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Will Medical Device Makers Get Interoperability Done?

Posted on September 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.

Most of the time, when I think about interoperability, I visualize communication between various database-driven applications, such as EMRs, laboratory information systems and claims records. The truth is, however, that this is a rather narrow definition of interoperability. It’s time we take medical device data into account, the FDA reminds us.

In early September, the FDA released its final guidance on how healthcare organizations can share data between medical devices and other information systems. In the guidance, the agency asserts that the time has come to foster data sharing between medical devices, as well as data exchange between devices and information systems like the ones I’ve listed above.

Specifically, the agency is offering guidelines to medical device manufacturers, recommending that they:

  • Design devices with interoperability in mind
  • Conduct appropriate verification, validation and risk management to ensure interoperability
  • Make sure users clearly understand the device’s relevant functional, performance and interface characteristics

Though these recommendations are interesting, I don’t have much context on their importance. Luckily, Bakul Patel has come to the rescue. Patel, who is associate director for digital health the FDA‘s Center for Devices and Radiological Health, offered more background on medical device interoperability in a recent blog entry.

As the article points out, the stakes here are high. “Errors and inadequate interoperability, such as differences in units of measure (e.g., pounds vs. kilograms) can occur in devices connected to a data exchange system,” Patel writes. Put another way, in non-agency-speak, incompatibilities between devices and information systems can hurt or even kill patients.

Unfortunately, device-makers seem to be doing their own thing when it comes to data sharing. While some consensus standards exist to support interoperability, specifying things like data formats and interoperability architecture design, manufacturers aren’t obligated to choose any particular standard, Patel notes.

Honestly, the idea of varied medical devices using multiple data formats sounds alarming to me. But Patel seems comfortable with the idea. He contends that if device manufacturers explain carefully how the standards work and what the interface requires, all will be well.

All told, If I’m understanding all this correctly, the FDA is fairly optimistic that the healthcare industry can network medical devices on the IoT with traditional information systems.

I’m glad that the agency believes we can work this out, but I’d argue that such optimism may be premature. Patel’s assurances raise a bunch of questions for me, including:

  • Do we really need another set of competing data exchange standards to resolve, this time for medical device interoperability?
  • If so, how do we lend the consensus medical device standards with consensus information system standards?
  • Do we need to insist that manufacturers provide more-consistent software upgrades for the devices before interoperability efforts make sense?

Hey, I’m sure medical device manufacturers want to make device-to-device and device-to-database data sharing as simple and efficient as possible. That’s what their customers want, after all.

Unfortunately, though, the industry doesn’t have a great track record even for maintaining their devices’ operating systems or patching industrial-grade security holes. Designing devices that handle interoperability skillfully may be possible, but will device-makers step up and get it done anytime soon?

The Impact of HIEs in Natural Disasters – #HITsm Chat Topic

Posted on September 19, 2017 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 9/22 at Noon ET (9 AM PT). This week’s chat will be hosted by Brian Mack (@BFMack) from @GLHC_HIE on the topic of “The Impact of HIEs in Natural Disasters.”

On August 29th, 2005, Hurricane Katrina, a category 3 storm, made landfall in SE Louisiana. Torrential rain and sustained winds exceeding 110 MPH quickly overwhelmed the protective measures in place, and the subsequent storm surge breached levies and flooded huge swaths of New Orleans and surrounding areas. Mass-devastation across Louisiana and Mississippi contributed to the deaths of nearly 1,500 people, forced tens of thousands more from their homes, and caused an estimated $108 billion in property damage. At that time, only 10% of physicians were actively using electronic medical records, and electronic health information exchange was still was in its infancy. An incalculable number of paper health records were lost forever. The lack of access to patient information during and following the storm significantly hindered medical response efforts, and required years to replace.

Fast forward to Aug. 24th-26th, 2017, when Hurricane Harvey, an even larger (Cat. 4) storm struck Southern Texas, and dumped more than 40 inches of rain on the greater Houston area. While Harvey has been described as “Houston’s Katrina” in terms of its intensity and impact, the story was significantly different for the healthcare delivery system. Two health information exchanges in the region, the Greater Houston Healthconnect (GHHC) and Healthcare Access San Antonio (HASA) worked together to assist both those who stayed through the storm, as well as those who were evacuated. GHHC staff actually shuttled between shelters in the Houston area, overseeing the set-up of HIE portals, to help clinicians provide care for patients. Providers were able to maintain access to patient records, even from remote locations, using laptops and WiFi to access EHR systems in the normal way. As a result, the response to medical needs, and continuity of care for the population impacted by Harvey across Texas was seamlessly maintained at a very high level.

This week’s #HITSM Twitter chat will discuss the opportunities, challenges, and value of community-based Health Information Exchange in connecting the “last mile” of interoperability, particularly in emergency situations.

Some additional reading:

Here are the questions that will serve as the framework for this week’s #HITsm chat:
T1: What lesson(s) should we, as participants in the healthcare ecosystem, take away from events like Hurricanes Katrina & Harvey? #HITsm

T2: What roles do/should stakeholders: government (local, state, federal), HC providers, private sector, citizenry play in assuring adequate preparation for disasters? #HITsm

T3: What responsibilities do health IT infrastructure vendors (EHR), and Health Information Exchange have in supporting successful emergency response? #HITsm

T4: How do community based HIE’s differ from national interoperability efforts and/or vendor based solutions in emergency situations? #HITsm

T5: What examples from your own local communities can you share where community-based health information exchange either made a difference, or COULD have made a difference in responding to a public emergency? #HITsm

Bonus: Aside from the basic task of networking disparate healthcare providers, how could Health Information Exchange contribute to better connected communities? #HITsm

Upcoming #HITsm Chat Schedule
9/29 – Condition Management vs Episodic Care Management
Hosted by Brian Eastwood (@Brian_Eastwood) from @ChilmarkHIT

10/6 – After Death Data Donation – A #hITsm Halloween Horror Chat
Hosted by Regina Holliday (@ReginaHolliday), Founder of #TheWalkingGallery

10/13 – Role of Provider Engagement for Improving Data Accuracy
Hosted by @CAQH

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Searching EMR For Risk-Related Words Can Improve Care Coordination

Posted on September 18, 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.

Though healthcare organizations are working on the problem, they’re still not as good at care coordination as they should be. It’s already an issue and will only get worse under value-based care schemes, in which the ability to coordinate care effectively could be a critical issue for providers.

Admittedly, there’s no easy way to solve care coordination problems, but new research suggests that basic health IT tools might be able to help. The researchers found that digging out important words from EMRs can help providers target patients needing extra care management and coordination.

The article, which appears in JMIR Medical Informatics, notes that most care coordination programs have a blind spot when it comes to identifying cases demanding extra coordination. “Care coordination programs have traditionally focused on medically complex patients, identifying patients that qualify by analyzing formatted clinical data and claims data,” the authors wrote. “However, not all clinically relevant data reside in claims and formatted data.”

For example, they say, relying on formatted records may cause providers to miss psychosocial risk factors such as social determinants of health, mental health disorder, and substance abuse disorders. “[This data is] less amenable to rapid and systematic data analyses, as these data are often not collected or stored as formatted data,” the authors note.

To address this issue, the researchers set out to identify psychosocial risk factors buried within a patient’s EHR using word recognition software. They used a tool known as the Queriable Patient Inference Dossier (QPID) to scan EHRs for terms describing high-risk conditions in patients already in care coordination programs.

After going through the review process, the researchers found 22 EHR-available search terms related to psychosocial high-risk status. When they were able to find nine or more of these terms in the patient’s EHR, it predicted that a patient would meet criteria for participation in a care coordination program. Presumably, this approach allowed care managers and clinicians to find patients who hadn’t been identified by existing care coordination outreach efforts.

I think this article is valuable, as it outlines a way to improve care coordination programs without leaping over tall buildings. Obviously, we’re going to see a lot more emphasis on harvesting information from structured data, tools like artificial intelligence, and natural language processing. That makes sense. After all, these technologies allow healthcare organizations to enjoy both the clear organization of structured data and analytical options available when examining pure data sets. You can have your cake and eat it too.

Obviously, we’re going to see a lot more emphasis on harvesting information from structured data, tools like artificial intelligence and natural language processing. That makes sense. After all, these technologies allow healthcare organizations to enjoy both the clear organization of structured data and analytical options available when examining pure data sets. You can have your cake and eat it too.

Still, it’s good to know that you can get meaningful information from EHRs using a comparatively simple tool. In this case, parsing patient medical records for a couple dozen keywords helped the authors find patients that might have otherwise been missed. This can only be good news.

Yes, there’s no doubt we’ll keep on pushing the limits of predictive analytics, healthcare AI, machine learning and other techniques for taming wild databases. In the meantime, it’s good to know that we can make incremental progress in improving care using simpler tools.

Willingness To Invest In Outpatient EHRs and PM Solutions Grows

Posted on September 15, 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.

While the ambulatory EHR market remains somewhat stable, the number of organizations preparing to get out of their existing system has climbed over previous years, along with an increase in the number of organizations prepared to upgrade their practice management solution, according to new data from HIMSS.

To conduct the 9th Annual Outpatient PM & EHR Study, HIMSS Analytics reached out to physicians, practice managers/administrators, practice CEOs/presidents, PAs, NPs and practice IT directors/staff. A total of 436 professionals responded to its web-based survey.

The survey concluded that 93% of hospital-owned outpatient facilities had a live, in-operation EMR in place. Meanwhile, 70% of respondents representing free-standing outpatient facilities said they had an EHR in place, down from 78% last year.

As part of its survey, HIMSS Analytics asked respondents whether they planned to purchase an entirely new ambulatory EHR system, replace the existing system upgrade the system within the next two years.

The responses suggest that there’s been some new movement in the ambulatory EHR market. Most notably, 10.6% of respondents said they plan to replace their current solution, up from 6.4% in 2014. This is arguably a significant change. Also, 23.8% respondents said they were upgrading their current ambulatory solution, up from 20.8% in 2014.

In addition, the number of respondents with no investment plans fell below 60% for the first time in four years, HIMSS Analytics noted.

Though the practice management system market seems to be a bit more stable, some churn appears to be emerging here as well. Eleven percent of respondents said they plan to upgrade their current PM solution, down from 20.8% in 2014, and 9.3% said they plan to replace their current system, up from 6.4% in 2014.

All in all, there’s not a great deal of replacement activity underway, though the data does suggest a small spike. That being said, I was interested to note that respondents’ willingness to invest in a new system was higher than their willingness to upgrade a system they have.

The question is, why would ambulatory providers be ready to junk their existing EHR and practice management solutions now as opposed to three years ago? Are we reaching the end of a grand health IT replacement cycle or is there more going on here?

One possibility is that with MACRA kicking in, outpatient providers have been forced to reevaluate their existing systems in terms of their ability to support participation in QPP. Another fairly obvious possibility is that ambulatory providers are choosing to systems they feel can support their movement into value-based care.

From what I can tell, providers choosing new systems for these reasons are actually a bit behind the curve, but not terribly so. When their peers attempt to push forward with their three, four or even five-year-old systems, then you may see a replacement frenzy. Sometimes you just can’t afford to stick with Old Faithful.

Create Happier Healthcare Staff in 3 Easy Steps

Posted on September 14, 2017 I Written By

The following is a guest blog post by Chelsea Kimbrough from Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms
Chelsea Kimbrough
Creating excellent patient experiences is the focus of nearly every healthcare organization. To do this, providers are increasingly turning to new patient engagement tools and technologies. It’s important to note, however, that patient experience woes cannot be mended with technology alone. The healthcare professionals facilitating communications and care will always play an integral role in patients’ overall satisfaction and loyalty.

Unfortunately, those providing in-person care are often distracted from important patient-facing responsibilities by front office tasks. Thankfully, many modern engagement tools are able to create more seamless operational workflows for healthcare professionals in tandem with enhanced patient experiences. But with the market growing increasingly competitive, it’s important to pick the tools and technologies that best serves both populations.

Outlined below are three steps healthcare organizations can take to create a more enjoyable workplace for their staff and what key capabilities are necessary to ensure the greatest ROI.

  1. Lessen the number of phone calls
    If the phone isn’t demanding attention, healthcare professionals are better able to focus their talent and effort on the patients and people in more immediate need of their expertise. This ability drives better health outcomes, operational efficiencies, and patient experiences.

    Telephone answering solutions and technology help achieve these results. However, it’s important whoever is answering your phones is prepared to handle any question, task, language, or call volume. Unfortunately, many internally-run call answering solutions are unable to swiftly manage fluctuating call volumes. By partnering with a third-party telephone answering service, healthcare organizations can ensure every call is met with exceptional care.

    When searching for a call center solution, healthcare organization should seek:

    • Flexible call answering solutions
    • Multilingual live agent support
    • Control over call flow & scripting
    • Proven experience & expertise
  1. Automate appointment reminders
    Patients crave convenient experiences – and so do healthcare professionals. Automating informational messages to patients, such as appointment reminders, population health notifications, and relevant event announcements, removes part of this communication responsibility from staff, directly enabling them to focus on in-person care.

    It’s important, however, that this particular service is able to integrate with the health systems’ EHR or EMR. This ability enables the health system to target a patient’s contact method of choice when sending automated messages, seamlessly enhancing their experience. And by communicating every interaction with the health system, staff members are kept informed and prepared to meet patients’ needs should they choose to reach out.

    When searching for a messaging solution, healthcare organization should seek:

    • Email, voice, and text messaging capabilities
    • Patient-specific customization
    • Easy message deployment
    • EHR/EMR connectivity
  1. Optimize patient scheduling
    Patients of all ages can benefit from a smoother appointment scheduling processes – and for many patients, online scheduling is the answer. By eliminating the need for a timely phone call, online scheduling better fits into the digitally-driven lives of today’s patients.  And when implemented properly, online scheduling can directly benefit both telephone answering and automated messaging, too.

    Because scheduling an appointment should be a pain-free process, healthcare organizations should simplify it by sending an automated reminder with a unique, secure link to digitally schedule an appointment from their phone, laptop, or other internet connected device. By choosing a tool that automatically communicates this information with the health system’s EHR, patients can call about their appointment and receive consistently accurate information no matter what healthcare employee answers the phone. What’s more, this particular patient engagement tool lessens the appointment scheduling burdening from staff, enabling them to provide better in-person care.

    When searching for an appointment scheduling solution, healthcare organization should seek:

    • Intuitive, user-friendly tools
    • Accurate appointment availability
    • Easy message deployment
    • EHR/EMR connectivity

When the right communication tools and technologies are implemented, entire healthcare organizations thrive. With the above three strategies and the technologies associated with them in place, healthcare professionals can better focus on patients with the reassurance their phones are answered by trained professionals, important messages are promptly delivered, and schedules are being filled.

Healthcare organizations that implement communication tools and technologies that benefit both patients and staff are better positioned to have happier, more satisfied team members. And with a happier staff tending to patients’ healthcare needs, organizations can better safeguard patient loyalty for years to come.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services. Connect with Stericycle Communication Solutions on social media: @StericycleComms

Better Tech is Here for Healthcare

Posted on September 13, 2017 I Written By

The following is a guest blog by Brandt Welker, CTO at MedicaSoft. This is the second blog in a three-part sponsored blog post series focused on new HIT for integration. Each month, a different MedicaSoft expert will share insights on new and innovative technology and its applications in healthcare.

What are some of the common complaints doctors and nurses have about their EHRs?

“I have to click too much.” “Information is buried.” “It doesn’t follow my workflow.” “It’s slow.”

“I feel like a data entry clerk.” “*insert your favorite gripe here*” There is no shortage of commentary on the issues irking clinicians when it comes to technology. What there is a shortage of are ideas to fix it.

Better technology is out there serving other industries … and it can be applied in healthcare. Technology should ease administrative loads and put clinicians back in front of patients! I’ve talked about some of this previously and how we keep clinicians involved in our design process. When it came to building an entirely new EHR, the driving force behind our team researching and adopting new technologies was to imagine a clean slate.

Most of our team came from backgrounds with the Department of Veterans’ Affairs (VA’s) world of VistA. We learned a lot about legacy systems over the years – both beloved and maligned – and asked ourselves what a system would look like if it was unencumbered by the past. How would that system look? What could that system be? What technology choices should we make to simplify things? How could it play nicely with other systems and encourage true interoperability? How could it support users’ clinical workflow?

From the beginning, we decided that the most important thing was to get the platform right. Build the platform and build it right and things will work together. Build it to play nicely with other technology and interoperate. Make it fast. Make it easy. Make it open. Make it affordable. All of these needs were a part of our system “wish list.”

So, how’d we do it? We researched technology working in other fields and also elected to use HL7® FHIR® to its fullest extent. By now, you’ve probably heard a lot about the HL7® FHIR® standard. Many companies are using HL7® FHIR® to build APIs that are doing amazing things across the industry. We decided to use the HL7® FHIR® document data model as the basis of our platform – it simplifies implementation without sacrificing information integrity. We coupled it with a very powerful database and search engine – Couchbase & Elasticsearch. These are two high-performance tools used across industries. When you need a whole lot of data to move fast, you use Couchbase and Elasticsearch.

Couchbase is our NoSQL database. Couchbase is open-source and optimized for interactive applications. It provides low-latency data management (read: lots of data very quickly) for large-scale applications (like an EHR!). It lets us store records as documents and it’s really good at data replication. You might recognize Couchbase  — many other industry giants such as ebay, LinkedIn, and Verizon use it. It is an open-source database optimized for interactive applications. We selected Elasticsearch as our search engine. Some of your favorite sites and services use Elasticsearch – Netflix, Facebook, LinkedIn, and Wal-Mart, to name a few.

On top of Couchbase and Elasticsearch are FHIR APIs. These interactions are managed by type. We also use a Parser/Assembler Service that lets us combine, rearrange, and augment documents. Data is placed in the proper JSON format to be sent through the FHIR API into Couchbase. Our Community Health Record sits on top of this and everything described here is a part of our open platform – the one we built from scratch and architected to be interoperable and easy. Pretty neat, huh?

Once you have the platform, you can build all kinds of things to sit on top of it. The sky is the limit! In our case, we have a Personal Health Record and an Electronic Health Record, but we built it this way so you can use a wide range of technologies with the platform – things like Alerts or Analytics or Population Health or Third Party Applications, even custom built items that folks may have developed in-house will work with the platform. Essentially, using the platform means we can integrate with whatever you already have in place. Maybe you have an EHR with some issues, but you don’t have the time or budget allotted for another huge EHR implementation. No problem – we can help you view your data with a modern interface – without having to buy a whole other EHR. Revolutionary!

There are several other technology choices we made along the way, too – Node.js, NGINX, Angular.js are a few more. Angular.js allows us to be speedy in our development process. We can develop and build features quickly and get changes in front of clinicians for their feedback, which results in less time between product builds and releases. It means folks don’t have to wait months and months for changes they want. Angular is also web-based, which means user interfaces are modern and just like the interfaces everybody uses in their day-to-day lives. Angular.js was created by Google and there are many large companies you’ll recognize who use it to develop – PayPal, Netflix, LEGO, YouTube, to name a few.

I believe healthcare is lagging in adopting new technologies and there are a lot of excuses around why user interfaces in healthcare are generally horrible – they range from the software being written before Web 2.0 to users accepting that it is how it is and finding a way to work around their technology. The latter is probably the saddest thing I see happening in hospitals and clinics. Tech is there to make work easier, not more complicated.

There was a great quote from Dale Sanders, Executive Vice President of Product Development at Health Catalyst in MedCity News last week:

“Every C-level in healthcare has to be a bit of a technologist right now,” he said. “They need to understand this world. If you’re not aware of technology, it puts you … at a strategic disadvantage.”

I can’t emphasize how true this statement is. If you’re not paying attention to where technology is going, you’re not paying attention to where healthcare is going and you’re going to get left behind.

About Brandt Welker
Brandt is a HIT architecture and software expert. He calls Reading, Pennsylvania home. He has architected software systems and managed large IT and innovations programs at the U.S. Department of Veterans Affairs (VA) and the National Aeronautics and Space Administration (NASA). He’s also trained astronauts at the Neutral Buoyancy Lab. He’s currently the Chief Technology Officer at MedicaSoft. Brandt can be found on LinkedIn.

About MedicaSoft
MedicaSoft designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.

The First Ever “Unchat” – #HITsm Chat Topic

Posted on September 12, 2017 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 9/15 at Noon ET (9 AM PT). This week’s chat will be hosted by…

That’s right! The #HITsm chat is going rogue this week. The #HITsm chat on Friday, 9/15 at Noon ET (9 AM PT) will have no agenda, no host, and no organization. It will be an hour long #HITsm free for all where anyone can propose any topic, thought, idea, meme that they want. You can share a link, a picture, a thought, a question, or anything else you feel like sharing.

Where this will end, no one knows, but that’s what makes it so exciting! If it falls flat, we’ll blame workflow and never do it again.

This chat was inspired by @burtrosen who asked for a chat where the #HITsm community can have a chance to “blow off steam.” I loved the idea and the “unchat” was born. There are so many great people in the #HITsm community, I’m sure that some amazing conversations will happen in this chat and likely on unexpected topics. Not to mention that random conversations are a great way to inspire new relationships.

To be clear, this is a true unchat. Those that join and participate will start the topics, extend the topics, ask questions, etc. The topics don’t even have to be related to health IT. If you want to talk about your holiday vacation plans, go for it. Is there a part of healthcare IT that’s really bothering you or has you really excited, let’s hear it. If you like cats as much as Brian Eastwood, share a cat photo. If you’ve fallen in love with your healthcare chat bot and want everyone to know it, share away. Of course, this is a community, so just be respectful and appropriate the way you’d be if we were hanging out or having dinner.

Given that this is an unstructured #HITsm unchat, there won’t be any formal questions for the chat. The threads will start and extend however the community sees fit. However, we will throw out this first question to get things started and the community thinking:

T1-5: What’s on your mind? #HITsm

We hope you’ll join us for this new #HITsm Unchat. Let’s get to know each other in new and unique ways.

Upcoming #HITsm Chat Schedule
9/22 – The Impact of HIEs in Natural Disasters
Hosted by Brian Mack (@BFMack) from @GLHC_HIE

9/29 – Condition Management vs Episodic Care Management
Hosted by Brian Eastwood (@Brian_Eastwood) from @ChilmarkHIT

10/6 – After Death Data Donation – A #hITsm Halloween Horror Chat
Hosted by Regina Holliday (@ReginaHolliday), Founder of #TheWalkingGallery

10/13 – Role of Provider Engagement for Improving Data Accuracy
Hosted by @CAQH

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

The Healthcare IT Field is Unique, Yorktel Discovers

Posted on September 11, 2017 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Health care professionals love to vaunt the uniqueness of the medical industry, and tend to demand special, expensive treatment on that basis. Reformers tend to discount this special status. (For instance, the security problems in health care are identical to those in other industries, and are caused by the same factors of insufficient investment and training.) Yet telecommunications in hospitals and clinics really is special, and video giant Yorktel has spent the past five years adjusting to that reality. On September 5, Yorktel announced that it has enhanced its solutions for patient telemedicine with Univago HE that includes robust video connections, monitoring, and analytics as a service.

To learn how the company enhanced their video teleconferencing for healthcare, I recently talked to Peter McLain, Senior Vice President of Healthcare, and John Vitale, Senior Vice President of Project Management. They disassembled the various features of Univago that deal with hospital environments, which require reliable 24/7 connectivity, deal with a good deal of noise (both audible and electronic), and demand fast, faultless authorization to protect privacy.

Directional audio

The triangular table-top sets, familiar to so many of us from business teleconferencing, are omni-directional in order to facilitate use by people seated around the table. In a hospital, they pick up the whirr of carts going by, the chatter in the hallway, and the beeps and gurgles of machines in the patients’ rooms themselves. So Yorktel had to substitute directional microphones.

Camera positioning

Remote monitoring requires much more detail than talking heads in a teleconference. For instance, a remote nurse may want to check whether an IV bag is getting empty. So the person on the remote end of the video connection can direct the camera at particular points in the room and zoom in. Originally offering joystick-like controls for this purpose, Yorktel found them too confusing and cumbersome, so they created a system where a user can just double-click on her own screen to focus in on the place she indicated.

Infrared cameras

Remote monitoring takes place continuously, including when the room is dark. The staff don’t want to wake the patient while monitoring him, so Yorktel cameras support the display of scenes scanned from infrared light. A mild alert, such as a soft buzz, lets an awake patient know that he’s being monitored, without disturbing a sleeping patient.

Integration with dashboards

Yorktel software can be seamlessly integrated with other applications so that staff can see vital signs and other data while in a video call. The developers have made the systems adhere to relevant standards, including Skype, Web RTC, and H.323.

Robustness

Conventional business teleconference systems are used for a few hours each day; hospital systems are used 24/7 and must promise long mean times between failures. Yorktel addressed this on both a hardware and a software level. In hardware, they broke down large, integrated components into modules that would be easy to replace. In software, they built a custom operating system on Unix, feeling that would offer maximum reliability. They use artificial intelligence techniques to detect whether the camera has frozen (a common failure) and reboot the system before it interferes with a video session. Components can still fail, but McLain says they can be replaced within 15 minutes instead of 3 to 6 hours.

Security

Yorktel has hardened its authentication and authorization process to make sure that no one at random can dial into a system and see a patient in his bed. At the same time, they have integrated that process into mobile devices so the physician can check in from home or the road in case of an emergency.

The systems follow industry best practices, as specified by the ISO 27001 security standard and HIPAA. In order to expand into UK’s National Health Service and the European Union, Yorktel achieved Privacy Shield certification. They also get penetration testing from a third party expert, and incorporate anti-microbial technology into their systems. The systems are pending approval as Class 1 medical devices (the most reliable level of use) by the FDA.

Following security by design principles, Yorktel maintains no information for a patient. A physician finds the right room through an external service and calls that room. (If the patient wants to be called, he presses a button by the bedside, and a message is sent through some appropriate alert, such as a text message or a flashing screen.) No information on the traffic is preserved, and the call records have no personally identifying information.

Specialized services

Each department in a hospital has different needs, and Yorktel has provided specific enhancements to make their systems more useful in various settings.

For instance, family visits are an excellent use case for videoconferencing. A session can be shared with family members who can’t get in to the hospital. It can also be recorded and saved by the hospital (as mentioned earlier, Yorktel does not preserve session traffic) so it can be viewed again or brought out to prove that the hospital fulfilled its responsibility. To enable family visits, Yorktel allows the staff to designate members of the call as guests. The visitors are called “guests” because they have no control over the systems, but can see and hear what goes on during the session.

For general use in medical settings, Yorktel also allows sidebar conversations. The patient can be put on hold while physicians discuss treatment candidly and privately among themselves.

Via these enhancements targeted at hospitals and clinics, Yorktel has expanded its business in health care. It started with a common application, remote monitoring in the ICU, but expanded to telestroke care, family health, behavioral health, and translational services. They also knew that hospitals already have expensive, dedicated systems for many of these tasks, and don’t want to throw them away, especially if the outcome is to be locked in yet again to some proprietary system. Hence Yorktel’s dedication to standards.

Currently, video conferencing in the hospital is so expensive that it tends to be restricted to ICUs and a few other applications. Ultimately, Yorktel’s subscription plans should offer systems at a low enough cost that they can be deployed universally in hospitals and clinics.

What can other technology developers, outside of two-way video, learn about health care from the Yorktel experience? Most of all, go into the environments where you want your systems used and get to know the needs and workflows of the participants. Systems must be flexible, because each user is different. The systems must also be secure from the ground up, robust, and conformant to standards. Cost is also an important issue in most settings, particularly given the cuts in reimbursement that are widespread.

As it designs systems to interact along standards with other vendors, Yorktel’s strength in software has grown exponentially. This parallels trends throughout many industries, from manufacturers through retailers. Marc Andreessen famously said in 2011 that software is eating the world, and along these line, many analysts say that all companies will soon be software companies–or be drowned by their more agile competition. In this sense, we can all learn from Yorktel.

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.

DirectTrust, CHIME Deal Not All It’s Cracked Up To Be

Posted on September 7, 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.

Recently, CHIME and DirectTrust announced a deal that sounded pretty huge on the surface. In a joint press release announcing the agreement, the two organizations said they had agreed to work together “to promote the universal deployment of the Direct Trust framework and health information exchange network as the common electronic interface for health information exchange across the U.S.”

Their plans include making the Direct exchange network available anywhere they can, including hospitals, medical practices, pharmacies, labs, long-term care facilities, payers, insurers and health departments, and to top it off, on applications. If things go the way they planned, you’ll hardly be able to kick a health IT rock without finding Direct under it.

As I noted earlier this year, DirectTrust is on something of a roll. In May, it noted that the number of health information service providers who engaged in Direct exchanges grew to almost 95,000 during the first quarter of this year. That’s a 63% increase versus the same period in 2016. The group also reported that the number of trusted Direct addresses which could share PHI grew 21%, to 1.4 million, and that there were 35.6 million Direct exchange transactions during the quarter, up 76% over the same period last year.

Sounds good. But let’s not judge this in a vacuum. For example, on the same day DirectTrust released its first quarter results, the Sequoia Project kicked out a press release touting its performance. In the release, Sequoia noted that its Carequality initiative was under full steam, with more than 19,000 clinics, 800 hospitals and 250,000 providers using the Carequality Interoperability Framework to share health data.

In considering the impact of Carequality, let’s not forget that late last year it connected with rival interoperability group CommonWell Health Alliance. I don’t know if you can say that interoperability effort can corner a market– the organizations using the rival health data sharing networks probably overlap substantially—but it’s certainly an interesting development. While the two organizations were both allied with a leading EMR vendor (CommonWell with Cerner and Carequality with Epic), the agreement has effectively brought the muscle of the two EMR giants together.

I guess it’s fair to say that the Carequality alliance and DirectTrust may own interoperabililty for now, rivaled only by the stronger regional HIEs.  That’s pretty impressive, I admit. Also, it’s interesting to see an accepted health IT organization like CHIME throw its weight behind Direct. I wouldn’t have expected CHIME to dive in here.

That being said, when you get down to it, none of the groups’ capacity for sharing health data is as great as it sounds. For example, if Epic’s Care Everywhere exchange only transmits C-CDA records, you have to ask yourself if Carequality is working at a higher level. If not, we’re in “meh” territory.

Bottom line, it seems clear that these organizations are winning the battle for interoperability mindshare. Both seem to have made a fair amount of progress. But between you and me in the lamppost, let’s not get excited just yet.