Interoperability

The innovation grants for state and regional health information exchanges will help them innovate their data sharing capabilities during public health emergencies – from pandemics to wildfires.

HIMSS Media are expanding their Europe/UK editions to encompass MEA, with Healthcare IT News and MobiHealthNews now including a more comprehensive and inclusive Europe, Middle East and Africa (EMEA) edition.

Kuwait’s 2035 vision aims to strengthen investment in high quality healthcare which has already led to increased efficiency, use of innovative technology and a changing culture. 

Chesapeake Regional Information System, MedStar Health Research Institute and other LEAP in Health IT awardees will launch new projects focused on use of FHIR and other exchange specs across a variety of use cases.

Researchers at UCSF describe the emergence of a new field dedicated to better integrating and supporting the clinical use of social determinants of health data.

UK charity, the Health Foundation has called for greater transparency around the COVID-19 contact tracing app, which is set to be launched across England and Wales tomorrow. It has raised concerns that the government has not revealed results of recent trials, which took place in the Isle of Wight and the London Borough of Newham. The original NHSX app, which was designed to collect data in a centralised database, was abandoned after privacy concerns and a poor success rate in tracking proximity to other devices. A redesigned version, which uses Google and Apple’s technology, works via Bluetooth to detect other smartphones nearby without using location data or sharing personal information.  Features of the new app include allowing users to scan QR codes to register visits to hospitality venues, check and report symptoms, book testing, find out test results and check local risk levels. But the Health Foundation says that in order to build public confidence and encourage people to use the app, there must be evidence that it is effective and ready for mass roll-out.  Meanwhile, according to the Associated Press, contact tracing apps in Europe have not been widely used due to privacy concerns, technical problems and lack of interest from the public. WHY IT MATTERS  Latest NHS test and trace figures reveal that 18,371 new people tested positive for COVID-19 in England between 3 September and 9 September, a substantial increase of 167% compared to the end of August.  The Health Foundation fears that existing health inequalities could be exacerbated by the app, leaving some demographics at more risk of infection. Ipsos MORI polling carried out on behalf of the charity found that participants from a black and minority ethnic (BME) background, women, the youngest and oldest age groups, routine and skilled manual workers, and the unemployed, had lower awareness about the app. THE LARGER CONTEXT  Figures from a Public Accounts Committee hearing about digitisation in the NHS, revealed that the new app is forecast to cost around £25 million, while a further £4 million was spent on the abandoned first app. In total nearly £40m will be spent this financial year on developing the app, according to figures reported in HSJ. Meanwhile, Scotland recently launched its contact tracing app called Protect Scotland, which has been downloaded by more than 600,000 people. ON THE RECORD  Josh Keith, a senior fellow at the Health Foundation, said: “For any major, nation-wide public health intervention it is important the government publishes evidence that it is effective and ready for mass roll-out in advance of its launch. “This is key for building confidence in the app as people will want to know that it will benefit them and their communities. But any data on the pilots that took place in August have been notably absent, leaving major questions over the app’s effectiveness unanswered.”

The solution, which will be implemented across all of Medcare’s hospitals and clinics in Dubai and Sharjah, is owned by US technology company, InterSystems.

The clinical manifestations of COVID-19 are varied, and patients are known to have rapidly changing signs and symptoms that must be tracked with laboratory testing. A patient may start his treatment journey with his primary care physician and will include lab centers, diagnostic centers, inpatient, and home quarantine centers.  It is crucial for the respective laboratory information or electronic health record systems to share the lab tests and diagnostic information with each other. Communicating the lab orders and results across multiple care settings and with treating physicians, quickly and effectively, is the need of the hour.   A patient encounter creates observational data such as vital signs, symptoms, diagnoses, and diagnostic information, along with prescription details. The observational data findings, and laboratory and diagnostic information, along with medical knowledge and clinical guidelines, forms part of a clinical database. The data here can be turned into information only when systems use the right terminology standards.  Terminologies are the heart and soul of a system  Terminology services help two health systems talk to each other and make the information stored within them, useful to both patients and practitioners across the care journey. Terminologies are the language in which computer systems can communicate physicians’ notes and observations with each other.  The HL7 2.x or FHIR API standards are the messengers that help deliver the language (read information) from one system to another. A simple example is the way different clinicians would write COVID-19 (is it COVID-19 or COVID 19 or just COVID?). As is always said, technology must adapt to its end users, and for a software to quickly understand and transmit information across systems terminologies packaged within HL7 2.x or FHIR standards are used. Laboratory testing is one of the significant parameters to track a pandemic like COVID. Public health management of the COVID-19 response needs complete laboratory testing data, including standardized test results and demographic details for contact tracing, mitigation, and control of the spread of the disease. One of the critical roles of technology is the usage of standard terminologies used by clinicians and laboratories while communicating patient information across different care settings and specialties. Two of the terminology standards used:  LOINC codes are used for the orders placed or the question that is asked of a viral test specimen, e.g. SARS-Coronavirus-2 RNA [Presence] in respiratory specimen by NAA with probe detection. The SNOMED-CT codes are used for the results or diagnostic answers, e.g. positive, negative, invalid, or specimen is unsatisfactory for evaluation. Specimen types, e.g., the serum, plasma, and nasopharyngeal swabs, are coded with SNOMED CT. The CARES Act mandates the use of de-identified data elements that must be reported for each test to the public health authorities, and these are available on the HHS site. The Regenstrief Institute has released new LOINC codes in the wake of the pandemic.  To increase semantic interoperability for laboratory reporting for detection of SARS-Coronavirus-2, the FDA, CDC, IICC, the Regenstrief Institute, and the Association of Public Health Laboratories (APHL) have developed a LOINC map for all SARS-Coronavirus-2 diagnostic tests listed on FDA Emergency Use Authorizations.  The CDC and FDA maintain the mapping of all the currently approved SARS-Coronavirus-2 in vitro diagnostic labs and their corresponding specimen types and results under the stewardship of the Office of the National Coordinator (ONC).  The ‘Observation’ resource in HL7 FHIR Real-world concepts in the healthcare system are linked together by FHIR packages called Resources. A Resource in FHIR is an entity with a URL by which it can be addressed and contains a set of structured data items as defined in the resource.  The ‘Observation’ resource in FHIR includes elements where the different components of terminology, i.e., the code, its description, values, units, and interpretation of the result, are contained within a resource or message. Systems transmit this resource or message to exchange information. Each resource includes elements where the terminologies and clinical concepts are included. This package, when exchanged across healthcare systems, helps to create interoperable information for the consumption of clinicians associated with the management of the patient. The FHIR framework includes four elements that have clinical terminologies: System: This is the URL that identifies the coding system. E.g. (www.loinc.org, http://snomed.org/) Version: The current version of the coding standard. E.g., LOINC V 2.68, SNOMED September 2019 Release Code: This is a unique identifier for the concept as defined by the code system Display: A description of the concept as defined by the code system Typically for lab tests, the ‘Observation’ resource within FHIR is used to convey the orders and results relevant to laboratory tests. The ‘Code’ and the ‘Display’ elements within the ‘Observation’ resource include the clinical terms for exchanging information.  In HL7 V 2.x data transmission, the Observation Request Segment (OBR) and Observation Result Segment (OBX) contain the laboratory tests and their corresponding results in lab test codes of LOINC or SNOMED CT. The LOINC and SNOMED CT codes are updated regularly, recently a set of new terms and codes for SARS coronavirus 2 have been released. Improve decision making and reporting of patient data across the care continuum In the scenario where a patient with COVID-19 moves from primary care to emergency care, quick decisions and tracking of laboratory results is necessary. The use of terminology standards can help reduce the time spent in exchanging, tracking, and reporting these tests across the patient journey.  This is a one-time activity that laboratory systems need to undertake to define all the tests in their catalogue correctly. Hospital systems will need to update their EHR systems with the updated orders for the COVID specific tests that they are ordering in collaboration with the referring labs.  This is a foundational activity not only towards data interoperability but also towards research with real-world evidence for the management of COVID. As Dr. Atul Gawande said in The New Yorker recently, the technologies are in place – it's the implementation that needs to be streamlined. Joyoti Goswami is a Principal Consultant at Damo Consulting, a growth strategy and digital transformation advisory firm that works with healthcare enterprises and global technology companies; she is a physician with varied experience in clinical practice, pharma consulting and healthcare IT.

OCR announced five more enforcement actions this week under the HIPAA Right of Access Initiative, which supports patients' ability to access their medical records.

With compliance requirements for ONC's info blocking rule just around the corner, a poll from Pew Charitable Trusts finds a big appetite for patient access, and widespread support for providers to do better information sharing between EHR systems.