Interoperability

Dr. Monika Sonu uses insights gained during her medical practice to develop technologies that improve patient and clinician experiences. The Healthinnovation Toolbox cofounder and HIMSS24 Changemaker explains.  

The release of CA v2.0, updated to require support for API exchange using the HL7 spec, allows TEFCA to "keep pace with the advanced, secure data services approaches" employed by the larger tech industry, says National Coordinator Micky Tripathi.

Digitalisation in healthcare holds the promise of optimising processes and expanding access to care. In some European countries such as Slovenia, Croatia, Estonia, Poland and Hungary, patients can access national portals that contain their prescriptions, referrals, discharge letters, etc. In other countries such as Belgium and Spain, patients can access regional portals. In the Netherlands, Germany and Switzerland, individual healthcare providers offer their own patient portals. This means if a person visits multiple facilities, they must use different portals to access their health data. The European Health Data Space (EHDS) legislation aims to improve access to and control by individuals of their electronic health data, expand healthcare data accessibility across borders, and use healthcare data for patient acute care and research. The range of changes tech could in theory bring to healthcare is extensive, including the following: Faster access to and improved coordination of care by having a more direct channel with clinicians through an online portal. Time saved by opting for telemedicine over an in-person visit. More precise diagnoses with the help of AI. Reduced burden on frontline staff due to tech-enabled capacity optimisations. On the dark side, there are patient concerns: Will my data be exploited? Is it safe? Will I lose the connection with my doctor? After all, people, especially those in vulnerable health situations, crave human touch and a reassuring voice. What do patients worry about? The European Patients' Forum is an umbrella organisation of patient organisations across Europe, with its 79 members including disease-specific patient groups active on the EU and national levels in Europe. Patients have a number of concerns about the digital transformation of healthcare, according to Gözde Susuzlu Briggs, programme manager at the European Patients' Forum:  Digitalisation could exacerbate existing health inequalities, especially where there is a significant digital divide. There is a risk of unauthorized access to or breaches of patients' personal health information (PHI). A lack of interoperability is hindering effective care. There are worries about the affordability and accessibility of digital health solutions. The shift to digital health requires an adjustment in how patients interact with healthcare systems. It is very difficult to stay on top of innovation in digital health. "Patient communities know their disease areas quite well, but in terms of other advanced technologies or work that's around legislations and legal frameworks are topics that are quite new unless it's their profession," Briggs said. Improving digital literacy and involving patients in the development of solutions are crucial for building public trust and ensuring a positive user experience. Education, explanation, collaboration On the EU level, several organisations work with and for patients on inclusion in data management and improving digital literacy. Non-profit organisation EUPATI (European Patients Academy on Therapeutic Innovation) provides education and training to increase the capacity and capability of patients and patient representatives in medicines R&D. In 2023, EUPATI designed a Digital Health module that provides an overview on digital health and its regulatory framework. "Based on the feedback so far, real-world evidence and real-world data seem to be specific areas where patients struggle to fully understand their role and relevant opportunities for involvement," said Maria Dutarte, executive director at EUPATI. More workshops and … national marketing? "I haven't yet met a patient who wants all their healthcare from a computer, including myself," said Kristof Vanfraechem, founder and CEO of Data for Patients – a European organisation focused on bringing data/digital experts who are also patients/caregivers into strategic change initiatives. "We see digital as an opportunity to enhance human healthcare – tools to bring the humans – frontline workers and patients – closer together more efficiently and effectively to get or, even better, keep patients as healthy as possible at all times," he said. Vanfraechem emphasized that digital transformation is a complex change at the society level. Data for Patients invests in supporting patient organisations in an approach close to them. Education and awareness may seem to be a straightforward solution to increasing knowledge, managing expectations about digitalisation in the patient population, improving utilization of solutions and decreasing unnecessary tech-related fears, but someone needs to do the groundwork. Since not all patients are deeply involved with patient organisations, this leaves many responsibilities to decision-makers implementing and introducing new digital solutions. Laws and regulations are only a starting point for successful digital transformations. Gözde Susuzlu Briggs is the programme advisor for the "Empowering Patients" track at the 2024 HIMSS European Health Conference & Exhibition, which is scheduled for 29-31 May 2024 in Rome. Kristof Vanfraechem is moderating the session "Leveling Up! Harnessing Health Literacy to Achieve Equity." Learn more and register.

Wagner Amaral, growth markets health industry lead at Avanade, talks about how Avanade’s comprehensive set of solutions with embedded security supports collaboration, boosts efficiency and improves patient outcomes across the healthcare ecosystem.

Over time interoperability standards have had a broadening effect on the healthcare technology industry, and the pace of improvements has increased, to the benefit of patients, says Michael Nusbaum, president of MH Nusbaum & Associates.  

Joe Gagnon, CEO of 1upHealth, talks about how collaborating more on APIs can help providers generate EHR requests for information from payers.  

Chief Digital and Information Officer Craig Richardville stresses three tenets: simplicity, alignment and risk sharing.

Now that participation among multiple QHINs is allowed under TEFCA, The Sequoia Project addresses how cybersecurity requirements apply to all entities exchanging protected health data.

Leidos' Partnership for Defense Health announced the deployment of MHS-Genesis, the U.S. Defense Department's Federal Electronic Health Record system, at the Captain James A. Lovell Federal Health Care Center (Lovell FHCC) in Chicago. The deployment was the first time DoD and Department of Veterans Affairs, the Federal Electronic Health Record Modernization office and the Leidos team have collaborated on a joint government EHR implementation, the company says. The FHCC integrated joint sharing site serves both DoD and VA patient populations. This deployment added 1,200 DoD and 2,000 VA clinicians, providers and other end-users. MHS GENESIS is now operational at over 3,890 locations worldwide, with over 197,200 end-users, and serving more than 9.5 million beneficiaries. For the VA, the deployment represents a key step forward in their EHR implementation efforts. Leidos is the lead systems integrator and prime contractor for the MHS Genesis deployment, with the Leidos Partnership for Defense Health (LPDH) consisting of industry leaders including Oracle Health, Accenture, Henry Schein One and dozens of supporting businesses. Leidos provides leadership and daily oversight to all programmatic functions, as well the overall architecture and deployment strategy. This includes virtual/in-person training during system deployments, as well as providing critical cybersecurity expertise to ensure the MHS GENESIS system meets the requirements necessary to protect DOD information. Through MHS GENESIS, service members and their family members receive an integrated health record that follows them throughout their lives and helps support their health decisions and healthy lifestyles. The platform is designed to help improve care outcomes by seamlessly exchanging health information across the federal government. With MHS GENESIS, clinicians no longer toggle between two systems – patient records are available in a single, common federal EHR. This means patients spend less time repeating health history to providers, undergoing duplicative tests, or managing printed health records. In addition, providers have access to patient data such as service treatment records, service medals and honors, housing status and other information to ensure patients receive earned benefits when they transition to civilian life. The platform also provides a more seamless care experience for patients, regardless of whether they receive care from the DoD, VA, Department of Homeland Security's U.S. Coast Guard or another health care system participating in the joint health information exchange. "The integration helps patient providers make more informed decisions about patient care as they have access to more relevant data," Alyssa Pettus, Leidos director of external communications, told HealthcareITNews via email. She noted additional federal agencies are expected to adopt it soon. In 2015, Leidos was awarded the $4.3 billion contract to modernize the DoD’s legacy healthcare systems. Beyond DoD garrison facilities and VA sites, the Leidos team has deployed Genesis to U.S. United States Military Entrance Processing Command, the U.S. Coast Guard, and the National Oceanic and Atmospheric Administration. "Beyond achieving 100 percent DoD deployment, the FHCC deployment represents a key milestone for the VA’s overall EHR implementation efforts, as well as DoD-VA connectivity, driving forward their future deployment efforts," Pettus said. Nathan Eddy is a healthcare and technology freelancer based in Berlin. Email the writer: nathaneddy@gmail.com Twitter: @dropdeaded209

The "outcomes-driven" strategy for the rest of this decade is focused on key goals: boosting access to electronic health information, improving the patient experience by prioritizing health equity and modernizing public health infrastructure.