Interoperability

A new Center for Connected Medicine/HIMSS Media survey of healthcare tech leaders shows that most hospitals and health systems are depending on a single, integrated EHR to solve their interoperability woes.

With more than a decade of experience as a registered nurse, Angela Ryan combines her clinical experience with her knowledge in health informatics toward the practical, meaningful and integrated use of digital health tools in Australia. In this interview with Healthcare IT News, she shares more on her role as the chief clinical information officer (CCIO) at the Australian Digital Health Agency (ADHA) and talks about why the My Health Record is a key pillar in Australia’s National Digital Health Strategy. Q. Could you tell us more about your role as CCIO of ADHA and your background in healthcare? A. In my role as chief clinical information officer at the Australian Digital Health Agency, I work collaboratively across the health system to develop and maintain strong relationships with key stakeholders in the community to promote adoption and meaningful clinical use of digital health services and technologies, to deliver benefit to all Australians. A key priority is ensuring strong clinical engagement with the National Digital Health Strategy and associated programs and services – including the My Health Record system – and clinical input and assurance into the design, development and delivery of digital health systems. The role provides clinical leadership for the implementation, advancement and optimisation of digital systems nationally. I’m a clinician with a background in health informatics, and decades of experience in hospitals and public sector organisations, with an emphasis on governance, design, development and deployment of digital health strategies and technologies. Before moving into digital health, I had more than 14 years’ experience as a registered nurse, including paediatric and adult intensive care. I am now able to apply my understanding of health systems and practice not just to optimise technology design and rollout, but to act as an effective agent of change, building engagement and momentum around transformational programs. Q. What are some of the latest projects/developments that you are currently working on at ADHA? A. The Australian Digital Health Agency is setting out the pathway to achieve our goals in the National Digital Health Strategy, to support the premise that “A workforce confidently using digital health technologies to deliver health and care will be required to address the technology adoption challenge and calls for supporting the workforce to better adapt to, use and embrace the changes and opportunities created by digital health innovation.” A digitally enabled workforce for Australia will benefit consumers, healthcare professionals and the broader health system. In addition, future innovations and approaches to healthcare delivery, such as applied data analytics, and technologies such as machine learning, artificial intelligence (AI) and advanced robotics, will require a shift in the skills mix of the healthcare workforce in order to obtain the greatest benefit of these advances for healthcare consumers. To support this, the Agency is undertaking a program to consult the health sector and other relevant stakeholders on strategies to address the enablement of the workforce and any perceived gaps. Our aim is to develop a holistic understanding of the potential skills and workforce shortages and develop strategies to address them. This will culminate in the development of a National Digital Health Workforce and Education Roadmap. The roadmap will be a focal point for a National Digital Health Workforce and Education Summit being planned for later in 2019. This event will bring together stakeholders from across the sector to consider the roadmap and agree the practical actions required to deliver the workforce Australia needs. Q. From your experience both as nurse and in healthcare informatics, what do you feel are the greatest challenges in the journey toward achieving better health outcomes through digital health? A. Striving to deliver real-time improvements in clinician workflow is the holy grail for me, but I know that we aren’t there yet. That said, l also know that many of my colleagues are deeply invested in this as an outcome, and recognise that to truly deliver on improvements in patient outcomes, we need to improve the way digital tools and technologies work inside healthcare environments. It might keep me awake at night, but I do believe we’ll see real change in the not-so-distant future. Q. In 2017, you were awarded a Churchill Fellowship to study methods to prevent patient harm through national digital health safety governance. Could you share with us some of your key insights/findings from the study, especially through your visits to the UK, USA and Canada? A. My Fellowship trip was life-changing and I met so many people who gave their time, their insights and knowledge so generously – Australia can undoubtedly benefit from this wealth of experience.  I developed a set of recommendations that drew on the overall findings and principles articulated within my Churchill report. I also drew on the premise of the ‘Health Information Technology (HIT) Safety Center’ model developed in the USA. I did this in part as it is the only fully elaborated model supported by an extensive evidence base, the structure of which is informed by learnings beyond the USA borders. The Center was originally recommended by the Institute of Medicine (IOM) Report ‘Health IT and Patient Safety: Building Safer Systems for Better Care’, published in 2012, with a subsequent commitment by the Obama administration to establish the roadmap to develop the Center.  It was further endorsed through the USA Food and Drug Administration Safety and Innovation Act (FDASIA) of 2015. While the Center has not been implemented as it was originally envisioned, many of its proposed members are active in the ‘Partnership for Health IT Safety’, a multi-stakeholder collaborative of more than 50 organisations that come together to analyse safety events and hazards, identify, and share solutions and safe practices, and inform policymakers and the broader healthcare community about priorities for health IT safety. I contend that Australia should assemble a taskforce of experts from across the health sector, to include clinicians, consumers, government, researchers, policy makers and industry to develop the vision, mission, outcomes and roadmap for better coordinated digital health patient safety in Australia. The taskforce’s expressed purpose is to ensure digital health is safer for patients and will build upon the significant progress already made in Australia, and internationally. More information can be obtained here.   

The U.S. Department of Veterans Affairs and the Defense Logistics Agency of the Department of Defense announced a new strategic partnership this week aimed at boosting the VA’s supply chain modernization efforts. WHY IT MATTERS Under the agreement, VA networks nationwide will have expanded access to DLA’s broader supply catalog, enabling greater productivity and efficiency, said government officials. With access to DLA’s worldwide procurement system VA will be able to acquire medical and surgical items, cleaning supplies and equipment and other items needed to support Veterans' health. By combining resources for a centralized ordering system, VA and DOD will also reducing risk, waste, fraud and abuse in medical equipment and supply purchasing. THE LARGER TREND In March, VA’s Captain James A. Lovell Federal Health Care Center became the pilot site for DLA’s Defense Medical Logistics Standard Support commodity ordering system. This is hardly the first healthcare collaboration between the Departments of Defense and Veterans Affairs, of course – especially as both organizations work to modernize their respective electronic health record systems. In June, they announced a new office, the Federal Electronic Health Record Modernization office, to improve collaboration on the EHR projects. This was less than a year after DOD and VA told the Senate they would create a single governance point to help manage the massive Cerner implementation. ON THE RECORD "The adoption of a single health care logistics system by VA and DOD highlights the commitment of both organizations to improve military and Veteran health care by increasing the access and quality of care they receive," said VA Secretary Robert Wilkie in a statement. "This is a huge step forward in our efforts to transform VA into a modern, high-performing organization by simplifying operations and leveraging DOD’s supply chain system to support our Veterans." "On behalf of DOD, we are proud to be a value-add to VA on behalf of America’s Veterans," added Lt. Gen. Darrell K. Williams. "Leveraging economies of scale, like the ones outlined in this agreement, help us reduce costs for the military services and other government partners like VA." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com Healthcare IT News is a publication of HIMSS Media.

Known as the ‘Father of FHIR’ and an experienced healthcare interoperability consultant, Grahame Grieve is FHIR Product Director at HL7 International. He has a background in laboratory medicine, software vendor development, clinical research, open source development and has also conceived, developed and sold interoperability and clinical document solutions and products in the Australian market and around the world. Grahame shares some updates on the current developments for FHIR and is increasingly convinced that clinical interoperability is not an Information Technology/Information Management (IT/IM) problem, but a clinical practice problem. Q. Could you tell us more about your role as FHIR Product Director at HL7 International? A. Fast Healthcare Interoperability Resources (FHIR) has two aspects – it’s a technical standard, and it’s also a community. The “FHIR Product” is really both parts, and as the product director, my role is to grow the community, manage HL7’s provision of processes that the community can follow so that it can produce technical agreements consistently, and then to integrate that growth into HL7’s business so that HL7 can flourish as the best host for the technical standard – which includes meeting its formal obligations as a standards organization. Q. Being an FHIR architect and interoperability consultant, what are some of the recent broad trends you observe in the development of healthcare data interoperability? Any insights with regard to the Asia Pacific region? A. Classically, healthcare integration within institutions has focused on a push-based messaging model – using mainly HL7, along with messaging routing and transformation services. Then a new model arose for cross-enterprise integration based on a common repository using documents (XDS/CDA). Unfortunately, these were 2 separate frameworks.  Now, people are increasingly looking for integration – a single framework using a combination of push, pull and subscription so that institutions and regions/countries can manage their data with much more flexibility, and build more integrated workflows. All the nodes in that framework should link up with both messaging and repositories as well – integration spans over time and place. In terms of Asia/Pacific – a combination of factors has generally meant that Asia/Pacific have been followers in terms of data integration, with adoption taking longer. This is both a risk and an opportunity – a risk that business manages (conservative everywhere) won’t take the risk to try building better workflows, but also an opportunity that because there’s less prior investment, the fallacy of sunk cost is less of a problem. But on the whole it seems premature to me to talk about general trends in such a wide area with great variation in culture and funding models. Q. You will be giving a keynote titled “How FHIR can really make a difference” at the upcoming HIMSS AsiaPac19 conference in October in Bangkok, Thailand. For those who are new to FHIR, what are three important things you would like to highlight about FHIR? 1. FHIR is a community and technical standard founded on the basis that openness – in both the standards process, and the health data management process – allows for great new possibilities that couldn’t arise in a closed system, and that those possibilities can transform health outcomes. 2. FHIR is the web, for healthcare. All the things that the web has meant in other industries – that can happen in healthcare.  3. FHIR is a small part of the overall picture – technical standards are only useful if they are used, and that’s a business/cultural/governance decision. There are many problems in those areas and these are big bad problems. Q. What are some of the most current developments/updates for FHIR? A. As a standard, FHIR is maturing; increasingly the standard is stable and becoming ready for large scale adoption. At a technical level, our work is mainly around building out the eco-system to allow things like large scale data extraction for analysis and research, and stabilizing the clinical summary content.  In terms of community, the set of participants is expanding quickly and we are focusing on how to scale our community processes, and collaborate much more directly with key partners such as HIMSS and IHE (we’ve collaborated with them for years, but now we need a much deeper partnership). Q. What are your thoughts on the future of healthcare data interoperability in the next 3-5 years? A. The most common question I get is ‘when will FHIR be widely deployed’. And I don’t actually know the answer to that; obviously, it will grow, but in many/most countries, how quickly that happens actually depends on key decisions made by very few people for political or business reasons, and so it’s very hard to predict how far it will go in that timeframe. I’m personally far more interested in how we as a community will come to understand that Clinical Interoperability (the ability to switch patients, teams, and algorithms/AI between different care providers) is not an IT/IM problem, but a clinical practice problem. It seems to me that change will be driven by business and wider cultural considerations and that sponsors of the changes (governments/businesses) will assume Clinical Interoperability exists. The fact that it doesn’t will prove expensive – but I wonder whether we’ll learn the right lessons.  Big questions there – but what I do see now is that people working in healthcare interoperability are going to be busier than ever over the next 3-5 years. Grahame Grieve will be giving a keynote titled “How FHIR Can Really Make a Difference” at the upcoming HIMSS AsiaPac19 conference happening from October 7-10 2019 in Bangkok, Thailand. Registration for the conference is open and more details can be found here. 

Use of Direct messaging increased by more than 50 percent over the previous quarter and nearly 400 percent since last year.

The tech giants have made progress on the pledge they made one year ago, and plan to do more, they said at the CMS Blue Button 2.0 Developer Conference.

The Blue Button API pilot, Data at the Point of Care, aims to connect clinicians with claims data, giving them deeper insights into their patients' care history.

The Office of the National Coordinator for Health IT says it's seeking public input and recommendations before it takes a "snapshot" of its Interoperability Standards Advisory toward the end of the year.

The groups urge the Senate to follow the House's lead and finally lift the ban on federal funding for a nationwide unique patient identifier, making the case that it can help avoid serious safety risks due to matching errors.

The cloud-based eMyLabCollect enables integration with any laboratory or hospital information system via HL7 feeds.