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Health IT Group Raises Good Questions About “Information Blocking”

Posted on September 8, 2017 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 21st Century Cures Act covers a great deal of territory, with provisions that dedicate billions to NIH funding, Alzheimer’s research, FDA operations and the war on opioid addiction. It also contains a section prohibiting “information blocking.”

One section of the law lists attempts to define information blocking, and lists some of the key ways healthcare players drag their feet when it comes to data sharing. The thing is, some industry organizations feel that these provisions raise more questions than they answer.

In an effort to nail things down, a trade organization calling itself Health IT Now has written to the HHS Office of Inspector General and ONC head Donald Rucker, MD, asking them to issue a proposed rule answering their questions.  Parties signing the letter include a broad range of healthcare and health IT organizations, including the American Academy of Family Physicians, athenahealth, DirectTrust, AMIA, McKesson and Oracle.

I’m not going to list all the questions they’ve asked. You can read the entirety yourself. However, I will share two questions and offer responses of my own. One critical question is:

  • What is information blocking and what is not?

I think most of us know what the law is trying to accomplish, e.g. foster the kind of data sharing needed to accomplish key research and patient care outcomes goals. And the examples of what it considers information blocking make sense:

  • Practices that restrict authorized access, exchange, or use [of health data] under applicable State or Federal law
  • Implementing health information technology in nonstandard ways that are likely to substantially increase the complexity or burden of accessing exchanging or use of electronic health information
  • Implementing health information technology in ways that are likely to lead to fraud, waste, or abuse, or impede innovations and advancements health information access, exchange, and use

The problem is, there are many more ways to hamper the sharing of electronic health data. The language used in the law can’t anticipate all of these strategies, which leaves compliance with the law very much open to interpretation.

This, logically, leads to how businesses can avoid running afoul of the law:

  • The statute institutes penalties on vendors to $1 million per violation. How should “per violation” be defined?

    Given the minimum detail included in the legislation, this is a burning question. Vendors need to know precisely whether they’re in the clear, violated the statute once or flouted it a thousand times.

After all, vendors may violate the statute

  • When they refuse data access to one individual within a business one time
  • When they don’t comply with a specific organization’s request regardless of how many employees were in contact
  • When a receiving organization doesn’t get all the data requested at the same time
  • When the vendor asks the receiving organization to pay an administrative fee for the data
  • When individuals try to access data through the web and find it difficult to do so

Would a vendor be on the hook for a single $1 million fine if it flat out refused to share data with a client?  How about if it refused twice rather than once? Are both part of the same violation?

Does the $1 million fine apply if the vendor inadvertently supplies corrupted data? If so, does the fine still apply if the vendor attempts to remedy the problem? How long does the vendor have to respond if they are informed that the data isn’t readable?

What about if dozens or even hundreds of individuals attempt to access data on the web can’t do so? Has the vendor violated the statute if it has an extended web outage or database problem, and if so how long does it should have to get web-based data access back online? Does each attempt to access the data count as a violation?

What standard does the statute establish for standard vs. non-standard data formats?  Could a vendor be cited once, or more than once, for using a new and emerging data format which is otherwise respected by the industry?

As I’m sure you’ll agree, these are just some of the questions that need to be answered before any organization can reasonably understand how to comply with the law’s information blocking provisions. Asking regulatory agencies to clarify their expectations is more than reasonable.

Study Offers Snapshot Of Provider App Preferences

Posted on March 20, 2017 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 recent study backed by HIT industry researchers and an ONC-backed health tech project offers an interesting window into how healthcare organizations see freestanding health apps. The research, by KLAS and the SMART Health IT Project, suggests that providers are developing an increasingly clear of what apps they’d like to see and how they’d use them.

Readers of this blog won’t be surprised to hear that it’s still early in the game for healthcare app use. In fact, the study notes, about half of healthcare organizations don’t formally use apps at the point of care. Also, most existing apps offer basic EMR data access, rather than advanced use cases.

The apps offering EMR data access are typically provided by vendors, and only allow users to view such data (as opposed to documenting care), according to the study report. But providers want to roll out apps which allow inputting of clinical data, as this function would streamline clinicians’ ability to make an initial patient assessment, the report notes.

But there are other important app categories which have gained an audience, including diagnostic apps used to support patient assessment, medical reference apps and patient engagement apps.  Other popular app types include clinical decision support tools, documentation tools and secure messaging apps, according to researchers.

It’s worth noting, though, that there seems to be a gap between what providers are willing to use and what they are willing to buy or develop on their own. For example, the report notes that nearly all respondents would be willing to buy or build a patient engagement app, as well as clinical decision support tools and documentation apps. The patient engagement apps researchers had in would manage chronic conditions like diabetes or heart disease, both very important population health challenges.

Hospital leaders, meanwhile, expressed interest in using sophisticated patient portal apps which go beyond simply allowing patients to view their data. “What I would like a patient app to do for us is to keep patients informed all throughout their two- to four-hours ED stay,” one CMO told researchers. “For instance, the app could inform them that their CBC has come back okay and that their physician is waiting on the read. That way patients would stay updated.”

When it came to selecting apps, respondents placed a top priority on usability, followed by the app’s cost, clinical impact, capacity for integration, functionality, app credibility, peer recommendations and security. (This is interesting, given many providers seem to give usability short shrift when evaluating other health IT platforms, most notably EMRs.)

To determine whether an app will work, respondents placed the most faith in conducting a pilot or other trial. Other popular approaches included vendor demos and peer recommendations. Few favored vendor websites or videos as a means of learning about apps, and even fewer placed working with app endorsement organizations or discovering them at conferences.

But providers still have a few persistent worries about third-party apps, including privacy and security, app credibility, the level of ongoing maintenance needed, the extent of integration and data aggregation required to support apps and issues regarding data ownership. Given that worrisome privacy and security concerns are probably justified, it seems likely that they’ll be a significant drag on app adoption going forward.

Healthcare Industry Leads In Blockchain Deployment

Posted on January 19, 2017 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 Deloitte concludes that healthcare and life sciences companies stand out as planning the most aggressive blockchain deployments of any industry. That being said, healthcare leaders are far from alone in paying close attention to blockchain, which seems to be coming into its own as corporate technology.

According to Deloitte, 39% of senior executives at large US companies had little or no knowledge of blockchain technology, but the other 61% reported their blockchain knowledge level as broad to expert. The execs who were well-informed about blockchain told Deloitte that it would be crucial for both their company and industry. In fact, 55% of the knowledgeable group said their company would be at a competitive disadvantage if they failed to adopt blockchain, and 42% believed it would disrupt their industry.

Given this level of enthusiasm, it’s not surprising that respondents have begun to invest in blockchain internally. Twenty-eight percent of respondents said their company had invested $5 million of more in blockchain tech to date, and 10% reported investing $10 million or more. Not only that,  25% of respondents expected to invest more than $5 million in blockchain technology this year.

While the level of blockchain interest seems to be pronounced across industries studied by Deloitte, healthcare and life science companies lead the pack when it came to deployment, with 35% of industry respondents saying that their company expects to put blockchain into production during 2017.

All that being said, aggressive deployment may or may not be a good thing just yet. According to research by cloud-based blockchain company Tierion, the majority of blockchain technology isn’t ready for deployment, though worthwhile experiments are underway.

Tierion argues that analysts and professional experts are overselling blockchain, and that most of blockchain technology is experimental and untested. Not only that, its research concludes that at least one healthcare application – giving patients the ability to manage their health data – is rather risky, as blockchain security is shaky.

It seems clear that health IT leaders will continue to explore blockchain options, given its tantalizing potential for sharing data securely and flexibly. And as the flurry of interest around ONC’s blockchain research challenge demonstrates, many industry thought leaders take this technology seriously. If the winning submissions are any indication, blockchain may support new approaches to health data interoperability, claims processing, medical records, physician-patient data sharing, data security, HIEs and even the growth of accountable care.

If nothing else, 2017 should see the development of some new and interesting healthcare blockchain applications, and probably the investment of record new amounts of capital to build them. In other words, whether blockchain is mature enough for real time deployment or not, it’s likely to offer an intriguing show.

ONC Takes Another Futile Whack At Interoperability

Posted on January 2, 2017 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.

With the New Year on its way, ONC has issued its latest missive on how to move the healthcare industry towards interoperability. Its Interoperability Standards Advisory for 2017, an update from last year’s version, offers a collection of standards and implementation specs the agency has identified as important to health data sharing.

I want to say at the outset that this seems a bit, well, strange to me. It really does seem like a waste of time to create a book of curated standards when the industry’s interoperability take changes every five minutes. In fact, it seems like an exercise in futility.

But I digress. Let’s talk about this.

About the ISA

The Advisory includes four technical  sections, covering a) vocabulary/code sets/terminology, b) content/structure standards and implementation specs, c) standards and implementation specs for services and d) models and profiles, plus a fifth section listing ONC’s questions and requesting feedback. This year’s version takes the detailed feedback the ONC got on last year’s version into account.

According to ONC leader Vindell Washington, releasing the ISA is an important step toward achieving the goals the agency has set out in the Shared Nationwide Interoperability Roadmap, as well as the Interoperability Pledge announced earlier this year. There’s little doubt, at minimum, that it represents the consensus thinking of some very smart and thoughtful people.

In theory ONC would appear to be steaming ahead toward meeting its interoperability goals. And one can hardly disagree that it’s overarching goal set forth in the Roadmap, of creating a “learning health system” by 2024 sounds attractive and perhaps doable.

Not only that, at first glance it might seem that providers are getting on board. As ONC notes, companies which provide 90% of EHRs used by hospitals nationwide, as well as the top five healthcare systems in the country, have agreed to the Pledge. Its three core requirements are that participants make it easy for consumers to access their health information, refrain from interfering with health data sharing, and implement federally recognized national interoperability standards.

Misplaced confidence

But if you look at the situation more closely, ONC’s confidence seems a bit misplaced. While there’s much more to its efforts, let’s consider the Pledge as an example of how slippery the road ahead is.

So let’s look at element one, consumer access to data. While agreeing to give patients access is a nice sentiment, to me it seems inevitable that there will be as many forms of data access as there are providers. Sure, ONC or other agencies could attempt to regulate this, but it’s like trying to nail down jello given the circumstances. And what’s more, as soon as we define what adequate consumer access is, some new technology, care model or consumer desire will change everything overnight.

What about information blocking? Will those who took the Pledge be able to avoid interfering with data flows? I’d guess that if nothing else, they won’t be able to support the kind of transparency and sharing ONC would like to see. And then when you throw in those who just don’t think full interoperability is in their interests – but want to seem as though they play well with others – you’ve pretty much got a handful o’ nothing.

And consider the third point of the Pledge, which asks providers to implement “federally recognized” standards. OK, maybe the ISA’s curated specs meet this standard, but as the Advisory is considered “non-binding” perhaps they don’t. OK, so what if there were a set of agreed-upon federal standards? Would the feds be able to keep up with changes in the marketplace (and technology) that would quickly make their chosen models obsolete? I doubt it. So we have another swing and a miss.

Given how easy the Pledge is to challenge, how much weight can we assign to efforts like the ISA or even ONC’s long-term interoperability roadmap? I’d argue that the answer is “not much.” The truth is that at least in its current form, there’s little chance the ONC can do much to foster a long-term, structural change in how health organizations share data. It’d be nice to think that, but thinking doesn’t make it so.

ONC’s Interoperability Standards Advisory Twitter Chat Summary

Posted on September 2, 2016 I Written By

The following is a guest blog post by Steve Sisko (@ShimCode and www.shimcode.com).

Yesterday the Office of the National Coordinator for Health Information Technology (ONC) hosted an open chat to discuss their DRAFT 2017 Interoperability Standards Advisory (ISA) artifacts.  The chat was moderated by Steven Posnak, Director, Office of Standards and Technology at Office of the National Coordinator for Health Information and used the #ISAchat hashtag under the @HealthIT_Policy account. The @ONC_HealthIT Twitter account also weighed in.

It was encouraging to see that the ONC hosted a tweetchat to share information and solicit feedback and questions from interested parties. After a little bit of a rough start and clarification of the objectives of the chat, the pace of interactions increased and some good information and ideas were exchanged. In addition, some questions were raised; some of which were answered by Steven Posnak and some of which were not addressed.

What’s This All About?

This post summarizes all of the tweets from the #ISAchat. I’ve organized the tweets as best as I could and I’ve excluded re-tweets and most ‘salutatory’ and ‘thank you’ tweets.

Note: The @hitechanswers  account shared a partial summary of the #ISAchat on 8/31/16 but it included less than half of the tweets shared in this post. So you’re getting the complete scoop here.

Topic 1: Tell us about the ISA (Interoperability Standards Advisory)
Account Tweet Time
@gratefull080504 Question: What is the objective of #ISAchat?   12:04:35
@onc_healthit To spread the word and help people better understand what the ISA is about 12:05:00
@gratefull080504 Question: What are today’s objectives, please? 12:08:43
@onc_healthit Our objective is to educate interested parties. Answer questions & hear from the creators 12:11:02
@johnklimek “What’s this I hear about interoperability?” 12:12:00
@cperezmha What is #PPDX? What is #HIE? What is interoperability? What is interface? #providers need to know the differences. Most do not. 12:14:41
@techguy Who is the target audience for these documents? 12:44:06
@healthit_policy HITdevs, CIOs, start-ups, fed/state gov’t prog admins. Those that have a need to align standards 4 use #ISAchat 12:46:18
@ahier No one should have to use proprietary standards to connect to public data #ISAchat 12:46:19
@shimcode Reference Materials on ISA
Ok then, here’s the “2016 Interoperability Standards Advisory” https://t.co/5QkmV3Yc6w
12:07:19
@shimcode And here’s “Draft 2017 Interoperability Standards Advisory” https://t.co/TUFidMXk0j 12:07:38
@stephenkonya #ICYMI Here’s the link to the @ONC_HealthIT 2017 DRAFT Interoperability Standards Advisory (ISA): https://t.co/VTqdZHUjBW 12:10:57
@techguy Question: Do you have a good summary blog post that summarizes what’s available in the ISA? 12:52:15
@onc_healthit We do! https://t.co/vVW6BM5TFW Authored by @HealthIT_Policy and Chris Muir – both of whom are in the room for #ISAchat 12:53:15
@healthit_policy Good? – The ISA can help folks better understand what standards are being implemented & at what level 12:06:29
@healthit_policy Getting more detailed compared to prior versions due largely to HITSC & public comments 12:29:48
@healthit_policy More work this fall on our side to make that come to fruition. In future, we’re aiming for a “standards wikipedia” approach 12:33:03
@survivorshipit It would be particularly helpful to include cited full documents to facilitate patient, consumer participation 12:40:22
@davisjamie77 Seeing lots of references to plans to “explore inclusion” of certain data. Will progress updates be provided? 12:50:00
@healthit_policy 1/ Our next milestone will be release of final 2017 ISA in Dec. That will rep’snt full transition to web 12:51:15
@healthit_policy 2/ after that future ISA will be updated more regularly & hopefully with stakeholder involved curation 12:52:21
@bjrstn Topic:  How does the ISA link to the Interoperability Roadmap? 12:51:38
@cnsicorp How will #ISA impact Nationwide Interoperability Roadmap & already established priorities? 12:10:49
@healthit_policy ISA was 1st major deliverable concurrent w/ Roadmap. Will continue to b strong/underlying support to work 12:13:49
@healthit_policy ISA is 1 part of tech & policy section of Roadmap. Helps add transparency & provides common landscape 12:53:55
@healthit_policy Exciting thing for me is the initiated transition from PDF to a web-based/interactive experience w/ ISA 12:30:51
@onc_healthit Web-based version of the ISA can be found here: https://t.co/F6KtFMjNA1 We welcome comments! 12:32:04
@techguy Little <HSML> From a Participant on the Ease of Consuming ISA Artifacts
So easy to consume!
12:40:57
@healthit_policy If I knew you better I’d sense some sarcasm :) that said, working on better nav approaches too 12:43:36
@techguy You know me well. It’s kind of like the challenge of EHRs. You can only make it so usable given the reqs. 12:45:36
@shimcode I think John forgot to enclose his tweet with <HSML> tags (Hyper Sarcasm Markup Language) 12:46:48
@ahier Don ‘t Use My Toothbrush!
OH (Overheard) at conference “Standards are like toothbrushes, everyone has one and no one wants to use yours”
13:15:43
Topic 2: What makes this ISA different than the previous drafts you have issued?
Account Tweet Time
@cnsicorp #Interoperability for rural communities priority 12:32:40
@healthit_policy Rural, underserved, LTPAC and other pieces of the interoperability puzzle all important #ISAchat 12:35:33
@cnsicorp “more efficient, closer to real-time updates and comments…, hyperlinks to projects…” 12:47:15
@shimcode Question: So you’re not providing any guidance on the implementation of interoperability standards? Hmm… 12:21:10
@gratefull080504 Question: Are implementation pilots planned? 12:22:51
@healthit_policy ISA reflects what’s out there, being used & worked on. Pointer to other resources, especially into future #ISAchat 12:24:10
@ahier The future is here it’s just not evenly distributed (yet) #ISAchat 12:25:15
@healthit_policy Yes, we put out 2 FOAs for High Impact Pilots & Standards Exploration Awards 12:25:56
@healthit_policy HHS Announces $1.5 Million in Funding Opportunities to Advance Common Health Data Standards. Info here: https://t.co/QLo05LfsLw
Topic 3: If you had to pick one of your favorite parts of the ISA, what would it be?
Account Tweet Time
@shimcode The “Responses to Comments Requiring Additional Consideration” section. Helps me understand ONC’s thinking. 12:45:32
@healthit_policy Our aim is to help convey forward trajectory for ISA, as we shift to web, will be easier/efficient engagement 12:47:47
@healthit_policy Depends on sections. Some, like #FHIR, @LOINC, SNOMED-CT are pointed to a bunch. 12:49:15
@gratefull080504 Question: What can patients do to support the objectives of #ISAchat ? 12:07:02
@gratefull080504 Question: Isn’t #ISAChat for patients? Don’t set low expectations for patients 12:10:44
@gratefull080504 I am a patient + I suffer the consequences of lack of #interoperability 12:12:26
@healthit_policy Certainly want that perspective, would love thoughts on how to get more feedback from patients on ISA 12:12:35
@gratefull080504 What about patients? 12:13:03
@gratefull080504 First step is to ensure they have been invited. I am happy to help you after this chat 12:13:57
@survivorshipit Think partly to do w/cascade of knowledge–>as pts know more about tech, better able to advocate 12:15:21
@healthit_policy Open door, numerous oppty for comment, and representation on advisory committees. #MoreTheMerrier 12:15:52
@gratefull080504 I am currently on @ONC_HealthIT Consumer Advisory Task Force Happy to contribute further 12:17:08
@healthit_policy 1 / The ISA is technical in nature, & we haven’t gotten any comments on ISA before from patient groups 12:08:54
@healthit_policy 2/ but as we look to pt generated health data & other examples of bi-directional interop, we’d like to represent those uses in ISA 12:09:51
@resultant TYVM all! Trying to learn all i can about #interoperability & why we’re not making progress patients expect 13:09:22
@shimcode Question: Are use cases being developed in parallel with the Interoperability Standards? 12:13:28
@shimcode Value of standards don’t lie in level of adoption of std as a whole, but rather in implementation for a particular use case. 12:16:33
@healthit_policy We are trying to represent broader uses at this point in the “interoperability need” framing in ISA 12:18:58
@healthit_policy 2/ would be great into the future to have more detailed use case -> interop standards in the ISA with details 12:19:49
@healthit_policy Indeed, royal we will learn a lot from “doing” 12:20:40
@shimcode IHE Profiles provide a common language to discuss integration needs of healthcare sites and… Info here: https://t.co/iBt2m8F9Ob 12:29:12
@techguy I’d love to see them take 1 section (say allergies) and translate where we’d see the standards in the wild. 12:59:04
@techguy Or some example use cases where people want to implement a standard and how to use ISA to guide it. 13:00:38
@healthit_policy Check out links now in ISA to the Interop Proving Ground – projects using #ISAchat standards. Info here: https://t.co/Co1l1hau3B 13:02:54
@healthit_policy Thx for feedback, agree on need to translate from ISA to people seeing standards implemented in real life 13:01:08
@healthit_policy Commenting on ISA Artifacts
We want to make the #ISA more accessible, available, and update-able to be more current compared to 1x/yr publication
12:34:22
@cperezmha #interoperability lowers cost and shows better outcomes changing the culture of healthcare to be tech savvy is key 12:35:10
@healthit_policy One new feature we want to add to web ISA is citation ability to help document what’s happ’n with standards 12:37:12
@shimcode A “discussion forum” mechanism where individual aspects can be discussed & rated would be good. 12:39:53
@healthit_policy Good feedback. We’re looking at that kind of approach as an option. ISA will hopefully prompt debate 12:40:50
@shimcode Having to scroll through all those PDF’s and then open them 1 by 1 only to have to scroll some more is VERY inefficient. 12:41:25
@shimcode Well, I wouldn’t look/think too long about it. Adding that capability is ‘cheap’ & can make it way easier on all. 12:43:48
@shimcode Question: What Can Be Learned About Interoperability from the Private Sector?
Maybe @ONC_HealthIT can get input from Apple’s latest #healthIT purchase/Gliimpse? What do they know of interoperability?
12:19:13
@healthit_policy > interest from big tech cos and more mainstream awareness is good + more innovation Apple iOS has CCDA sprt 12:22:59
@drewivan Testing & Tools
I haven’t had time to count, but does anyone know approximately how many different standards are included in the document?
12:47:29
@healthit_policy Don’t know stat off had, but we do identify and provide links for test tools as available. 12:56:31
@drewivan And what percentage of them have test tools available? 12:54:38
@shimcode According to the 2017 ISA stds just released, a tiny fraction of them have test tools. See here: https://t.co/Jbw7flDuTg 12:58:02
@shimcode I take back “tiny faction” comment on test tools. I count 92 don’t have test tools, 46 do. No assessment of tool quality though. 13:08:31
@healthit_policy Testing def an area for pub-private improvement, would love to see # increase, with freely available too 12:59:10
@techguy A topic near and dear to @interopguy’s heart! 12:59:54
@resultant Perhaps we could replace a couple days of HIMSS one year with #interoperability testing? #OutsideBox 13:02:30
 
Walk on Topic: Promotion of ISA (Thank you @cperezmha)
What can HIE clinics do to help other non-users get on board? Is there a certain resource we should point them too to implement?
Account Tweet Time
@davisjamie77 Liking the idea of an interactive resource library. How will you promote it to grow use? 12:35:57
@healthit_policy A tweetchat of course! ;) Also web ISA now linking to projects in the Interoperability Proving Ground 12:39:04
@davisjamie77 Lol! Of course! Just seeing if RECs, HIEs, other #HIT programs might help promote. 12:40:44
@healthit_policy Exactly… opportunities to use existing relationships and comm channels ONC has to spread the word 12:41:28
@stephenkonya Question: How can we better align public vs private #healthcare delivery systems through #interoperability standards? 12:42:23
Miscellaneous Feedback from Participants
Account Tweet Time
@ahier Restful APIs & using JSON and other modern technologies 12:54:03
@waynekubick Wayne Kubick joining from #HL7 anxious to hear how #FHIR and #CCDA can help further advance #interoperability. 12:11:30
@resultant We all do! The great fail of #MU was that we spent $38B and did not get #interoperability 12:14:21
@waynekubick SMART on #FHIR can help patients access and gain insights from their own health data — and share it with care providers. 12:17:44
@resultant I think throwing money at it is the only solution… IMHO providers are not going to move to do it on their own… 12:20:44
@shimcode @Search_E_O your automatic RT’s of the #ISAChat tweets are just clouding up the stream. Why? smh 12:08:30
@ahier
Do you see #blockchain making it into future ISA
12:28:02
@healthit_policy Phew… toughy. lots of potential directions for it. Going to segue my response into T2 12:28:58
@hitpol #blockchain for healthcare! ➡ @ONC_HealthIT blockchain challenge. Info here: https://t.co/vG60qRAqqa 12:31:33
@healthit_policy That’s All Folks!
Thank you everyone for joining our #ISAchat! Don’t forget to leave comments.
PDF version

 
About Steve Sisko
Steve Sisko has over 20 years of experience in the healthcare industry and is a consultant focused on healthcare data, technology and services – mainly for health plans, payers and risk-bearing providers. Steve is known as @ShimCode on Twitter and runs a blog at www.shimcode.com. You can learn more about Steve at his LinkedIn page and he can be contacted at shimcode@gmail.com.

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.

ONC Offers Two Interoperability Measures

Posted on July 14, 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 a while now, it’s been unclear how federal regulators would measure whether the U.S. healthcare system was moving toward the “widespread interoperability” MACRA requires. But the wait is over, and after reviewing a bunch of comments, ONC has come through with some proposals that seem fairly reasonable at first glance.

According to a new blog entry from ONC, the agency has gotten almost 100 comments on how to address interoperability. These recommendations, the agency concluded, fell into four broad categories:

  • Don’t create any significant new reporting burdens for providers
  • Broaden the scope of interoperability measurements to include providers and individuals that are not eligible for Medicare and Medicaid EHR incentives
  • Create measures that examine usage and usefulness of exchanged information, as well as the impact on health outcomes, in addition to measuring the exchange itself
  • Recognize that given the complexity of measuring interoperability, it will take multiple data sources, and that more discussions will be necessary to create an effective model for such measurements

In response, ONC has come up with two core measures which address not only the comments, but also its own analysis and MACRA’s specific definitions of “widespread interoperability.”

  • Measure #1: Proportion of healthcare providers electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding (querying); and integrating information received outside sources.
  • Measure #2: Proportion of healthcare providers who report using information electronically received through outside providers and sources for clinical decision-making.

To measure these activities, ONC expects to be able to draw on existing national surveys of hospitals and office-based physicians. These include the American Hospital Association’s AHA Information Technology Supplement Survey and the CDC National Center for Health Statistics’ annual National Electronic Health Record Survey of office-based physicians.

The reasons ONC would like to use these data sources include that they are not limited to Medicare and Medicaid EHR incentive program participants, and that both surveys have relatively high response rates.

I don’t know about you, but I was afraid things would be much worse. Measuring interoperability is quite difficult, given that just about everyone in the healthcare industry seems to have a slightly different take on what true interoperability actually is.

For example, there’s a fairly big gulf between those who feel interoperability only happens when all data flows from provider to provider, and those who feel that sharing a well-defined subset (such as that found in the Continuity of Care Document) would do the trick just fine. There is no way to address both of these models at the same time, much less the thousand shades of gray between the two extremes.

While its measures may not provide the final word on the subject, ONC has done a good job with the problem it was given, creating a model which is likely to be palatable to most of the parties involved. And that’s pretty unusual in the contentious world of health data interoperability. I hope the rollout goes equally well.

ONC Kicks Off Blockchain Whitepaper Contest

Posted on July 11, 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.

Hold onto your hats, folks. The ONC has taken an official interest in blockchain technology, a move which suggests that it’s becoming a more mainstream technology in healthcare.

As you may know, blockchain is the backbone for the somewhat shadowy world of bitcoin, a “cryptocurrency” whose users can’t be traced. (For some of you, your first introduction to cryptocurrency may have been when a Hollywood, CA hospitals was forced to pay off ransomware demands with $17K in bitcoins.)

But despite its use by criminals, blockchain still has great potential for creating breakthroughs for legitimate businesses, notably banking and healthcare. Look at dispassionately, a blockchain is just a distributed database, one which maintains a continuously growing list with data records hardened against tampering and revision.

Right now, the most common use the blockchain is to serve as a public ledger of bitcoin transactions. But the concept is bubbling up in the healthcare world, with some even suggesting that blockchain should be used to tackle health data security problems.

And now, the ONC has shown interest in this technology, soliciting white papers that offer thoughtful take on how blockchain can help meet important healthcare industry objectives.

The whitepaper, which may not be no longer than 10 pages, must be submitted by July 29. (Want to participate, but don’t have time to write the paper yourself? Click here.Papers must discuss the cryptography and underlying fundamentals of blockchain technology, explain how the use of blockchain can meet industry interoperability needs, patient centered outcomes research, precision medicine and other healthcare delivery needs, as well as offering recommendations for blockchain’s implementation.

The ONC will choose eight winning papers from among the submissions. Winning authors will have an opportunity to present the paper at a Blockchain & Healthcare Workshop held at NIST headquarters in Gaithersburg, MD on September 26th and 27th.

In hosting this contest, ONC is lending blockchain approaches in healthcare a level of credibility they might not have had in the past. But there’s already a lot of discussion going on about blockchain applications for health IT.

So what are people talking about where blockchain IT is concerned? In one LinkedIn piece, consultant Peter Nichol argues that blockchain can address concerns around scalability and privacy electronic medical records. He also suggests that blockchain technology can provide patients with more sophisticated privacy control of their personal health information, for example, providers can enhance health data security by letting patients combine their own blockchain signature with a hospital’s signature.

But obviously, ONC leaders think there’s a lot more that can be done here. And I’m pretty confident that they’re right. While I’m no security or cryptocurrency expert, I know that when a technology has been kicked around for several years, and used for a sensitive function like financial exchange without racking up any major failures, it’s got to be pretty solid. I’m eager to see what people come up with!

The Real HIPAA Blog Series on Health IT Buzz

Posted on April 8, 2016 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.

If you’re not familiar with the Health IT Buzz blog, it’s the Health IT blog that’s done by ONC (Office of the National Coordinator). I always love to see the government organizations blogging. No doubt they’re careful about what they post on their blog, but it still provides some great insights into ONC’s perspective on health IT and where they might take future regulations and government rules.

A great example of this is the Real HIPAA series of blog posts that they posted back in February. Yes, I realize I’m behind, but I’ll blame it on HIMSS.

Here’s an overview of the series:

It’s a common misconception that the Health Insurance Portability and Accountability Act (HIPAA) makes it difficult, if not impossible, to move electronic health data when and where it is needed for patient care and health. This blog series and accompanying fact sheets aim to correct this misunderstanding so that health information is available when and where it is needed.

The blog series dives into the weeds a bit and so it won’t likely be read by the average doctor or nurse. However, it’s a great resource for HIPAA privacy officers, CIOs, CSOs, and others interested in healthcare interoperability. I can already see these blog posts being past around management teams as they discuss what data they’re allowed to share, with whom, and when.

What’s clear in the series is that ONC wants to communicate that HIPAA is meant to enable health data sharing and not discourage it. We all know people who have used HIPAA to stop sharing. We’ll see if we start seeing more people use it as a reason to share it with the right people at the right time and the right place.

Workflow Redesign Is Crucial to Adopting a New Health IT System – Breakaway Thinking

Posted on January 20, 2016 I Written By

The following is a guest blog post by Todd Stansfield, Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Todd Stansfield
Workflow analysis and redesign have long been touted as essential to health IT adoption. Most organizations recognize the importance of modifying current workflows to capitalize on efficiencies created by a new application and identify areas where the system must be customized to support existing workflows. Despite this recognition, there remains room for improvement. In fact, last month the Office of the National Coordinator (ONC) identified the impact of new IT systems on clinical workflows as one of the biggest barriers to interoperability (ouch).

A successful redesign includes both an analysis of current workflows and desired future workflows.

Key stakeholders – direct and indirect – should take part in analyzing existing workflows. An objective third party should also be present to ask the right questions and facilitate the discussion. This team can collaborate to model important workflows, ideally in visual form to stimulate thorough analysis. To ensure an efficient and productive meeting, you should model workflows that are the most common, result in productivity losses, have both upstream and downstream consequences and involve multiple parties. The National Learning Consortium recommends focusing only on what occurs 80 percent of the time.

Once you document current workflows, you can set your sights on the future. Workflow redesign meetings are the next step; you need them to build a roadmap of activities leading up to a go-live event and beyond – from building the application to engaging and educating end users. Individuals from the original workflow analysis sessions should be included, and they should be joined by representatives from your health IT vendor (who can define the system’s capabilities) and members of your leadership team (who can answer questions and provide support).

After the initial go-live, you need to periodically perform workflow analysis and continue adjusting the roadmap to address changes to the application and processes.

Why should you spend all the time and effort to analyze and redesign workflows? Three reasons:

  1. It makes your organization proactive in your upcoming implementation and road to adoption. You’ll anticipate and avoid problems that will otherwise become bigger headaches.
  2. It’s the perfect opportunity to request customizations to adapt your application to desired workflows.
  3. It gives your staff a chance to mentally and emotionally prepare for a change to their daily habits, increasing buy-in and decreasing resistance to the switch.

Thorough and disciplined workflow redesign is an important step to adopting a new health IT application, but of course it’s not the only one. You’ll still need leadership to engage end users in the project, education that teaches learners how to use the new application to perform their workflow, performance metrics to evaluate adoption, and continual reinforcement of adoption initiatives as the application and workflows change over time.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.