Categories

Tag: Interoperability

Defining Interoperability: An Interview with Grahame Grieve

flying cadeuciiGrahame Grieve is a long-time leader within HL7 and one of the key drivers behind FHIR. He chats with Leonard Kish about what’s been happening and what’s ahead for interoperability.

LK: First tell me how you got into standards… it’s kind of an odd business to get into.  Why have you chosen this and why are you excited about it?

G: It happened by accident.  I was working for a vendor and we were tasked with getting some exchanges and I wanted them to be right the first time.  That was the philosophy of the vendor.  If we did it right the first time, then we wouldn’t have to keep revisiting and that meant that using the standards correctly.  The more I got involved, the more I discovered that it wasn’t obvious how to do that…and that the standards themselves weren’t good.  I felt personally that we need really good standards in healthcare.  So it became a personal mission and I got more involved through the company I was working for and eventually I left so I could continue doing what I wanted doing with the standards – I enjoy the community aspect of the standards and feel very strongly that it’s worth investing time in and I had the opportunity to build a business out of it, which not many people do. So now I freelance in standards development and standards implementation.

LK: There’s a lot of talk in Congress about the lack of interoperability and everyone probably has their own definition. Do you have a working definition of interoperability or is there a good definition you like for interoperability?

G: The IEEE definition to get data from one place to another and use it correctly is pretty widely used.  I guess when you’re living and breathing interoperability you’re kind of beyond asking about definitions.

LK: Are there ways to measure it then?  Some people talk about different levels; data interoperability, functional interoperability, semantic interoperability.  Are there different levels and are there different ways to measure interoperability?

G: We don’t have really have enough metrics.  It’s actually relatively easy to move data around.  What you’ve got to do is consider the costs of moving it, the fragility of the solution, and whether the solution meets the user’s needs around appropriateness, availability, security, and consent.  Given the complexity of healthcare and business policy, it’s pretty hard to get a handle on those things.  One thing that is key is that interoperability of data is neither here nor there in the end because if providers continue with their current work practices, the availability of data is basically irrelevant, because they treat themselves as an island. They don’t know how depend on each other.  So I think the big open area is clinical interoperability.

LK: Interoperability in other verticals mostly works.  We hear talk about Silicon Valley and open APIs.  There’s perhaps less commotion about standards, maybe because there are less conflicting business interests than in healthcare.  Why is healthcare different?

G: First of all – from an international perspective, I don’t think other countries are by and large better off or different (where incentives are different).  They all have the same issues and even though they don’t have the business competition or the funding insanity that you do in the US, they still have the same fundamental problems.  So I hear a lot of stuff from the US media about that and I think it’s overblown.  The problem is more around micro level transactions and motivations for them and fundamentally the same problem around getting people to provide integrated clinical care when the system works against them doing that.                  

LK:  So can you give me an example of how things are maybe the same with NHS or another country vs. the US in terms of people not wanting to exchange clinical data?

G: In Australia, there’s a properly funded medical health care system where the system is overwhelmed by the volume of work to be provided.  No one get’s any business benefit from not sharing content with other people. Still, because you have to invest time up ahead to exchange data and other people get the benefits later, there’s very low participation rates for any kind of voluntary data sharing schemes that you set up. There’s scandalously low adoption rates.  And that’s not because it’s not a good business idea to get involved but it’s because the incentives are misaligned at the individual level (and the costs are up front).

LK: Right, so it’s maybe it’s also a lack of consumer drive?  It’s there data and you’d expect the incentives to align behind them, but they don’t ask and don’t get, maybe because we (or our providers) only access your record when we really need them.  It’s not like banking or email or other things we use on a daily basis?    

G: Probably that’s part of it, but from a consumer’s point of view, what does it do for them getting access to their data?  Continue reading…

ONC’s Interoperability Plan: a Day Late and $19bn Short

Screen Shot 2015-10-21 at 8.40.34 AMEarlier this month, the Office of the National Coordinator for Health Information Technology released an update to Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap. The roadmap was first announced back in January, and the changes shared this month aren’t significant.

Ultimately, it calls for all healthcare providers nationwide to be able to send and receive electronic clinical information by the end of 2017.

This is a good plan on the surface, although it comes six years and millions of dollars late, and like other programs it may be more cumbersome that it first seems. Essentially, there are three facets:

1) Data standards to format and request/receive data

2) Incentives (again!)

3) Governance

Despite the intention to move data across the Union, each state will have the right to create its own unique rules on how to manage the exchange of information. This is a problem as we have seen before in the simple Case of e-prescription routing. A few states make it almost impossible to send e-scripts and layer on their own special form of bureaucracy. This inhibits the ultimate goal of reducing costs and errors and increasing Efficiency at the expense of both providers and patients.

Continue reading…

ONC Report on Health Information Blocking: A Solid Double, But NOT a Home Run

flying cadeuciiLast Friday ONC (the Office of the National Coordinator for Health IT) released a long-awaited Report On Health Information Blocking. The ONC blog capsulizes the report:

Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Our report examines the known extent of information blocking, provides criteria for identifying and distinguishing it from other barriers to interoperability, and describes steps the federal government and the private sector can take to deter this conduct.

We were struck with two major reactions to the ONC Info Blocking Report:

  • It’s a solid double: it does a credible job of recognizing that the major problems of interoperability and blocking are not technical or due to a lack of standards, but rather due to business practices and business models. The report also proposes a baseline of potential solutions.
  • It’s not a home run: the report misses the opportunity to describe a comprehensive approach to combat information blocking.Continue reading…

The Blocking of Health Information Undermines Interoperability and Delivery Reform

The secure, appropriate, and efficient sharing of electronic health information is the foundation of an interoperable learning health system—one that uses information and technology to deliver better care, spend health dollars more wisely, and advance the health of everyone.

Today we delivered a new Report to Congress on Health Information Blocking that examines allegations that some health care providers and health IT developers are engaging in “information blocking”—a practice that frustrates this national information sharing goal.

Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Our report examines the known extent of information blocking, provides criteria for identifying and distinguishing it from other barriers to interoperability, and describes steps the federal government and the private sector can take to deter this conduct.

This report is important and comes at a crucial time in the evolution of our nation’s health IT infrastructure. We recently released the Federal Health IT Strategic Plan 2015 – 2020 and the Draft Shared Nationwide Interoperability Roadmap. These documents describe challenges to achieving an interoperable learning health system and chart a course towards unlocking electronic health information so that it flows where and when it matters most for individual consumers, health care providers, and the public health community.

Continue reading…

Why the Market Can’t Solve the EHR Interoperability Problem

Screen Shot 2015-04-06 at 7.20.19 PMNiam Yarhagi’s  THCB piece, Congress Can’t Solve the EHR Interoperability Problem (March 21, 2015) raises excellent points with which I mainly agree.  So why write a responding blog?  Because I don’t agree with his solution.

To review:  Dr. Yarhagi discusses a draft congressional bill that calls for the creation of a “Charter Organization” that “shall consist of one member from each of the standard development organizations accredited by the American National Standards Institute and representatives that include healthcare providers, EHR vendors, and health insurers.”

Four agreements:   I agree with Dr. Yarhagi’s conclusion that the proposed charter organization will not succeed; I agree with his prediction that it won’t be able to develop useful interoperability measures (hint: these are the same vendors that have refused to cooperate for the past 30 years); I agree that the ONC or CMS will not decertify an EHR vendor that has over 50% of all American patients and providers; and I agree that there are some medical providers who intentionally refuse to share patient information (because they think it gives them a competitive advantage over their local rivals).

One disagreement:  But I disagree strongly with Dr. Yarhagi’s faith in the market to ensure that healthcare information technology (HIT) vendors will be obliged to “develop sustainable revenue stream through reasonable exchange fees negotiated with the medical providers.”  That is, he asserts that if there were a real market without federal subsidies and requirements that all healthcare providers buy the HIT,  then providers and the HIT vendors would agree on reasonable fees for exchanging patient records.Continue reading…

Precision Medicine’s First Real Patient: The National Health IT System

Niam YaraghiIn his 2015 State of the Union address President Obama announced the launch of his precision medicine initiative, an audacious initiative to address these issues. In a nutshell, precision medicine customizes health care; That is, medical decisions are tailored based on the individual characteristics of the patients, ranging from their genes to their lifestyle. To have a clear understanding of the relationship between individual characteristics of patients and medical outcomes, it is necessary to collect various types of data from a large population of individuals. The precision medicine initiative requires a longitudinal cohort of one million individuals to provide researchers with various data types including DNA, behavioral data, and electronic health records. Assembling such a large sample of many different data types proposes two unique challenges pertaining to healthcare information technology: interoperability and privacy.

The federal government has already spent $28 billion to incent medical providers to adopt electronic health record (EHR) systems. As a result, almost all of the medical providers in the United States currently compile an electronic archive of their patients’ medical records. However, most of the EHR systems are not able to exchange information with each other. This is a strange problem in the age of information technology and Internet connectivity. There are a variety of technical and economic reasons, which make it especially complicated and difficult to solve.

Given the current lack of interoperability between EHR systems, it seems highly unlikely to be able to obtain a complete medical history of one million Americans. To succeed, the precision medicine initiative has to either overcome the lack of interoperability problem in the nation’s health IT system or to find a way around it. Congress members in both the House and Senate are considering new rules that would stop EHR vendors from interfering with medical providers that had already started transferring records. These efforts are fraught with difficulty and will take a very long time to produce tangible results.Continue reading…

Spring Deliveries from Washington

Screen Shot 2015-03-22 at 9.22.36 PMIt may have been a quiet week in Lake Wobegon, but not in Washington DC.  Last week, we saw the introduction of two congressional bills here (SGR fix) and here (EHR interoperability) and two proposed rules from HHS (one from CMS and one from ONC) – all of which would have substantive impact on health care in the US, and the role of information technology in how health is optimized and care is delivered.  While the iron’s still hot, let’s take a 30,000-foot view at all of this.   I’ll follow up later in the week with a more detailed overview of the ONC and CMS proposed rules with a bit more of an editorial voice on the SGR fix and Burgess’ interoperability bill.

  1. The first document to land – way back on March 10th – was the bill from Representative Burgess.

Some context: he’s a physician.  He understands the physician perspective – and is – like many physicians – confused by the paradox that several years and $20B after the passage of HITECH – we don’t have plug-and-play interoperability between health IT systems yet.  He might be asking: “isn’t this what was supposed to happen by now?”  Compelled by his training as a physician and (as my wife would argue) a human with a Y chromosome, Rep Burgess sees a problem and wants to fix it – hence this legislation.  HHS didn’t fix this?  Industry didn’t fix it?  Well, then, let’s see if Congress can fix it!  What’s the approach?

  1. The bill attempts to redefine interoperability as:

“open access”

“complete access”

and

“does not block access.”

Continue reading…

HIT Newser: The Judy Faulkner Foundation or Whatever We’re Calling It

Screen Shot 2015-03-19 at 6.29.02 AM

Epic’s Faulkner Shares Charitable Foundation Plans

In an interview with Modern Healthcare, Epic founder/CEO Judith Faulkner reveals that she will leave much of her wealth to a specially created charitable foundation that will operate and fund not-for-profit organizations in healthcare and other areas. The 71-year-old Faulkner says that almost all her shares of Epic stock will go to the foundation upon her death, or sooner if she chooses.

The plan is also designed to keep Epic private. “My stock will go to the foundation,” Faulkner said. “The foundation will control the stock. This plan is designed to preserve the company as a private company forever.”

Faulkner, who has an estimated worth of $2.8 billion, says she never wanted the money personally or for her family and wonders, “What would you want with all that money? It doesn’t seem right and I can’t tell you why.”

What’s not to like about Faulkner’s values or her plan?

Continue reading…

Grading the Federal Health IT Strategic Plan

Optimized-SalwitzIt is a heart pounding, head spinning, edge of your seat page-turner; the sort of rare saga that takes your breath away as it changes you, forever.  It hints at a radically different future, a completely new world a few years away, which will disrupt the lives of every man, woman and child.  Available now, from the National Coordinator for Health Information Technology (ONC), Office of the Secretary, United States Department of Health and Human Services, is finally, without further ado; the Federal Health IT Strategic Plan 2015 – 2020.

You think I am kidding.  A satirical dig at another monstrous, useless, governmental report?  Absolutely not.  The concepts outlined in this blueprint will transform healthcare.  It is a tight, clear, document, which at only 28 pages, delivers almost as much change per word as the Declaration of Independence.  This may be the most powerful application yet of computerized information technology.

If you want to know where healthcare and health IT are headed, The Plan is absolutely worth a read.

I have only one complaint; it is coated with too much sugar.  Restricted by policy structure and jargon, the report does not go far enough.

Continue reading…

CVS Caremark Enters CommonWell

One of the most critical issues facing our healthcare system is the fact that the IT systems we’ve put in place have not yet led to a more connected, intelligent approach to patient care.

While we have made notable headway toward interoperability through health information exchange solutions, we must dramatically accelerate our progress to support the transition to value-based care and realize our full potential as an industry.

With this vision in mind, McKesson, Cerner and other leading healthcare IT companies announced the CommonWell Health Alliance last year at HIMSS13. Members of the Alliance are united by a shared commitment to develop a core set of interoperability services and standards that will enable patient data to be shared securely across care settings and electronic health record (EHR) platforms.

In the twelve months since, tremendous progress has been made in making this aspiration a reality. CommonWell is running robust initial projects and collaborating with a myriad of practices. We’re also continuing to expand with new members who share our ideal of the trusted exchange of patient data, regardless of vendor, system, or setting.

Now, the Alliance is welcoming its first pharmacy member in CVS Caremark. This is a watershed event for several reasons.

CVS Caremark is one of the nation’s largest retail pharmacy chains and pharmacy benefit management companies. Few organizations in any segment of healthcare have more access to patient data and more trusted influence.

But CVS Caremark’s role in driving innovation in our healthcare system, and its importance to the goal of interoperability, is vital for other reasons.

Continue reading…

Registration

Forgotten Password?