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Can Machine Learning Tame Healthcare’s Big Data?

Posted on September 20, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Big data is both a blessing and a curse. The blessing is that if we use it well, it will tell us important things we don’t know about patient care processes, clinical improvement, outcomes and more. The curse is that if we don’t use it, we’ve got a very expensive and labor-hungry boondoggle on our hands.

But there may be hope for progress. One article I read today suggests that another technology may hold the key to unlocking these blessings — that machine learning may be the tool which lets us harvest the big data fields. The piece, whose writer, oddly enough, was cited only as “Mauricio,” lead cloud expert at Cloudwards.net, argues that machine learning is “the most effective way to excavate buried patterns in the chunks of unstructured data.” While I am an HIT observer rather than techie, what limited tech knowledge I possess suggests that machine learning is going to play an important role in the future of taming big data in healthcare.

In the piece, Mauricio notes that big data is characterized by the high volume of data, including both structured and non-structured data, the high velocity of data flowing into databases every working second, the variety of data, which can range from texts and email to audio to financial transactions, complexity of data coming from multiple incompatible sources and variability of data flow rates.

Though his is a general analysis, I’m sure we can agree that healthcare big data specifically matches his description. I don’t know if you who are reading this include wild cards like social media content or video in their big data repositories, but even if you don’t, you may well in the future.

Anyway, for the purposes of this discussion, let’s summarize by saying that in this context, big data isn’t just made of giant repositories of relatively normalized data, it’s a whirlwind of structured and unstructured data in a huge number of formats, flooding into databases in spurts, trickles and floods around the clock.

To Mauricio, an obvious choice for extracting value from this chaos is machine learning, which he defines as a data analysis method that automates extrapolated model-building algorithms. In machine learning models, systems adapt independently without any human interaction, using automatically-applied customized algorithms and mathematical calculations to big data. “Machine learning offers a deeper insight into collected data and allows the computers to find hidden patterns which human analysts are bound to miss,” he writes.

According to the author, there are already machine learning models in place which help predict the appearance of genetically-influenced diseases such as diabetes and heart disease. Other possibilities for machine learning in healthcare – which he doesn’t mention but are referenced elsewhere – include getting a handle on population health. After all, an iterative learning technology could be a great choice for making predictions about population trends. You can probably think of several other possibilities.

Now, like many other industries, healthcare suffers from a data silo problem, and we’ll have to address that issue before we create the kind of multi-source, multi-format data pool that Mauricio envisions. Leveraging big data effectively will also require people to cooperate across departmental and even organizational boundaries, as John Lynn noted in a post from last year.

Even so, it’s good to identify tools and models that can help get the technical work done, and machine learning seems promising. Have any of you experimented with it?

Mobile Health App Makers Still Shaky On Privacy Policies

Posted on September 16, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new study has concluded that while mobile health app developers are developing better privacy practices, these developers vary widely in how they share those policies with consumers. The research, part of a program launched in 2011 by the Future of Privacy Forum, concludes that while mHealth app makers have improved their practices, too many are still not as clear as they could be with users as to how they handle private health information.

This year’s FPF Mobile App Study notes that mHealth players are working to make privacy policies available to users before purchase or download, by posting links on the app listing page. It probably has helped that the two major mobile health app distribution sites require apps that collect personal info to have a privacy policy in place, but consumer and government pressure has played a role as well, the report said. According to FPF researchers, mHealth app makers are beginning to explain how personal data is collected, used and shared, a step privacy advocates see as the bare minimum standard.

Researchers found that this year, 76% of top overall apps on the iOS App Store and Google Play had a privacy policy, up from 68% noted in the previous iteration of the study. In contrast, only 61% of health and fitness apps surveyed this year included a link to their privacy policies in their app store listing, 10% less than among top apps cutting across all categories.  “Given that some health and fitness apps can access sensitive, physiological data collected by sensors on a mobile phone, wearable, or other device, their below-average performance is both unexpected and troubling,” the report noted.

This disquieting lack of thorough privacy protections extended even to apps collecting some of the most intimate data, the FPF report pointed out. In particular, a subset of mHealth developers aren’t doing anything much to make their policies accessible.

For example, researchers found that while 80% of apps helping women track periods and fertility across Google Play and the iOS App Store had privacy policies, just 63% of the apps had posted links to these policies. In another niche, sleep tracking apps, only 66% of even had a privacy policy in place, and just 54% of these apps linked back to the policy on their store page. (FPF terms this level of performance “dismal,” and it’s hard to disagree.)

Underlying this analysis is the unfortunate truth that there’s still no gold standard for mHealth privacy policies. This may be due more to the complexity of the still-maturing mobile health ecosystem than resistance to creating robust policies, certainly. But either way, this issue won’t go away on its own, so mHealth app developers will need to give their privacy strategy more thought.

Engaging Patients With Health Data Cuts Louisiana ED Overuse

Posted on September 15, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Maybe I’m misreading things, but it seems to me that few health IT pros really believe we can get patients to leverage their own health data successfully. And I understand why. After all, we don’t even have clear evidence that patient portals improve outcomes, and portals are probably the most successful engagement tool the industry has come up with to date.

And not to be a jerk about it, but I bet you’d be hard-pressed to find HIT gurus who believed the state of Louisiana would lead the way, as the achingly poor southern state isn’t exactly known for being a healthcare thought leader.  As it so happens, though, the state has actually succeeded where highfalutin’ health systems have failed.

Over one year, the state has managed to generate a 23% increase in health IT use among at-risk patients, and also, a 10.2% decrease in non-emergent use of emergency departments by Medicaid managed care organization members, thank you very much.

So how did Louisiana’s top healthcare brass accomplish this feat? Among other things, they launched a HIE-enabled ED data registry, along with a direct-to-consumer patient engagement campaign. These efforts were done in partnership with the Louisiana Health Care Quality Forum, which developed statewide marketing plans for the effort (See John’s interview with the Louisiana Health Care Quality Forum for more details).

They must have created some snazzy marketing copy. As Healthcare IT News noted, between August 2015 and May 2016, patient portal use shot up 31%, consumer EHR awareness rose 23% and opt-in to the state’s HIE grew by 3%, Quality Forum marketer Jamie Martin told HIN.

Not only that, the number of patients asking for access to or copies of electronic health data increased by 12%, and the number of patients with current copies of their health information grew by 9%, Martin said.

This is great news for those who want to see patients buy in to the digital health paradigm. Though it’s hard to tell whether the state will be able to maintain the benefits it gained in its initial effort, it clearly succeeded in getting a substantial number of patients to rethink how they manage their care.

But (and I’m sorry to be a bit of a Debbie Downer), I was a bit disappointed when I saw none of the gains cited related to changing health behaviors, such as, say, an increase in diabetics getting retinal exams.

I know that I should probably be focused on the project’s commendable successes, and believe it or not, I do find them to be exciting. I’m just not sure that these kinds of metrics can be used as proxies for health improvement measures, and let’s face it, that’s what we need, right?

Apple App Store Toughens Guidelines For Health Apps

Posted on September 13, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In a precedent-setting move, Apple has released new guidelines for its iOS App Store which impose new limitations on health and medical app developers.  iMedicalApps contributor Iltifat Husain, M.D., who wrote a piece about the changed standards, said they contain “the most stringent language I have ever seen Apple used for the health and medical category of apps.”

According to Husain, highlights from Apple’s new developer guidelines include:

  • A warning that if an app could possibly cause physical harm, Apple could reject it
  • A warning that apps which provide inaccurate data or information that could be used to diagnose or treat patients will get increased scrutiny
  • A reminder that apps which calculate drug dosage must come from the drug manufacturer, a hospital, university, health insurance company or other approved entity. In other words, independent developers cannot post a medical app for drug dosages themselves.
  • A ban on marijuana-related apps
  • A ban on apps that encourage people to place their iPhones under a mattress or pillow while charging (such as some sleep monitors)

Historically, Apple has been relatively lax about hosting potentially dangerous health apps, Husain says. For example, he notes that apps purporting to measure a consumer’s blood pressure by using the iPhone’s camera and microphone tend to be quite inaccurate in their measurements, but that Apple had not screened them out.  Now things have changed for the better, Husain writes. “Apps [like these] would not get through the screening review process under Apple’s new guidelines.”

Husain argues that the new guidelines are more important than the FDA’s recently-updated guidelines on health apps: “There is no way the FDA can regulate the hundreds of thousands of health and medical apps and the updates made to them,” Husain writes. “The screening process is what has to change.” And given Apple’s market footprint and influencer status it’s hard to disagree with him.

At this point the question is whether Google will follow suit. After all, while the Apple app store hosted 2 million apps as of June, Google Play offered 2.2 million apps, according to one study, and as of February there were three Android users for every iPhone user. So If Google doesn’t put more stringent health app requirements in place as well, creators of dodgy health apps can still develop for Android and find a wide audience.

That being said, neither Google nor Apple are required to impose new restrictions on health apps, and are likely to be governed by commercial pressure more than medical appropriateness. Also, both parties are free to set any rules they choose, and uses might not be aware of important differences between the two sets of policies. In other words, if the goal is to protect consumers, relying on guidelines generated by app store hosts probably won’t fly over the long-term.

I’m not necessarily suggesting that the FDA or other regulatory body should come down on the app stores like a ton of bricks. That would be overkill, and as Husain notes, is probably beyond their capabilities.

But doctors in the know about apps might want to warn patients about their potential limitations, and offer some criteria as to what they can expect from health apps. After all, most consumers have experimented with one health app of the other, so even if the doctor doesn’t prescribe them, patients need to be educated about their options. So if you’re a mobile health savvy clinician reading this, consider increasing patients on these issues.

Study: Health IT Costs $32K Per Doctor Each Year

Posted on September 9, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new study by the Medical Group Management Association has concluded that that physician-owned multispecialty practices spent roughly $32,500 on health IT last year for each full-time doctor. This number has climbed dramatically over the past seven years, the group’s research finds.

To conduct the study, the MGMA surveyed more than 3,100 physician practices across the U.S. The expense number they generated includes equipment, staff, maintenance and other related costs, according to a press release issued by the group.

The cost of supporting physicians with IT services has climbed, in part, due to rising IT staffing expenses, which shot up 47% between 2009 and 2015. The current cost per physician for health IT support went up 40% during the same interval. The biggest jump in HIT costs for supporting physicians took place between 2010 and 2011, the period during which the HITECH Act was implemented.

Practices are also seeing lower levels of financial incentives to adopt EHRs as Meaningful Use is phased out. While changes under MACRA/MIPS could benefit practices, they aren’t likely to reward physicians directly for investments in health IT.

As MGMA sees it, this is bad news, particularly given that practices still have to keep investing in such infrastructure: “We remain concerned that far too much of a practice’s IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing patient care,” the group said in a prepared statement. “Unless we see significant changes in the final rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process.”

But the MGMA’s own analysis offers at least a glimmer of hope that these investments weren’t in vain. For example, while it argues that growing investments in technologies haven’t resulted in greater administrative efficiencies (or better care) for practices, it also notes that more than 50% of responders to a recent MGMA Stat poll reported that their patients could request or make appointments via their practice’s patient portal.

While there doesn’t seem to be any hard and fast evidence that portals improve patient care across the board, studies have emerged to suggest that portals support better outcomes, in areas such as medication adherence. (A Kaiser Permanente study from a couple of years ago, comparing statin adherence for those who chose online refills as their only method of getting the med with those who didn’t, found that those getting refills online saw nonadherence drop 6%.)

Just as importantly – in my view at least – I frequently hear accounts of individual practices which saw the volume of incoming calls drop dramatically. While that may not correlate directly to better patient care, it can’t hurt when patients are engaged enough to manage the petty details of their care on their own. Also, if the volume of phone requests for administrative support falls enough, a practice may be able to cut back on clerical staff and put the money towards say, a nurse case manager for coordination.

I’m not suggesting that every health IT investment practices have made will turn to fulfill its promise. EHRs, in particular, are difficult to look at as a whole and classify as a success across the board. I am, however, arguing that the MGMA has more reason for optimism than its leaders would publicly admit.

Electronic Prescribing Of Controlled Substances Rates Spiking

Posted on September 1, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Back in the day, say a decade ago or so, when e-prescribing itself was a new and big deal, the feds – especially the DEA – didn’t think much of the e-prescribing of controlled drugs like opiates. But a few years later the agency eventually came around. In June of 2010, it released a rule which allowed providers to issue such prescriptions nd pharmacies to receive, dispense and archive these scripts electronically nationwide.

Since then, electronic prescribing of controlled substances (EPCS) has taken off, according to a story in Search HealthIT. In fact, EPCS has been growing rapidly, particularly during 2015, according to national pharmacy IT network Surescripts.

Specifically, the number of ECPS transactions shot up 600% last year, from 1.67 million to 12.8 million scripts issued, according to Surescripts’ 2015 National Progress Report. Part of the reason for this surge is that providers are getting on board at a brisk pace. The number of providers enabled to use EPCS grew 359% last year.

Among the interesting stats to be culled from the Surescripts report is that 32% of drugs prescribed were opioids. This statistic should draw a lot of interest from public officials and enforcement agencies trying to stem the tide of opioid overdoses which killed more than 28,000 Americans in 2014. That’s four times as many who died of this cause in 2010, according to Surescripts’ sources.

A Drop in the Bucket

It’s worth noting that the number of EPCS transactions still pales in contrast to the number of transactions hosted on the Surescripts network that year. The network handled 9.7 billion transactions in 2015, up 40% from the previous year, the company reported. That means the EPCS is still a drop in the bucket overall.

Also, levels of EPCS-enabled pharmacies and physicians vary across the U.S. For example, 91% of pharmacies are EPCS-enabled in New York, the top state for such pharmacies. (A New York State rule requiring every practitioner in the state to e-prescribe all medications went into effect in March.) Other top-ranked states for pharmacy penetration included Massachusetts, California and Texas. On the other hand, only 73% of pharmacies were EPCS-enabled in Georgia and Florida.

Still, with adoption levels seemingly evening out between states – and the gap small enough to close over the next few years – it seems like EPCS is becoming an established practice. Surescripts contends that this is for the best, and argues that EPCS reduces fraud and improper prescribing by making it easier to track such medications. And with states like New York mandating e-prescribing for all providers, the growth in EPCS is likely to stay healthy.

However, for every action there’s a reaction, and the other shoe may not have dropped where EPCS risks are concerned. It may take a few years to find out whether the confidence some have in this approach was merited.

Improving Clinical Workflow Can Boost Health IT Quality

Posted on August 18, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

At this point, the great majority of providers have made very substantial investments in EMRs and ancillary systems. Now, many are struggling to squeeze the most value out of those investments, and they’re not sure how to attack the problem.

However, according to at least one piece of research, there’s a couple of approaches that are likely to pan out. According to a new survey by the American Society for Quality, most healthcare quality experts believe that improving clinical workflow and supporting patients online can make a big diference.

As ASQ noted, providers are spending massive amounts of case on IT, with the North American healthcare IT market forecast to hit $31.3 by 2017, up from $21.9 billion in 2012. But healthcare organizations are struggling to realize a return on their spending. The study data, however, suggests that providers may be able to make progress by looking at internal issues.

Researchers who conducted the survey, an online poll of about 170 ASQ members, said that 78% of respondents said improving workflow efficiency is the top way for healthcare organizations to improve the quality of their technology implementations. Meanwhile, 71% said that providers can strengthen their health IT use by nurturing strong leaders who champion new HIT initiatives.

Meanwhile, survey participants listed a handful of evolving health IT options which could have the most impact on patient experience and care coordination, including:

  • Incorporation of wearables, remote patient monitoring and caregiver collaboration tools (71%)
  • Leveraging smartphones, tablets and apps (69%)
  • Putting online tools in place that touch every step of patient processes like registration and payment (69%)

Despite their promise, there are a number of hurdles healthcare organizations must get over to implement new processes (such as better workflows) or new technologies. According to ASQ, these include:

  • Physician and staff resistance to change due to concerns about the impact on time and workflow, or unwillingness to learn new skills (70%)
  • High cost of rolling out IT infrastructure and services, and unproven ROI (64%)
  • Concerns that integrating complex new devices could lead to poor interfaces between multiple technologies, or that haphazard rollouts of new devices could cause patient errors (61%)

But if providers can get past these issues, there are several types of health IT that can boost ROI or cut cost, the ASQ respondents said. According to these participants, the following HIT tools can have the biggest impact:

  • Remote patient monitoring can cut down on the need for office visits, while improving patient outcomes (69%)
  • Patient engagement platforms that encourage patients to get more involved in the long-term management of their own health conditions (68%)
  • EMRs/EHRs that eliminate the need to perform some time-consuming tasks (68%)

Perhaps the most interesting part of the survey report outlined specific strategies to strengthen health IT use recommended by respondents, such as:

  • Embedding a quality expert in every department to learn use needs before deciding what IT tools to implement. This gives users a sense of investment in any changes made.
  • Improving available software with easier navigation, better organization of medical record types, more use of FTP servers for convenience, the ability to upload records to requesting facilities and a universal notification system offering updates on medical record status
  • Creating healthcare apps for professional use, such as medication calculators, med reconciliation tools and easy-to-use mobile apps which offer access to clinical pathways

Of course, most readers of this blog already know about these options, and if they’re not currently taking this advice they’re probably thinking about it. Heck, some of this should already be old hat – FTP servers? But it’s still good to be reminded that progress in boosting the value of health IT investments may be with reach. (To get some here-and-now advice on redesigning EMR workflow, check out this excellent piece by Chuck Webster – he gets it!)

One Example Of Improving Telehealth Documentation 

Posted on August 16, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Over the past year or two, the pressure has risen for providers to better document telehealth encounters, a pressure which has only mounted as the volume of such consults has grown. But until recently, telemedicine notes have been of little value, as they’ve met few of the key criteria that standard notes must meet.

The fact that such consults aren’t integrated with EMRs has made such an evolution even trickier. I guess doctors might be able to squeeze the patient’s video screen into one corner, allowing the clinician to work within the existing EMR display, but that would make both the consult and the note-taking rather inefficient, wouldn’t it?  The bottom line is that if telemedicine is to take its place alongside of other modes of care, this state of affairs is unsustainable.

For one thing, health plans that reimburse for telehealth services won’t be satisfied with vague assurances that such care made a difference – they’ll want some basis for analyzing its impact, which can’t be done without at least some basic diagnostic and care-related information. Also, providers will need similar records, for reasons which include the need to integrate the information into the patient’s larger record and to track the progress of this approach.

All of which is to note that I was happy to stumble across an example of a telemedicine provider that’s making efforts to improve its consult notes. While the provider, Doctor on Demand, hasn’t exactly reinvented the telehealth record, it’s improving those records, and to my way of thinking that deserves a shout-out.

As some readers may know, Doctor on Demand is a consumer-facing telemedicine provider which offers video visits with primary care doctors, counselors and psychiatrists. Its competitors include HealthTap and American Well. Because the company works with my health plan, United Healthcare, I’ve used its services to deal with off-hours issues as they arise.

Just today I had a video visit with a Doctor on Demand doctor to address a mild asthma care issue, after which I reviewed the physician’s notes. When I did so, I was happy to see that those notes included a ICD-10 diagnosis code. The notes also incorporated a consumer-level summary of what the diagnosed condition was, what to do about it, what its prognosis was and how to follow up. Essentially, Doctor on Demand’s notes have evolved from a sentence of two of informal suggestions to a more-structured document not unlike a set of hospital discharge instructions.

Don’t get me wrong, I’m certainly well aware that these are just baby steps. Doctor on Demand will have to move a lot further in this direction before consult documentation offers much to other providers. That being said, adding a formal diagnosis code gives the company a better means for analyzing key patterns of utilization internally by presenting condition, which can help its leaders look at whom they serve. Doctor on Demand can also use this information to pitch deals with potential partners, by sharing data on its population and underscoring its capabilities. In other words, these changes should make an impact.

Ultimately, telehealth documentation will have to meet the same expectations that other healthcare documentation does. And it’s not clear to me how freestanding telemedicine firms like Doctor on Demand will bridge that gap. After all, generating complete documentation takes far more than a few useful gestures. Even if the company threw a high-end EMR at the problem, merging it with the existing workflow is likely to be a huge undertaking. But still, making a bit of progress is worthwhile. I hope Doctor on Demand’s competitors are taking similar steps.

E-Patient Update:  Registration Can Add Value To Care 

Posted on August 15, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

For those of you who end up seeking care in hospital emergency departments now and again, the following will probably be familiar. You’re spending the precious few minutes you get with the ED doc discussing your situation, having a test done or asking a nurse some rather personal questions, and a hapless man or woman shows up and inserts themselves into the moment. Why? Because they want to collect registration information.

While these clerks are typically pleasant enough, and their errand relatively brief, their interruption has consequences. In my case, their entry into the room has sometimes caused a nurse or doctor to lose their train of thought, or an explanation in progress was never finished. As if that weren’t irritating enough, the registration clerk – at least at my local community hospital – typically asks questions I’ve already answered previously, or asks me to sign forms I could easily have reviewed at an earlier stage in the process.

Not only that, there have been at least a couple of situations in which a nurse or doctor was so distracted by the clerk’s arrival that some reasonably important issues didn’t get handled. Don’t get me wrong, the skilled team at this facility recovered and addressed these issues before they could escalate, but there’s no guarantee that this will always happen, particularly if the patient isn’t used to keeping track of their care process.

Also, given that alarm fatigue is already leading to patient care mistakes and near-misses, it seems odd that this hospital would squeeze yet another distraction into its ED routine. At least the alarms are intended to serve as clinical decision support and avoid needless errors. Collecting my street address a second time doesn’t rise to that level of importance.

Of course, hospitals need the information the clerk collects, for a variety of legal and operational reasons. I have no problem signing a form giving it permission to bill my insurer, affirming that I don’t need disability accommodations or agreeing to a facility’s “no smoking on campus” policy. And I certainly want any provider that treats me to have full and accurate insurance information, as I obviously don’t want to be billed for the care myself!  But is it really necessary to interrupt a vital care process to accomplish this?

As I see it, verifying registration information could be done much more effectively if it took place at a different point in the sequence of care – at the moment when physicians decide whether to discharge or admit that patient.  After all, if the patient is well enough to answer questions and sign forms while lying in an ED bed, they’re likely to remain so through the admissions process, and verify their financial and personal information once they’re settled (or even while they’re waiting to be transported to their bed). Meanwhile, if the patient is being discharged, they could just as easily provide signatures and personal data as they prepare to leave.

But the above would simply make registration less intrusive. What about adding real value to the process, for both the hospital and the patient? Instead of having a clerk gather this information, why not provide the patient with a tablet which presents the needed information, allowing patients to enter or edit their personal details at leisure.

Then, as they digitally sign off on registration, it would be a great time to ask the patient a few details which help the facility understand the patient’s need for support and care coordination. Why not find out, before the patient is discharged, whether they have a primary care doctor or relevant specialist, whether they can afford their medications, whether they can get to post-discharge visits and the like? This improves results for the patient and ties in with a value-based focus on continuity of care.

These days, it’s not enough just to eliminate pointless workflow disruptions. Let’s leverage the amazing consumer IT platforms we have to make things better!

ONC Announces Winners Of FHIR App Challenge

Posted on August 3, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The ONC has announced the first wave of winners of two app challenges, both of which called for competitors to use FHIR standards and open APIs.

As I’ve noted previously, I’m skeptical that market forces can solve our industry’s broad interoperability problems, even if they’re supported and channeled by a neutral intermediary like ONC. But there’s little doubt that FHIR has the potential to provide some of the benefits of interoperability, as we’ll see below.

Winners of Phase 1 of the agency’s Consumer Health Data Aggregator Challenge, each of whom will receive a $15,000 award, included the following:

  • Green Circle Health’s platform is designed to provide a comprehensive family health dashboard covering the Common Clinical Data Set, using FHIR to transfer patient information. This app will also integrate patient-generated health data from connected devices such as wearables and sensors.
  • The Prevvy Family Health Assistant by HealthCentrix offers tools for managing a family’s health and wellness, as well as targeted data exchange. Prevvy uses both FHIR and Direct messaging with EMRs certified for Meaningful Use Stage 2.
  • Medyear’s mobile app uses FHIR to merge patient records from multiple sources, making them accessible through a single interface. It displays real-time EMR updates via a social media-style feed, as well as functions intended to make it simple to message or call clinicians.
  • The Locket app by MetroStar Systems pulls patient data from different EMRs together onto a single mobile device. Other Locket capabilities include paper-free check in and appointment scheduling and reminders.

ONC also announced winners of the Provider User Experience Challenge, each of whom will also get a $15,000 award. This part of the contest was dedicated to promoting the use of FHIR as well, but participants were asked to show how they could enhance providers’ EMR experience, specifically by making clinical workflows more intuitive, specific to clinical specialty and actionable, by making data accessible to apps through APIs. Winners include the following:

  • The Herald platform by Herald Health uses FHIR to highlight patient information most needed by clinicians. By integrating FHIT, Herald will offer alerts based on real-time EMR data.
  • PHRASE (Population Health Risk Assessment Support Engine) Health is creating a clinical decision support platform designed to better manage emerging illnesses, integrating more external data sources into the process of identifying at-risk patients and enabling the two-way exchange of information between providers and public health entities.
  • A partnership between the University of Utah Health Care, Intermountain Healthcare and Duke Health System is providing clinical decision support for timely diagnosis and management of newborn bilirubin according to evidence-based practice. The partners will integrate the app across each member’s EMR.
  • WellSheet has created a web application using machine learning and natural language processing to prioritize important information during a patient visit. Its algorithm simplifies workflows incorporating multiple data sources, including those enabled by FHIR. It then presents information in a single screen.

As I see it, the two contests don’t necessarily need to be run on separate tracks. After all, providers need aggregate data and consumers need prioritized, easy-to-navigate platforms. But either way, this effort seems to have been productive. I’m eager to see the winners of the next phase.