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Some High Level Perspectives on FHIR

Posted on April 20, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Before HIMSS, I posted about my work to understand FHIR. There’s some great information in that post as I progress in my understanding of FHIR, how it’s different than other standards, where it’s at in its evolution, and whether FHIR is going to really change healthcare or not. What’s clear to me is that many are on board with FHIR and we’ll hear a lot more about it in the future. Many at HIMSS were trying to figure it out like me.

What isn’t as clear to me is whether FHIR is really all that better. Based on many of my discussions, FHIR really feels like the next iteration of what we’ve been doing forever. Sure, the foundation is more flexible and is a better standard than what we’ve had with CCDA and any version of HL7. However, I feel like it’s still just an evolution of the same.

I’m working on a future post that will look at the data for each of the healthcare standards and how they’ve evolved. I’m hopeful that it will illustrate well how the data has (or has not) evolved over time. More on that to come in the future.

One vendor even touted how their FHIR expert has been working on these standards for decades (I can’t remember the exact number of years). While I think there’s tremendous value that comes from experience with past standards, it also has me asking the question of why we think we’ll get different results when we have more or less the same people working on these new standards.

My guess is that they’d argue that they’ve learned a lot from the past standards that they can incorporate or avoid in the new standards. I don’t think these experienced people should be left out of the process because their background and knowledge of history can really help. However, if there isn’t some added outside perspective, then how can we expect to get anything more than what we’ve been getting forever (and we all know what we’ve gotten to date has been disappointing).

Needless to say, while the industry is extremely interested in FHIR, my take coming out of HIMSS is much more skeptical that FHIR will really move the industry forward the way people are describing. Will it be better than what we have today? I think it could be, but that’s not really a high bar. Will FHIR really helps us achieve healthcare interoperability nirvana? It seems to me that it’s really not designed to push that agenda forward.

What do you think of FHIR? Am I missing something important about FHIR and it’s potential to transform healthcare? Do you agree with the assessment that FHIR very well could be more of the same limited thinking on healthcare data exchange? I look forward to continue my learning about FHIR in the comments.

HL7 Backs Effort To Boost Patient Data Exchange

Posted on December 8, 2014 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.

Standards group Health Level Seven has kicked off a new project intended to increase the adoption of tech standards designed to improve electronic patient data exchange. The initiative, the Argonaut Project, includes just five EMR vendors and four provider organizations, but it seems to have some interesting and substantial goals.

Participating vendors include Athenahealth, Cerner, Epic, McKesson and MEDITECH, while providers include Beth Israel Deaconess Medical Center, Intermoutain  Healthcare, Mayo Clinic and Partners HealthCare. In an interesting twist, the group also includes SMART, Boston Children’s Hospital Informatics Program’s federally-funded mobile app development project. (How often does mobile get a seat at the table when interoperability is being discussed?) And consulting firm the Advisory Board Company is also involved.

Unlike the activity around the much-bruited CommonWell Alliance, which still feels like vaporware to industry watchers like myself, this project seems to have a solid technical footing. On the recommendation of a group of science advisors known as JASON, the group is working at creating a public API to advance EMR interoperability.

The springboard for its efforts is HL7’s Fast Healthcare Interoperability Resources. HL7’s FHir is a RESTful API, an approach which, the standards group notes, makes it easier to share data not only across traditional networks and EMR-sharing modular components, but also to mobile devices, web-based applications and cloud communications.

According to JASON’s David McCallie, Cerner’s president of medical informatics, the group has an intriguing goal. Members’ intent is to develop a health IT operating system such as those used by Apple and Android mobile devices. Once that was created, providers could then use both built-in apps resident in the OS and others created by independent developers. While the devices a “health IT OS” would have to embrace would be far more diverse than those run by Android or iOS, the concept is still a fascinating one.

It’s also neat to hear that the collective has committed itself to a fairly aggressive timeline, promising to accelerate current FHIT development to provide hands-on FHIR profiles and implementation guides to the healthcare world by spring of next year.

Lest I seem too critical of CommonWell, which has been soldiering along for quite some time now, it’s onlyt fair to note that its goals are, if anything, even more ambitious than the Argonauts’. CommonWell hopes to accomplish nothing less than managing a single identity for every person/patient, locating the person’s records in the network and managing consent. And CommonWell member Cerner recently announced that it would provide CommonWell services to its clients for free until Jan. 1, 2018.

But as things stand, I’d wager that the Argonauts (I love that name!) will get more done, more quickly. I’m truly eager to see what emerges from their efforts.

Lab Interfaces and EHR

Posted on June 4, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a great response on LinkedIn by Robert D. Coli, M.D. to my post about Lab Interfaces Being an EHR Standard. I’d love to hear your thoughts about what he says in the comments.

There are now a total 880,000 professionally active U.S. physicians, working in 200,000 mostly small private practices (100K with one or two members and 160,000 with 8 or less). Because of ARRA/HITECH’s carrots and sticks, over 60% of them have now installed ONC-certified EHRs. There are also a total of more than 8,800 hospital-based and over 5,600 independent, community-based clinical labs using LIS products sold by over 200 vendors, many of which are using proprietary LIS-Provider Link (LPL) software and middleware from a least a dozen EHR-LIS system integrators. Creating bidirectional ambulatory and inpatient EHR-LIS interfaces reportedly costs in the range of $10,000 to $50,000 per installation.

The owners of every lab business and physician practice would love to see the day that open source interoperability standards (for both data transport and content exchange) usher in the era of “commoditized connectivity” (what Dr. Doug Fridsma describes as “the arrows between the boxes”) between physician EHRs (which are used to order the tests) and LISs (which process the patient specimens and make the test results available to the ordering physician, and more recently with the new CLIA regulations, directly to patients). Currently however, there are no marketplace financial incentives for EHR and LIS vendor businesses to replace their millions of expensive customized interfaces (an innovation that sustains their business model) with the lower cost, more efficient and convenient commodity interfaces (an innovation that would disrupt their business model).

The potentially very good news (for labs, private practice physicians and vendors who are adapting to the constructive disruption of HIE 1.0) is that with the emergence of over 600 ACOs and thousands of PCMHs, tangible value-driven, risk-based incentives, a low profile, open source triad of EHR to Lab LIS interoperability standards are moving from pilot projects to production/deployment versions..

Since January 2011, right on the successful launch of the Direct Project Protocol pilots, over 3,000 individuals and organizations, including some of the biggest vertically integrated EHR/PHR, LIS, and HIE platform vendors in the U.S., have been busily creating an extensive portfolio of open source standards specifically aimed at overcoming many of the major barriers to health IT connectivity and seamless interoperability. You can find a good chronology of these efforts in the link to the archive of S&I Framework newsletters here.

The S&IFramework’s Lab Results Interface (LRI), Lab Orders Interface (LOI) and electronic Directory of Services (eDOS) Initiatives have been underway since January 2011. Notwithstanding the potential major impact on the global health IT systems interoperability markets and its vendors, the LRI+LOI+eDOS Initiatives have received little media coverage and exposure outside of some health IT media channels.

Over the next 3-5 years, if they are demanded and widely adopted and used by the knowledgeable customers of EHR and LIS vendors, the HL7-ballotted, normative versions of these three components of an open source interface solution can significantly reduce the costs of creating and maintaining millions of customized EHR-LIS interfaces and enable more efficient, less costly and more accurate ordering and reporting of the results of all 5,000+ available clinical lab tests to physicians and their patients.

If that actually occurs, the vendors of EHR, PHR and HIE platform products will ultimately have to consider reinventing their venerable business models by embracing disruptive IT innovations that enhance the value of the applications “inside their boxes” and can allow them to compete successfully on the basis of the price and quality of their products.

The Irony Of Healthcare Standards

Posted on March 13, 2014 I Written By

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

Healthcare delivery should be standardized. Medicine is, after all, primarily a science. Providers must diagnose and treat patients. Clinicians must form hypotheses, test hypotheses, and act. As providers obtain new information, they must adjust their thesis and repeat the cycle until patients are treated. Although there is an art to patient interaction, the medical process itself is scientific.

Science is based on repeatable, nullable hypotheses. Diagnostics and treatments are too.

And yet, it’s widely known that healthcare delivery is anything but standardized. Even basic pre-operative checklists vary dramatically across locations. Although some of this variation can be accounted for by physical constraints and capital limits, most of the aberrations can be attributed to management and culture. Checklists and protocols attempt to standardize care, but even the protocols themselves are widely debated within and between organizations.

It’s also widely known that most innovations take the better part of two decades to roll out through the US healthcare system. For an industry that should be at the cutting edge, this is painful to acknowledge.

There’s a famous saying that vendors represent their clients. It should be no surprise that major health IT vendors are slow to innovate and respond. Providers are used to slow changes, and have come to expect that of their vendors. Since providers often cannot absorb change that quickly, vendors become complacent, the pace of innovation slows, and innovations slowly disperse.

In the same light, health IT vendors are equally unstandardized. In fact, health IT vendors are so unstandardized that there’s an entire industry dedicated to trying to standardize data after-the-fact. The lack of standards is pathetic. A few examples:

Claims – Because insurance companies want to reject claims, they have never agreed on a real standard for claims. As such, an entire industry has emerged – clearing houses – to help providers mold claims for each insurance company. In an ideal world, clearing houses would have no reason to exist; all claim submissions, eligibility checks, and EOBs should be driven through standards that everyone adheres to.

HL7 – It’s commonly cited that every HL7 integration is just that: a single HL7 integration. Although HL7 integrations share the same general format, they accommodate such a vast array of variety and choice that every integration must be supported by developers on both sides of the interaction.

As a technologist, the lack of interoperability is insulting. Every computer on this planet – Windows, Mac, iOs, Android, and other flavors of Linux – communicate via the TCP/IP and HTTP protocols. Even Microsoft, Apple, and Google play nicely within enterprises. But because of the horribly skewed incentives within healthcare, none of the vendors want their customers to interact with other vendors, even though cooperation is vital.

Perhaps the most ironic observation is that technology is widely considered to be hyper-competitive. Despite hyper-competition, the tech giants have coalesced around a common set of standards for communication and interoperability. Yet health IT vendors, who operate within a vertical that prides itself on its scientific foundations, fail to communicate at the most basic levels.

High Costs of Health IT, ePrescribing, and HIE — #HITsm Chat Highlights

Posted on June 29, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

The following is our regularly scheduled roundup of tweets from yesterday’s #HITsm chat. You can also check out John’s blog post on yesterdays #HITsm topics.

Topic One: Costs vs benefits. Will high costs always be the #1 barrier cited to #healthIT adoption?

 

Topic Two: Why does ePrescribing have such widespread acceptance while #telehealth adoption is so low?

 

Topic Three: #HIE as a noun or a verb? Does negative press for HIE organization$ hinder health data exchange as a whole?

#HITsm T4: Is #CommonWell just a bully in a fairy godmother costume?

 

Topic Five: Open forum: What #HealthIT topic had your attention this week?

Bringing Long Term Care Into HIEs Without An EMR

Posted on March 13, 2013 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.

HIEs will never achieve their full potential if all players in the healthcare process aren’t included in the network. But without an EMR to connect to the HIE, how can a provider participate?

A new software package developed by Geisinger Health System and the Keystone Beacon Community Program offers a new option allowing nursing homes, home health agencies and other long-term care facilities without EMRs to upload data to HIEs, reports EHR Intelligence.

The package, KeyHIE Transform, extracts data from the Minimum Data Set and Outcome and Assessment Information Set that nursing homes already submit to CMS. It turns that information into a Continuity of Care Document usable by any EMR which is HL7-compatible.

This approach provides a bridge to a wide range of data which currently gets left behind by most HIEs. And as EHR Intelligence rightly notes, with telehealth and remote monitoring becoming more popular ways of managing senior  health, as well as assisted living, it will be increasingly important for other providers to have access to all of the seniors’ data via the HIE.

Geisinger’s KeyHIE has already run several  pilot programs using t his technology in long-term care facilities and home health agencies. It expects to launch the technology to the market in April of this year.

As is often the case, Geisinger seems to be ahead of the market with a solution that makes great sense.  After all, finding a way to integrate new data into an HIE — especially one that draws on existing data — is likely to add significant value to that HIE.  I’m eager to see whether this technology actually works as simply as it sounds.

The Next Generation of Doctors – #HITsm Chat Highlights

Posted on January 27, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

The theme for today’s chat was “The Next Generation of Doctors.” When I read this, I wasn’t sure what to expect. It definitely sounded like an interesting topic, and it proved to be one. Here are the questions that were asked, and some of my favorite responses:

Topic One: Who are the emerging leaders you admire for their ideas in shaping the future of medicine? Why? Share resources!

 

 

 

Topic Two: Do you think new ways of learning will attract different types of personalities to the field of medicine?

 

 

Topic Three: How can the next generation of doctors learn from patients who are active through social media?

 

 

 

Topic Four: What does the next generation of doctors think of Quantified Self? How will the role of hte docotr change because of #OS?

 

Topic Five: What is your big idea or dream for the future of medicine.

 

EMR Vendors, Patient Privacy, and Election Day — #HITsm Chat Highlights

Posted on November 17, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: When EMR vendors leave the marketplace or discontinue a product, how can usability be sustained?

Topic Two: How do we protect patient privacy with payer-based HIEs?

 

Topic Three: How can we draw attention to patient safety in the U.S. prison system?

Topic Four: Are we over the election and back to business as usual with healthcare?

Data Capture, Electronic Data, and Interoperability — #HITsm Chat Highlights

Posted on October 20, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: When can we seriously say the data being captured and stored in EHRs is leading to new opportunities for patient care?

Topic Two: Do hospitals prioritize complete data capture for max reimbursement or for an aid for clinicians in patient care?

#HITsm T3: Does electronic data entry really take more time than paper notes? What can improve speed?

 

#HITsm T4: Interoperability. What can be done to increase awareness of the CCD and CDA standards designated for data exchange?

Patient Portal, HIE Policy, and Portable Technologies — #HITsm Chat Highlights

Posted on October 6, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: How would you make a business case to leaders of an organization for a basic patient portal? 

 

 

 

Topic Two: What should an HIE policy regarding information sharing consent include? Can other technologies help? 

 

 

 

Topic Three: Why are portable technologies being adopted at a quicker rate than other health IT?

 

 

 

Topic Four: Free for All: What other health IT news/issues have interested you most this past week?