Interoperability

The cooperative aims to bring stakeholders together to find new and pragmatic approaches to data sharing, and come up with ways to combat information blocking.

Bettina Experton, MD, and CEO of Humetrix, talks about the history of CMS’s Blue Button project and how 53 million Americans covered by Medicare will now have access to their data through an API to ensure patient safety and interoperability.

HITRUST launched a security program to help start-up companies bolster their privacy and security foundations, including the adoption of the most comprehensive risk management, compliance and security services. WHY IT MATTERS The goal is to support startups in adopting best practices as they grow. HITRUST is working closely with those small businesses to ensure these security features are baked into their products from the beginning. To accomplish this, HITRUST is bundling and pricing its programs to align with small businesses that have been in business for less than three years, have fewer than 50 employees and less than $10 million in annual revenue. The program will streamline HITRUST adoption. ON THE RECORD “Navigating risk management and compliance requirements can be costly and a strain on internal resources and can be daunting for any company, but it can be compounded in start-ups that are focusing on bringing their vision to market,” Mike Parisi, HITRUST’s vice president of assurance strategy and community development, said in a statement. THE TREND HITRUST was formed in 2007 and is seen as one of the industry’s gold standards for security. In May, it launched a certification program for the NIST Cybersecurity Framework for hospitals and health systems to ensure security compliance. The RightStart Program will ensure these startups embed these security standards into “their evolving business models,” Parisi added. HITRUST officials stressed that often these types of security measures are seen as a barrier to adoption. And as a result, companies will add programs in an ad hoc way, which leads to a loss of time and money, without a guaranteed improved risk posture. To Hoala Greevy, Paubox CEO, the hope is that the program will give the company the ability to adopt a security framework that will scale with the organization. “HITRUST provides us with the tools for secure, compliant growth needed to increase our bottom line,” Greevy said in a statement. “Our customer focus demands we have security, compliance, and risk management in place by design and not as an afterthought.” .jumbotron{ background-image: url("http://www.healthcareitnews.com/sites/default/files/u2231/cybersecurity-jumbotron-712.jpg"); background-size: cover; color: white; } .jumbotron h2{ color: white; } Focus on Cybersecurity In October, we take a deep dive into security strategy and pressing threats. Twitter: @JF_Davis_ Email the writer: jessica.davis@himssmedia.com

A researcher discovered the North Carolina-based tech vendor is leaking protected patient data through its Amazon S3 bucket twice in a month.

A hacker obtained access to an employee email account of California-based Gold Coast Health Plan, attempting to fraudulently move funds to their account.

With a proverbial flip of the switch at three locations in Florida and Arizona, Mayo Clinic has completed its $1.5 billion Epic electronic health record implementation, linking all Mayo sites on an integrated EHR and revenue cycle management system. WHY IT MATTERS The Mayo Clinic rollout, called the Plummer Project, in honor of Henry Plummer, MD, who developed a patient-centered health record at Mayo in 1907, is one of the largest, most complex and most expensive Epic implementations ever. First announced in early 2015, the initiative, which sought to replace the health system's existing Cerner and GE systems, had been under consideration for years, said Mayo Clinic CIO Cris Ross. "We really believe that an integrated EHR, across all of our organizations, can help us with that core mission of meeting patients' needs," he told Healthcare IT News at the time. Ross predicted then that rollout would take "about four years to complete." Given that the first two-dozen sites went live in Juy 2017, it's coming in ahead of schedule. There were several milestones along the way, notably go-lives at Mayo Clinic Health System in in November 2017 and Mayo Clinic in Rochester this past May. All told, the project depended on the expertise of nearly 500 IT staff. Now, some 52,000 Mayo employees are using Epic across 90 hospitals and clinics in the Minnesota, Florida and Arizona. "The project is highly complex due to the number of specialties and subspecialties involved," said Ross in another interview earlier this year. "We are not only focused on building and delivering a converged technical solution. We are also invested in the people side of change to support them in adopting, utilizing, and becoming proficient in the Epic system. This is being accomplished through a comprehensive change management strategy." WHAT IS THE TREND Mayo Clinic says the complexity and expense of the project were worthwhile investment for a single unified system that connects patients and providers across the health system, enabling easier access to clinical and billing information regardless of location. More and more, large U.S. health systems such as Mayo are gravitating toward either Epic and Cerner, and the same trend is now also playing out overseas. Other major Epic deals this year include Chicago-based Advocate Health Care and Trinity Health in Michigan. ON THE RECORD "Having one integrated system builds on our core mission of putting the needs of patients first,” says Steve Peters, MD, co-chair of the Plummer Project, in a statement. "This will enable us to enhance services, accelerate innovation and provide better care." "The commitment and expertise of outstanding Mayo staff, Epic colleagues and implementation partners brought us to this day," added co-chair Richard Gray, MD. "We envision even greater collaboration among experts in delivering the patient care, research and education that are hallmarks of Mayo." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

For National Health IT Week 2018, HIMSS Analytics delivered new research exploring some key trends, looking closely at established software infrastructure and emerging technologies alike. "What we're seeing as far as a state of the market is acceleration beyond the EMR," said Blain Newton, executive vice president of HIMSS Analytics. "We're seeing it manifest in a few different ways." Those post-EHR technologies and trends include blockchain, cloud computing, security, precision medicine, supply chain, telehealth and, of course, network infrastructure. Electronic health records. EHRs are a key piece of the health IT infrastructure and the market segment is very mature with near universal adoption, according to HIMSS Analytics data – but only 2 percent of hospitals have a single vendor enterprise EHR. Instead, the average system has 15 vendors across its affiliates — making the next issue a complex mess. "We're seeing migration past the EMR as a foundation as well as retrofitting how we create scale and secure infrastructure," Newton said. Interoperability. With mega-mergers such as Dignity and CHI and CVS Health and Aetna – as well as Amazon's partnership with JPMorgan Chase and Berkshire Hathaway – significant challenges are arising amid the hodgepodge of EHR vendors. "Creating a secure environment where interoperability can happen is not a challenge of desire," said Newton. "It's very technical." Telehealth. Whereas the U.S. has surpassed a 50 percent adoption rate for telehealth capabilities, the average hospital has upwards of five different products installed, meaning it has yet to widely reach enterprise-level deployments. The surprise HIMSS Analytics found in its data is that the highest adoption levels for telemedicine tools are among non-profit hospitals with 100 beds or fewer. "For a technology that the ROI is not yet entirely clear, you're seeing nonprofits with a very significant lead in adoption, presumably to reach out to rural populations," said Newton. "Either way, it's an unexpected view, we thought it would be large hospitals." When asked whether they plan to invest in telehealth in the next two years, 27 percent said yes, 18 percent said no and 55 percent said they weren't sure. Precision medicine. In contrast to EHRs' near-ubiquity and telehealth on the rise, precision medicine adoption today is limited. The top three reasons are a lack of funds, technologies, and the clinical expertise necessary to undertake such programs. That said, 45 percent of respondents to HIMSS Analytics research said they plan to expand precision medicine work, while 23 percent do not and 32 percent are unsure. Security. This should come as no surprise, but Newton said that "healthcare is absolutely a target," for nefarious attacks as 29 percent of breaches last year hit healthcare, a higher rate than any other industry. "Twelve percent of hospitals do not have basic IT security systems," Newton said. "That's a bit frightening because whether you're the Mayo Clinic or a rural provider in South Dakota, you're a target." Protecting health data is one of the reasons more hospitals are looking to the cloud. But it's not the only one. Cloud computing. Sixty-five percent of hospitals currently use cloud services in some capacity, and Newton said that it's expected the majority of EMRs will be cloud-based by 2020. Among the reasons healthcare organizations move to the cloud: 37 percent said it's for disaster recovery, while 25 percent said the cloud lowers current IT maintenance costs, another 25 percent answered that it'd sue to a lack of on-site IT staff or expertise and 13 percent do so to meet the need for a scalable always-on app or service. "There's a significant component just looking at baseline IT costs, regardless of the motivator, the cloud is coming, on-premise is a thing of the past," he said. "It has really shifted wholesale here because of efficiencies and levels of service. I would expect this to continue increasing."  Blockchain. Blockchain is still in the hype stage, to be certain, though it also appears that some early days type of activities are happening with 50 percent of health org's either investigating or building a business case around Blockchain, and doing so with plans to run a proof of concept in the next 24 months. But payers, pharma and tech vendors are moving more quickly than healthcare providers, which may be hanging back to let the others figure it out first. Non-providers, in fact, are twice as likely as providers to conduct a proof of concept or pilot in the next two years. Patient-generated health data. This was another surprising finding. "Organization said they are at least moderately prepared for consumer-generated data," said Newton. While more than 80 percent of patients are already expecting to see data in their record, in fact, 67 percent of hospitals are looking to invest. Just don't expect it to happen quickly. "When we talk to CIOs, they flat out said this is an issue of data governance," he explained. "We don't believe we have adequate governance in place to manage consumer generated data." Supply chain. Acknowledging that a better name for supply chain in this context might be utilization management and resource stewardship, Newton described it as "one of the biggest things we see happening." Four of the top 10 predictive technologies are supply chain management related and hospitals should proactively invest in clinical infrastructure for tools that alert clinicians to risk or enable traceability that helps determine which products or people are safest and most cost-effective, as well as technology to enable learning systems. "I see this as becoming something significant over the next 18 months or so and becoming much more enterprise focused as folks look to drive down costs and improve care," he added. "We see this as a powerful new capability that organizations are looking to go after." What it all means Broadly speaking, the state of HIT today is a digitized system now in place and a renewed investment in infrastructure to harness that and drive emerging trends such as predictive analytics, patient engagement and population health on the road to value-based care.   Some of it is being done on the EHR foundation while other work is more about retrofitting older technologies to create secure infrastructure scale that accordingly.   "People are looking up and saying the infrastructure we put in place 10 years ago isn't robust enough today," Newton said. "It's a mix of true innovation and securing things built to support a tech stack from a few years ago." Twitter: @SullyHIT Email the writer: tom.sullivan@himssmedia.com

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 shows how care coordination software is helping Children's National Health System disseminate key discharge documents to the right subacute providers.

Security experts share insights about crafting lessons learned plans to obtain more resources — and one critical mistake to avoid.