HIE

Many EHR and health IT vendors have eliminated obstacles to participation, and most have made connection to the network plug-and-play, a new report says.

Hospitals and health systems using IT from CommonWell member companies will be able to bilaterally exchange patient data within their EHR workflows.

Myongji Hospital, which was established in 1987 in South Korea, has recently signed an agreement with BICube, an IT company based in Korea to co-develop a blockchain-based medical information exchange system. According to the official press release by the hospital, the main purpose of the agreement is to “build a hybrid cloud that combines public and private clouds, and to secure the safety of online medical information exchange system by combining blockchain technology in the process of exchanging medical data through the cloud.” Although blockchain technologies are commonly associated with the virtual currency-based technologies, the hospital said that this project will use medical data and store new data, as well as prevent the data from being tampered. The two parties plan to use to use a virtual private network (VPN) solution to build a security system which includes features such as physical authentication and anti-piracy, anti-tampering, data protection through device authentication, remote verification, and signature codes. Webinar: IEEE: Bringing Together Blockchain, Healthcare and Emerging Technology With the patient’s agreement to release their medical information, the hospital will also provide its data exchange service through the inter-hospital blockchain to other hospitals online. During the information exchange process, the hybrid cloud plays the role of data relay, communicating between the patient and the hospital, and takes charge of various payments but does not store any medical information. Both parties plan to commercialise the blockchain-based service by 2019. Myongji Hospital Director Kim Hyung-soo said, “When a blockchain-based medical information exchange system is commercialised, it can prevent unnecessary administrative procedures as well as ensuring safety.” Earlier in June this year, Myongji Hospital became the first hospital in South Korea to join the Mayo Clinic Care Network. Launched in 2011, the Mayo Clinic Care Network consists of more than 40 member organisations in the U.S., China, Mexico, Philippines, Saudi Arabia, Singapore and the United Arab Emirates.

Military health leaders from Australia, Singapore & the UK came together at the inaugural International Military Health IT plenary at HIMSS AsiaPac 18 in Brisbane to discuss the key challenges in their respective military health systems.

As healthcare providers worldwide strive to provide a more seamless experience to their patients through the better integration of information systems and shift from paper-based medical records to electronic medical records, the successful implementation of Health Information Exchange (HIE) projects becomes a critical part of this process. However, this is a daunting task at both local/regional and national levels, requiring collaboration from various stakeholders from a technical and policy standpoint. Jürgen Brandstätter spoke to Healthcare IT News about his experiences and insights in HIE implementation in Europe and the Middle East. "Integrating the Healthcare Enterprise" (IHE) is a global not-for-profit initiative with regional and national branches. It provides a pragmatic methodology ensuring interoperability between healthcare IT systems resulting in a body of technical and semantic specifications, which are published by IHE as Technical Framework(s). IHE Europe engages clinicians, health authorities, industry and users to improve healthcare interoperability. This is done through helping national and European stakeholders and policy-makers in adopting, promoting and implementing IHE specifications, as well as developing tools and services in support of interoperability testing. Could you tell us more about your role as vendor co-chair at IHE Europe? How has the journey been like for the past 2 years? As co-chair of IHE Europe, together with the user co-chair and the other members of the executive board, we are responsible for the management of the organization on behalf of the IHE Europe Steering Committee. The executive board is supported by chairs and directors of the different sub-committees, such as IHE Services, EU Affairs or MarCom. The IHE-Europe Connectathon provides a unique opportunity for vendors to test the interoperability of their products in a structured environment with peer vendors. Credit: IHE Europe IHE Europe is a fabulous organization and it was a pleasurable ride the past 2 years. We have conducted two Connectathons, which are growing in size by every year and we see our operative arm IHE Services getting involved in more and more national programs, consulting in architecture and strategy and covering the interoperability task by its vast experience out of the development of our testing tool Gazelle. Our relationship to the European Commission is excellent and we are involved into several European projects. All in all, I am happy to have been recently re-elected for a second term to continue my engagement to further advance IHE Europe and the IHE mission. You have been a consultant on various e-health exchange projects in Europe and the Middle East. What are some of the common challenges experienced by healthcare providers that you work with in these projects? Do you have any memorable examples or case studies? During my engagements in various Health Information Exchange projects globally it was not much surprising to see that eHealth interoperability use-cases are pretty much similar everywhere. If you examine closer Patient Identification, Clinical Document Sharing, e-Prescription, e-Immunization or other use-cases, you realize that they are similar in its core, no matter where you want to implement it - even if you consider all national specialties of the respective countries. This is actually the added-value the IHE standards initiative contributes to society, namely to cover this “common core” once-for-all on a global scale to safe costs and increase sustainability. So from a technical perspective the most common e-Health use-cases are very well worked out already and best practice and successful case-studies are available – just take a look at them here. But apart from that, also the challenges are usually overlapping, foremost the need of good and stable political governance and policy, the building of local capacity and the need of strict alignment to international standards, which can become a serious risk to the project if not considered sufficiently. One memorable example was as I engaged into the specification of the e-Prescription track of the Saudi eHealth Exchange (SeHE) project right after I accomplished the specification of e-Medication in Austria. Both countries differ so much in location, culture and the way how medications are prescribed, but in the end the course of the workshops with the doctors as well as the final specifications were so much similar. It was amazing. In terms of experience with Health Information Exchange (HIE) systems, you have been a vendor, created profiles and oversaw organizational development, which is certainly invaluable as you understand the different roles and requirements at different levels of HIE systems implementation. How do you think stakeholders at the different levels can work together towards implementing an effective HIE system? From my perspective, the success of a HIE project is mostly depending on its degree of acceptance in the short term and sustainability in the long term. So it is essential that the stakeholders of a HIE system do proper local capacity building and then seek out for international case-studies and standards to see if their intended eHealth use-case is already covered by the standardization community. Look around what works and communicate with others, before you make up your own plans. There are plenty of global initiatives out there, which could serve as a platform for such communication, as for example the recently founded “Global Digital Health Partnership” to foster this for example on government level. Also, the stakeholders should get in contact and engage with the standards community. Sustainability requires leveraging international standards and the standards community is open and ready to collaborate. Most likely the standards and even standard-compliant software ready-to-buy for the use-case is already in place, but even if not, it’s cheaper to invest into creating the required standard at this occasion rather than inventing on your own. Interoperability is one of the key priorities in the implementation of HIE systems. What are your thoughts on achieving true interoperability across different HIE systems? From my perspective, it’s important that interoperability is challenged on a global scale and in the form of actually tested systems rather than standards on paper. The IHE standards initiative, with its profiling and attached testing activities (Connectathon, Conformity Assessment), is filling exactly this gap and is covering the last mile from the base standards (HL7 CDA, FHIR, DICOM, SNOMED, …) to “real” interoperable systems, which are ready to be bought off the shelf. Today’s question is not “how” you can do it, today’s question is how you can do it in the “most sustainable and cost effective” way! What are some current notable trends or technologies that you observe in the development of HIE systems? Due to the speed and energy the FHIR development has brought to the standards and developer community, FHIR has clearly become a notable trend and there is clearly to see the attempt to leverage this standard for all kinds of HIE interoperability problems. From IHE perspective, FHIR is a great new standard, which is very suitable to a variety of interoperability use-cases, especially in the area of mHealth and we our current profiling work is strongly considering this new technology. However it shall not be forgotten that other existing standards are still in place perfectly working for the use-cases they have been created for, so we recommend to look to the future but be careful to not let any trend overcome meaningful usage of what’s already existing (this also applies to “blockchain”, another current trend). Also, the FHIR standard is still under development and requires profiling work on global scale to be fully optimal useable. This refers back to question 3, where it needs collaboration between stakeholders and the standards-community on global scale to level up the usage of FHIR from “locally created FHIR Implementation Guides” to globally used “FHIR based IHE profiles”. To tackle this profiling work, the “Gemini” project, a Joint Venture of IHE and HL7 to Advance Use of FHIR for Interoperability, has been formed to enable and foster the “joint” development of such FHIR based IHE profiles. I am honored to serve on the Gemini Steering Committee to drive forward this initiative. What do you think are some key lessons that healthcare providers in Asia Pacific can learn from based on Europe’s experience and journey in HIE systems implementation? Europe has done some substantial ground work in exploring the possibilities of national eHealth Information Exchange projects, especially when it comes to cross-border exchange of information between member states. But there are also very interesting case-studies in certain countries which are worth being looked at from an architectural/technical point of view, but also from a strategic/governance perspective. One key lesson is certainly that a standards-based and collaborative approach is always more sustainable in the end as doing an own development, which seems to be cheaper on the first view. In the meanwhile European member states are very much used to collaborate with their neighbors and know about this importance. Another key lesson is that vendor-independence is crucial for success, if the size of the project exceeds certain boundaries. That again points to the importance of international standards, which need to be profiled to lead into interoperable, standards-based, exchangeable products on the market which ideally you can buy off-the-shelf. This profiling is the part IHE is taking care of. Jürgen Brandstätter is a keynote speaker (Connect Track) at HIMSS AsiaPac 18 in Brisbane this November. To learn more about this event, click here. He will also be speaking at the IHE AsiaPac Summit happening on 5 November 2018.

This case study looks at a health information network that has gone from zero uniquely identified patients to 7.6 million – and nearly all major health systems statewide are set to participate in its Common Key Service.

The Indiana Health Information Exchange needed to gather more complete and accurate data to reduce unnecessary tests, replace retrospective chart reviews and better manage contract alignment for its customers.

CommonWell Executive Director Jitin Asnaani says they are on track to make this generally available this summer.

Adopting application programming interfaces enables health information exchanges such as CRISP to more effectively deliver data to hospital and payer members.

Health Catalyst announced a new surveillance module for its Patient Safety Monitor suite that aims to help hospitals protect patient safety by deploying predictive analytics to monitor, predict and prevent inpatient risk. Built atop the Health Catalyst Data Operating System, the new module was developed over two years of intensive and expensive research – nearly $50 million, the company said. It's a trigger-based surveillance system, incorporating predictive algorithms and artificial intelligence, that can spot patterns of harm and offer decision support to address potential hazards. By combining text analytics and near real-time data from multiple sources, the technology can detect safety risk for inpatients. Health Catalyst noted that the standard approach of manual reporting of hospital safety events, often using data that is at least 30 days old, reportedly finds less than 5 percent of all-cause harm. Meanwhile many electronic health records and data warehouses have drawbacks of their own, missing the AI capabilities that could enable wider surveillance. Many hospitals, therefore, are limited in their approach to patient safety, using point solutions focused on specific risks, rather than whole-person safety. As part of its patient safety efforts, Health Catalyst has applied for certification as a Patient Safety Organization with the Agency for Healthcare Research and Quality. If approved, the Health Catalyst PSO will offer an environment where hospital clients can collect and analyze patient safety events from their EHRs to learn and improve, the company said. The surveillance technology release comes on the heels of Health Catalyst completing the acquisition of Medicity from Aetna to expand its footprint in the outpatient space and combine analytics with HIE. The merger adds Medicitiy's 75 health system clients, with more than 1,000 hospitals and 185,000-plus physicians, in addition to nearly two-dozen HIEs as well as payers and employers. In an interview, Health Catalyst CEO Dan Burton said the company will leverage Medicity’s data sets and transactional capabilities to complement its own analytics tools and help its clients maker smarter, data-driven decisions to enable value-based care. "We've amassed a big data set focused more on the acute care setting, which is were we grew up, whereas Medicity has strong transactional capabilities that are really a complement to our analytics space capabilities, and they're more ambulatory focused," Burton said. By adding Medicity's technology, Health Catalyst expands its reach beyond its existing client base of 400 hospitals and 4,000 ambulatory sites, bringing real-time analytics right to the workflow inpatient and outpatient EHRs, he said. "Clinically integrated networks and others have rightly noted a gap in Health Catalyst's experience set with real-time transactional capabilities," said Burton. "Offering that data exchange capability, in-depth, is not something we've had a great answer for." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com