to natively ingest the plethora of unstructured information that exists on a patient. This unstructured content includes things like diagnostic medical images, clinical documents and notes, visible light images and more. According to many industry estimates, as much as 75 percent of the information that exists on a patient lives outside of core applications like EHRs. Instead, this unstructured content is scattered in a multitude of legacy data silos.
Manage your unstructured clinical content
A recent whitepaper by Signify Research illustrates just how pervasive ineffective management of unstructured content is in today’s health systems, and just how vital this effort is to interoperability initiatives. In the paper, author Steve Holloway explains how the growth of healthcare networks resulting from merger and consolidation activity is driving the need for true interoperability. These ever-larger healthcare enterprises are increasing demand for incoming and outgoing information exchange between a diverse ecosystem of providers, patients and payers.
He continues to say that EMRs and health information exchanges have had “limited success in addressing the myriad of nuanced applications and unstructured content outside of core administrative patient records and financial billing processes.”
Holloway proposes that support for multi-disciplinary care and robust, multi-node interoperability will never be achieved without a more holistic approach to integrating structured and unstructured data.
Make the connection, see your whole patient
Providing a “holistic approach” to integrating structured and unstructured healthcare content is a core focus at Hyland Healthcare. Experience has shown that providing a suite of connected healthcare solutions allows healthcare providers to harness the unstructured content in every corner of their enterprise — whether it be a diagnostic medical image, clinical document, video file or audio recording — and link it to the core clinical or business applications they use every day. Addressing unstructured content needs is made possible by combining both a full suite of content services and enterprise imaging tools.
In short, healthcare providers – and by extension the entire healthcare enterprise – work best when it is possible to see your whole patient. By enhancing the EHR or other core clinical application with unstructured content that currently resides in disparate data silos, provider organizations can complete the patient picture. This delivers a truly comprehensive medical information repository at the fingertips of key healthcare stakeholders.
America’s healthcare system is notoriously disjointed, with patchwork information technology and disparate data. The quest for interoperability as an answer – the ability to easily share health records between sites of care – has had varying levels of success. But it’s a solution that is crucial to healthcare’s value-based transformation and can’t be allowed to fail, especially by going too slow to be meaningful.
The challenges associated with interoperability – from fragmented sources of patient information to data being kept in varied formats, to difficulties using an electronic health record (EHR) as a secure central “home” for a patient’s data – were highlighted in a recent American Hospital Association (AHA) report on “The Hospital Agenda for Interoperability.”
The report highlighted challenges for providers and underscored that a collaborative approach is necessary for improving the lives of families and their caregivers for the long-term. The AHA report not only represents frustrations with EHR and Health Information Exchange (HIE) but calls for extending efforts at digital transformation that logically layer on top of that.
As the debate and progress inches forward to 2020, it is vital to return to what hospitals are telling us.
Beyond technical challenges
The difficulty in interoperability goes beyond technicalities. For example, while healthcare providers generate clinical data and payers create claims data, their current structures are not conducive for synchronization and insight generation. Payers and providers have different objectives (whether it’s clinical notetaking, billing, clinical decision support, etc.) so there’s more to the underlying friction than just a variety of data formats.
The AHA calls out additional reasons for issues with interoperability and the high costs that result. That includes expensive workarounds, overcomplicated user interface design, lack of documentation consistency, unrealistic expectations for technical solutions, issues with regulatory compliance for data security, privacy and use, and pricing models that “toll” information sharing. It’s also clear that business and technical challenges with interoperability should not be conflated – each technology Band-Aid further burdens healthcare organizations with ad hoc, un-intuitive technology that will cost more over time and fail to solve interoperability challenges.
In the quest to use technology to save money, improving interoperability between healthcare systems and using powerful data analytics to extract insights from systems working in concert appears to be an expensive and elusive goal. But the cost of not committing to a more universal approach is far greater, because it prevents clear and effective insights on where improvements are needed. Insights are only ever as good as the data that feeds them, and if there isn’t a clearly defined data analytics and data governance strategy aligned with industry best practices, the results will be half-baked.
The need for leadership
Leaders who may have not been exposed to technology outside of healthcare may not be aware of open source, cloud-based tools to rapidly and more cost effectively meet interoperability needs. As they implement piecemeal or outdated, point-to-point solutions, technology costs rise significantly, while perception of technology’s efficacy goes out the window. Worse, paying to ship data to third-party vendors instead of focusing on an internal and overarching connectivity strategies involving every vertical means opportunities to maximize their data’s potential will be lost.
In other words, healthcare organizations might find that they are ironically spending immense amounts of money on technology intended to reduce costs under a value-based payment system. But they might not be spending it wisely. And as other industries steam ahead with movements akin to interoperability on a national scale, leaders in healthcare need to stay focused on the larger task of consistency as not to fall even further behind. Unlike industries like retail, the quality of lives for patients and their caregivers are at stake.
Technology – and business – challenge
As the AHA report emphasizes, the challenges involved go beyond technology and land firmly in the realm of business. Healthcare organizations need to be open to making health data available, whether it’s a secure transfer to another provider, or to the patients. CMS recently renamed “meaningful use” to “promoting interoperability” in efforts to provide a model and further incentives for “advancing care information.”
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.
