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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Health Data Interoperability Needs Information Blocking to End

Health Data Interoperability Needs Information Blocking to End | EHR and Health IT Consulting | Scoop.it

From federal government agencies and the medical industry to patient advocate groups and vendor-neutral companies, the push for greater health data interoperability with the healthcare market remains strong.


As seen in the proposed rule for Stage 3 Meaningful Use Requirements, the Centers for Medicare & Medicaid Services (CMS) along with the Office of the National Coordinator for Health IT (ONC) continue to stress the importance of health data interoperability.

ONC explains on its website that EHR systems will only reach their full promise when they effectively exchange medical data throughout the healthcare continuum. Health data interoperability through health IT systems and certified EHR technology will improve physician workflows and enable betterhealth information exchange.


There are certain health IT interoperability standards that are necessary for improving data exchange and these cover how users interact with a system, the messaging capabilities of differing platforms between each other, the management of health data exchange, and the integration of consumer tools with relevant medical systems.

While the federal government knows the importance of health data interoperability and continues to stress its importance, there may be certain entities including healthcare providers and EHR vendors that have played a role in blocking information flow throughout the healthcare industry.


Entities within the medical sector have charged large interface fees when data access requests were made and Congress is now attempting to put an end to information blocking through these means.

“Providers are fed up with interface fees and at how hard it is to accomplish the workflow required by Accountable Care business models including care management and population health. They are unsatisfied with the kind of summaries we’re exchanging today which are often lengthy, missing clinical narrative and hard to incorporate/reconcile with existing records,” stated John D. Halamka, MD, MS, Chief Information Officer of Beth Israel Deaconess Medical Center, in his latest blog post.


Halamka lays out a few key solutions for the problems surrounding health data interoperability and the ongoing issues of information blocking. First, it is important to define the necessities of care coordination and care management. Additionally, Halamka insisted that it’s time to put an end to the meaningful use requirements under the EHR Incentive Programs, explaining that they are no longer necessary.


A few other steps necessary for improving health data interoperability, according to Halamka, are: (1) creating a national provider directory in order to route messages, (2) developing a voluntary national identifier in healthcare, and (3) guiding state privacy laws to break down information blocking.


The American Medical Informatics Association (AMIA) also recently provided recommendations for improving health data interoperability within health IT systems. The organization emphasized the need for EHR certification standards that offer more technical requirements for boosting EHR interoperability and secure medical information exchange.


Additionally, more healthcare providers would benefit from developing a comprehensive healthcare IT roadmap. The latest results from Frost & Sullivan show that approximately half of medical providers worldwide do not have an IT roadmap stressing EHR interoperability. By following the steps set forth among these medical groups, researchers, and experts, the healthcare industry may be able to significantly improve health data interoperability over the next several years.

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Health Data Exchange Advanced in New Pilot Program

Health Data Exchange Advanced in New Pilot Program | EHR and Health IT Consulting | Scoop.it

Nationwide health data exchange and EHR interoperability continue to impact the healthcare sector, as these objectives are the overarching goals of the Medicare and Medicaid EHR Incentive Programs as well as many healthcare organizations and patient advocacy groups. At the HIMSS15 Annual Conference and Exhibition in Chicago, the topic of health data exchange remains at the forefront of company initiatives.

Healtheway is one organization that developed a new initiative called Carequality, which essentially consists of an inner network of EHR interoperability. In its pilot phase, Carequality is expected to connect 200,000 physicians and 40,000 medical practices around the country.

At the HIMSS15 Annual Conference, HealthITInteroperability.com spoke with Healtheway CEO Mariann Yeager and Carequality Director Dave Cassel to learn more about the health IT platforms necessary to develop effective health data exchange models and improve EHR interoperability.


When asked about how the Carequality initiative began and the motivations behind it, Mariann Yeager stated, “A little over a year ago, Healtheway was approached by different groups who felt that there has been enough progress, uptake, and building of data sharing networks that there needed to be a neutral forum to figure out how to connect those networks.”


“We did some due diligence and realized there are very large data sharing networks, such as the eHealth Exchange, and others being formed and growing — CommonWell, lab networks, pharmacy networks, payer networks — and we’re reaching the point where there was just a desire and a need to figure out how to connect them,” Yeager continued. “Rather than doing it point-to-point, why not try to find a standardized way to do so. That was really culmination of all those discussions, which led to the formation Carequality to serve as a public-private endeavor.”


HealthITInteroperability.com asked the HIMSS15 participants about the requirements needed to be included in this pilot program. Carequality Director Dave Cassel explained that there are certain rules and regulations that need to be followed in order to take part in a health data exchange platform.


“There is what we call the Carequality framework that consists of a few central elements. One of them is the common rules of the road that you would agree to as legally-binding rules for the data sharing network and the participants within that network as well, but we’re doing it through the networks,” Cassel said. “The framework also includes technical specifications. We’re not a standards body. We’re not creating new standards. We’re identifying the standards to be used and in some case further constraining them to remove optionality.”

“We do envision using the framework for many different use cases. We want to engage with the payer community. We want to engage with long-term post-acute care. We want to engage with mental and behavioral health,” Cassel continued. “We want to understand their EHR interoperability needs, figure out how to leverage the framework, and – this ability from the rules of the road standpoint – to connect everyone in a fairly generic fashion. And then we’ll pick the right standards for each of those use cases. I would envision there would be use cases to leverage Direct messaging, FHIR — it’s all coming. One of the things we have to do is work with what’s already out there in the field. The whole point of connecting data sharing networks is to get existing instant scale from efforts that are already in place and to do that you need to meet people where they are today, which is with the IHE profiles for the most part.”


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The Evolution of Enterprise Databases and EHR Interoperability

The Evolution of Enterprise Databases and EHR Interoperability | EHR and Health IT Consulting | Scoop.it

There are many parallels between the enterprise database sector and EHRs. Can the evolution of this database industry guide progress in the EHR front? I think there are a number of similarities and solutions which can address the proposed problems facing EHRs and the global healthcare system.

Oracle, the first commercially available database system, has been in existence for more than 35 years.  As a company, Oracle has encountered numerous competitive, technologic and economic challenges forcing it to re-think, re-engineer and re-develop its platform while maintaining backward access to huge volumes of data for its customers.  Many enterprise database companies have since entered the marketplace, all bringing a unique and proprietary set of options, designs and performance.

Despite these differences, enterprise database systems, along with open source and the relatively new NoSQL databases are able to interoperate to meet the demands of customers who are dependent on reliable, scalable, high performing, usable and secure access to data.

Dr. Donald Voltz

Hospital EHRs are babies when compared to enterprise database systems, but they share a great deal of similarities and have become a central player in our healthcare system. Physicians, patients and other healthcare providers are becoming dependent on EHRs for the daily management of patients. Meanwhile, administrators, insurers and regulatory bodies have been developing policies, process and practices to using EHR data for population health, patient engagement and development of best practices at a systems level. 

With the development of large scale, high performance ways to store and access increasingly larger data sets, enterprise applications have evolved to utilize the changing functionality with a commensurate understanding of customer demands leading to increased database functionality.

A cycle of sorts advanced the capabilities and allowed for the migration of application-centric software applications which were slow to change due to interdependencies. Looming was the real possibility of losing business critical functionality during upgrades to software as a service models (Saas) allowing for better scalability, more frequent software updates and higher reliability with lower overall costs.

The history of enterprise databases, and that of other enterprise software, shared similar criticisms as technologic advances occurred. The integration of legacy systems with evolving technology presented the greatest barrier to adoption, even when validated claims of higher performance, increased functionality, and lower costs were realized. These same criticisms have been voiced for EHR technology and are not likely to quite any time soon. 

The problem of integrating new and old technology or bringing technology into an area traditionally administered by manual, static and labor intensive means, boils down to the misapplication and misunderstanding of prior solutions. In enterprise database applications and others, middleware integration architecture was introduced, but was slow to fix these challenges.

Middleware was dispelled and slow to be applied to the enterprise software problem, stemming from attempting to solve integration problems of evolving technology with middleware platforms built upon prior technology.  

EHR interoperability in the early state of implementation and development does not have the legacy middleware problem since nothing existed before. In light of health information exchanges, proposals to develop data sharing standards, little has been presented on the middleware as a viable solution to the interoperability problem in healthcare. Although early in the implementation of EHR’s, they have made a large splash in healthcare and will be required to quickly scale to the available technology, including mobile.  Medicine is many years behind other fields in the deployment of enterprise software solutions to meet the needs of hospitals and patients. 

Oracle recently announced the release of a node.js database driver. This is yet another example of how large, proprietary enterprise software understands the need to implement middleware access so other innovative and motivated companies can develop new solutions to business, personal and social needs.

As we look forward, patient engagement with their health data, insurance, medical decisions and access to healthcare providers will necessitate additional development onto existing and emerging technologies.  If healthcare follows the trends of other enterprise software, and there is no reason to suggest it will not, middleware has been the only architectural pattern to solve the integration problem in a cost effective way while supporting scaling, security and reliability of critical business operations.



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Health Data Outside the Doctor’s Office | The Health Care Blog

Health Data Outside the Doctor’s Office | The Health Care Blog | EHR and Health IT Consulting | Scoop.it

Health primarily happens outside the doctor’s office—playing out in the arenas where we live, learn, work and play. In fact, a minority of our overall health is the result of the health care we receive.  If we’re to have an accurate picture of health, we need more than what is currently captured in the electronic health record.

That’s why the U.S. Department of Health and Human Services (HHS) asked the distinguished JASON group to bring its considerable analytical power to bear on this problem: how to create a health information system that focuses on the health of individuals, not just the care they receive. JASON is an independent group of scientists and academics that has been advising the Federal government on matters of science and technology for over 50 years.

Why is it important to pursue this ambitious goal? There has been an explosion of data that could help with all kinds of decisions about health. Right now, though, we do not have the capability to capture and share that data with those who make decisions that impact health—including individuals, health care providers and communities.

The new report, called Data for Individual Health, builds upon the 2013 JASON report, A Robust Health Data Infrastructure.  It lays out recommendations for an infrastructure that could not only achieve interoperability among electronic health records (EHRs), but could also integrate data from all walks of life—including data from personal health devices, patient collaborative networks, social media, environmental and demographic data and genomic and other “omics” data.


This report, done in partnership with the Agency for Healthcare Research and Quality (AHRQ) and the Office of the National Coordinator for Health Information Technology (ONC) with support from the Robert Wood Johnson Foundation, comes at a pivotal time: ONC is in the process of developing a federal health IT strategic plan and a shared, nationwide interoperability roadmap, which will ensure that information can be securely shared across an emerging health IT infrastructure.

Data sharing is a critical piece of this equation. While we need infrastructure to capture and organize this data, we also need to ensure that individuals, health care professionals and community leaders can access and exchange this data, and use it to make decisions that improve health.

Initiatives like Blue Button and OpenNotes are already empowering patients and allowing them to take a more active role in their care. But giving individuals access to integrated streams of data from inside and outside the doctor’s office can increase the ways in which people engage directly in their own health and wellness.

Broadening data beyond the four walls of the doctors’ office will give health care professionals a more holistic view of their patient’s health. Sharing that data among members of the health care team will also lead to greater care coordination. Ensuring this data is used in meaningful ways will of course require training our health care workforce to a higher level of quantitative literacy.

Efforts now underway like County Health Rankings guide community leaders in setting priorities for improving health. With access to more data, communities can make faster, smarter decisions that support health—creating healthier homes, schools, workplaces and neighborhoods. For example, if a city wants to plan bike infrastructure, they could invest millions in conducting studies into where bike lanes should go, or they instead could quickly access information generated by bikers, such as Map My Ride or Strava, to see where people are actually riding.

While there are an enormous number of uses for the data that we can imagine and many more we cannot yet anticipate, it will be vitally important that we all make every effort to protect the privacy and security of these data. The report highlights numerous ways to protect the data in ways that benefit health and wellness, while also prompting accelerated innovation.

We’re excited by the potential to take this emerging data and turn it into useable information to build a Culture of Health—a nation where everyone has the opportunity to live longer, healthier lives.

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Institute for Critical Infrastructure Technology's curator insight, December 8, 2014 10:13 AM

for more news on critical infrastructure see the Institute for Critical Infrastructure Technology blog http://icitech.org/latest-critical-infrastructure-news-cybersecurity-healthcare/

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Future of EHRs: Interoperability, Population Health, and the Cloud

Future of EHRs: Interoperability, Population Health, and the Cloud | EHR and Health IT Consulting | Scoop.it

Ever since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009 and the Medicare and Medicaid EHR Incentive Programs were established, healthcare providers have been quickly implementing EHR systems and adopting health IT tools. The overall movement toward improved quality of care and greater access to healthcare information will likely stimulate the future of EHRs.


Before predictions regarding the future of EHRs and their designs can be considered, it is critical to examine the history and evolution of EHR technology over the last five decades. The American Medical Association Journal of Ethics discussed how the earliest developments in EHR design took place in the 1960s and 1970s.  Healthcare leaders began forming organizations as early as the 1980s to develop standards for the increased use of EHR systems across the sector.

The very first health IT platforms, developed by Lockheed in the mid-1960s, were called clinical information systems. This particular system has been modified over the years and is now part of Allscripts’ platforms.  The clinical information system was capable of having multiple users on at once due to its high processing speed. During the same period, the University of Utah developed the Health Evaluation through Logical Processing (HELP) system and later Massachusetts General Hospital created the Computer Stored Ambulatory Record (COSTAR).


The COSTAR platform was able to separate key healthcare processes into separate entities such as accounting or billing versus clinical information. The federal government adopted an EHR system in the 1970s through the Department of Veteran Affairs’ Computerized Patient Record System.


Over the last several decades, there have been even more developments in EHR design and implementation, especially since the federal government constructed meaningful use objectives under the EHR Incentive Programs. In 1991, the Institute of Medicine (IOM) published a report analyzing the effects of paper health records and making a case for the use of EHR systems. The report also covered challenges to EHR adoption such as costs, privacy and security concerns, and a lack of national standards.


In 2000, the IOM also published its infamous report To Err is Human in which the high rates of medical errors were discussed and health IT systems were addressed as a potential solution. The history surrounding health IT will likely impact the future of EHRs, as the same principles toward better quality of care, lower costs, and improving patient health outcomes are at the forefront of EHR adoption.

EHRIntelligence.com spoke with three leaders in the healthcare IT industry to discuss the future of EHRs and the trends to expect over the coming years. Bob Robke, Vice President of Interoperability at Cerner Corporation, mentioned the importance of healthcare data sharing across multiple platforms.


“We’re moving out of the era of EHR implementation and adoption and into the era of interoperability,” Robke said. “Now that we’ve automated the health record, the next phase is connecting all of the information in the EHR. We need interoperability and open platforms to accomplish this.”


The functionalities possible in future EHR systems will also focus greatly on interoperability and Big Data. As telehealth functions spread across the country, patient health outside of the medical facility will be greatly considered.


“Interoperability has the potential to unlock a richer set of data that clinicians can use to help improve the care they provide to patients,” Robke explained. “More than ever, clinicians will need access to information about the patient’s care that happens outside of their four walls as healthcare moves from fee-for-service to value-based models.”

When asked what healthcare trends are affecting the design of EHR systems, Robke replied, “There is a lot of exciting work being done to advance open standards that enable information stored in one EHR to be accessed by other systems. A good example of this is the work being driven by the Argonaut Project to advance the development and adoption of the FHIR standard. We’re big supporters of the SMART on FHIR approach that allows information to be accessed from directly within the EHR workflow, and are enabling that within the Cerner EHR.”

Health information exchange and EHR interoperability will continue to impact the future of EHRs over the coming decades, as the healthcare industry continues to strive toward meaningful use of health IT systems. Robke spoke on the benefits of health information exchange and the strategic actions of the Commonwell Health Alliance, which is geared toward nationwide healthcare data exchange.


“Interoperability is a critical next step in the EHR world. Interoperability can provide clinicians with the data they need to manage the health of their populations and truly put the patient at the center of care,” Robke explained. “For interoperability to succeed, it will require all of the different information system suppliers coming together to find ways to connect their platforms, like those vendors who have joined together in the CommonWell Health Alliance. The great thing about CommonWell is vendors representing 70 percent of the acute market share in the U.S. have joined together to make interoperability a reality.”

When discussing how telemedicine and population health measures will affect the future of EHRs and the development of health IT platforms, Robke stated: “Connecting different information sources are key to successful telehealth and population health management strategies. Health care organizations need to access a patient’s full health history regardless of where that care was provided or what information system houses that information.”


“And yet, when it comes to results, there is an alarming failure in the healthcare industry.  Despite huge investments in enterprise systems, venerable healthcare organizations failing even at the basics like exchanging information electronically, communicating amongst care teams, and engaging patients,” Bush elaborated on the topic. “Some are even going bankrupt!  The shortcomings of software – the cost, the inability to share information at scale, the demands for onsite management and maintenance, and the sluggish pace of innovation—are chiefly responsible for this.”


The revenue cycle in the healthcare industry will also have a great impact on the future design of EHR systems and trends within this sector, Bush explained. The costs of investing in complex technologies will affect the future adoption rates while the financial incentives of the Medicare and Medicaid EHR Incentive Programs will also stimulate hospitals and physician practices.


“That’s why I believe that health care leaders are going to start thinking in terms of the total cost of driving results, not the total cost of ownership, when they contemplate the HIT of the future,” Jonathan Bush explained. “It’s crucial in the current landscape to adopt a cost calculation that accounts for labor and operational costs across several departments, as well as the opportunity costs of an underperforming system. As CIOs and health system boards are increasingly held to account for their investment decisions, I think we’ll start to see a new model for total cost of ownership emerge—and a fleet of next-generation services emerge to keep up.”


When asked what functionalities he thinks health IT systems will be able to obtain in the future, Bush replied: “Malleable IT strategies available from the cloud will reinvent what we ever thought HIT was capable of.  I agree with a recent IDC report and its vision for a future filled with ‘3rd Platform EHRs’ capable of functions we just don’t see in software today.”


“Those functionalities would include easy access to data; population-wide analytics; and network intelligence that crowd sources the wisdom of many to improve overall performance,” he continued. “These functionalities are already being built in to service value-based care organizations.  The promise is better healthcare in an accountable care environment.”


Next, the Athenahealth CEO discussed the importance of connectedness and interoperability when it comes to the design of EHR technology and future trends in health IT.


“Connectedness is a huge barrier to humanity in health care, as well as to the design of intelligent IT systems,” Bush said. “Achieving connectedness, or the meaningful use of health IT, isn’t reliant on getting all providers onto one system.”


“I believe that the one-size-fits all mantra is finally waning and that healthcare will continue to demand what I like to think of as the ultimate ‘backbone’ solution: lightweight technology that can unite data across multiple platforms and support advanced levels of care coordination and connectedness. That sort of infrastructure is not only more cost effective, nimble, and future-proof; it’s also best for patient choice and access and — ultimately — quality care.”


Some of the typical trends that are affecting the future of EHR technology include telehealth, population health management, accountable care, and health information exchange. Population health management in particular will affect the development of analytics software and statistical measurements vital for demonstrating healthcare quality improvements.


“The arrival of population health is, and will continue to be, huge. It’s trending in M&A, has wound its ways into vendors’ capability descriptions, and is on the required ‘must support’ list for healthcare organizations of all sizes,” Jonathan Bush explained.


“To do population health correctly, EHRs will need to gain insight into patient populations, translate that insight into meaningful knowledge for care teams, and enable a new standard of connectedness to manage and deliver care. To do such complex, hairy, and crucial processes, EHRs will have to leverage a combination of software, knowledge, and work.  Software alone simply isn’t cut out to do the job.”


EHRIntelligence.com also spoke with Practice Fusion Founder and Chief Executive Officer Ryan Howard about future trends in EHR design. Howard spoke about the importance of data sharing among health IT systems.


“The single biggest trend will be cloud-based EHRs. The biggest single problem in the space is not deployment of EHRs. It is sending data back and forth whether it’s for quality and accountable care or sharing data with a payer or a lab or other doctors,” said Howard. “In every spirit of this, data from EHR needs to be shared with another EHR system.”


“The challenges of that is to install software offsite. Most of the major competitors have enterprise solutions. The data is incredibly difficult to get out. A cloud-based model inherently has an exponential cognitive scale that allows it to do this easily,” Howard explained. “In our case, when we connected to Quest, every doctor on our platform has a connection to Quest now because they’re all the same multi-tenant cloud-based systems. I think the biggest problems in health IT will be solved by simple integration into the cloud.”


Howard was of the same opinion as the other CEOs when it comes to the functionalities EHRs will need in the coming years. Interconnectedness, interoperability, or the efficient sharing of health data between disparate systems will become a necessity in the quest to improve patient care and health outcomes.


“The biggest single thing [that will affect the future of EHRs] is that systems need to seamlessly connect to each other,” the Practice Fusion CEO stated. “Most of the systems are pretty robust, but I think the major cloud-based systems will need to interoperate. I think the major cloud-based vendors in the marketplace will connect and all their doctors will be able to interoperate. I think all the doctors will migrate to cloud-based systems.”


“This is only possible in a web-based or cloud-based model where the population data is in one place,” Howard said. “There’s very little value in doing this in a solution that’s installed in the doctor’s office. In that situation, all the data isn’t in one place and, in a population health management program, you’re constantly rolling out new rules and tackling new chronic conditions.”


When asked what healthcare trends will affect the design of EHR systems, Howard replied: “Population health management in addition to the electronic health records role in enabling telemedicine will all be key in the marketplace. Unless you have the patient’s record which only exists in the EHR, then there will be very little value on the telemedicine platform.”


“However, if I’m using a telemedicine platform that’s connected to the EHR, I have all that data in real-time. Most EHRs that are certified do drug-drug and drug-allergy checking dynamically in the system. That’s a good example of the value that comes from the platform.”


In predicting the coming impacts in EHR developments, Howard said, “cloud-based systems, population health management, private care management, and big data” are the major catalysts in health IT design.

“I think most vendors don’t have a population health management solution. The challenges of that is that population health does not work unless all the data is in one place,” Howard stated. “For population health management to work, take a look at diabetes. What the system is doing in a population health management model is that it is constantly monitoring your patient on a day-to-day basis.”


If a patient hasn’t had a required test done, “the system should automatically be reaching out to that patient to drive awareness – get them to book an appointment – and the system should also be prompting the physician with the standard of care during the visit.”


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Vermont Gets More Robust With Data Exchange

Vermont Gets More Robust With Data Exchange | EHR and Health IT Consulting | Scoop.it

Southwestern Vermont Medical Center (SVMC) and Vermont Information Technology Leaders (VITL) have just completed a project that developed five connections to transmit health data from the hospital to the Vermont Health Information Exchange (VHIE).

According to officials of the organizations, the five interfaces were built to:

  • Send immunization data from SVMC to the VHIE. The immunization data is then forwarded on to the Vermont Department of Health Immunization Registry.
  • Modernize the existing laboratory results interface from SVMC to the VHIE.
  • Send patient demographics, radiology reports, expanded laboratory results (pathology, microbiology and blood bank), and transcribed reports (information about procedures, admissions, discharges and consults) from SVMC to the VHIE.

The SVMC interfaces complete VITL's goal of connecting all 14 Vermont hospitals to the VHIE, the statewide health data network operated by VITL. Although SVMC has been contributing laboratory results to the VHIE for over eight years, the four new connections will increase the amount of clinical and demographic data available to providers involved in a patient’s care, better informing health care decisions, its officials say.

The final phases of the SVMC interface project included the addition of a move-in process, where engineers, analysts and project managers met face-to-face at the VITL office in Burlington. The interface teams met for two in-person sessions that lasted two weeks at a time, and allowed them to completely focus on integration and quality assurance testing of health data flowing from SVMC into the health information exchange, according to officials.

The new clinical interfaces allow SVMC data to be shared with any provider in Vermont. “Southwestern Vermont Medical Center has been a part of the VHIE for over eight years, and we have actively used the data network to distribute electronic lab results to primary care practices in the southwestern Vermont health care service area,” Rich Ogilvie, chief information officer at SVMC, said in a statement. “The additional connections deliver data and reporting abilities that will enhance the provider-patient care relationship in the Bennington service area and across the state.”


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Effects of Interoperability on Health Data Privacy Policies | EHRintelligence.com

Effects of Interoperability on Health Data Privacy Policies | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

Interoperability enables healthcare providers to make the most well-informed decisions for individual patients, but it introduces the potential for sensitive patient health data to become compromised if the technologies exchanging information or the pipeline between these systems are unsecured.

“In terms of what I think some of those challenges are, it’s no big secret; we’re working on interoperability,” Lucia Savage, the new Chief Privacy Officer for the Office of the National Coordinator for Health Information Technology, recently told HealthITSecurity.com.

“Of course there are the topics that have been well-discussed in the press, like data lock and all that stuff that have to with people’s proprietary systems,” she continued. “But what’s really more essential in the privacy and security realm is making sure people understand how are current legal and regulatory environment actually help support interoperability — right now, at this very moment in time.”

New models for care delivery (e.g., accountable care organizations) emphasize the need for interoperable EHR and health IT systems, added Savage. Interoperability, however, is limited to certain geographies and contexts. In short, there is tremendous room for improvement.

“For example, insurance companies contract with large systems to the ACOs. For that to succeed, just like the Medicare ACOs, data has to flow between the two parties,” Savage explained. “That data is flowing right now in some ways, and in some ways it could flow better and could make better use of the delivery system was built with the meaningful use incentive.”

According to the ONC’s Chief Privacy Officer, a lack of health information exchange (HIE) as a result of limited interoperability comes as a surprise to patients who “thought their doctors were doing this already.” And what is essential is that the healthcare organizations and providers, both private and public, make use of new forms of exchanging information while adhering to the privacy and security rules laid out by HIPAA.

“The HIPAA environment we have is perfectly designed for that. It’s media-neutral, meaning 20 years ago when faxes were new, that’s how the information started to move. Now the information is moving through other media but the rule hasn’t changed. We’re going to capitalize on that,” she maintained.

The next step involves the building of trust among providers and patients, which will come with time and use:

When we introduce a pretty significant technological innovation it takes optimally to breed trust. If through interoperability it facilitates physicians engaging their patients through electronic health record systems and the portal, and giving patients access, giving dialogue with patients about their data that they collect and share about themselves, then patients confidence in the system will grow because they’re using it too.

For the ONC, the path forward requires the federal agency to gather information and listen carefully to the insights of subject-matter experts so that the “potential benefits and the possible risks” of a fully interoperable, HIE-enabled healthcare environment are understood and incorporated into emerging and evolving regulation and oversight.

“Most of the people in the know understand well how HIPAA works for these big data analytics, but there’s new sources of data, whether its wearables or patient generated data or the way people want to take a healthcare transactional data and add data from public records systems to it for analytics purposes,” Savage said.

Not only is interoperability a challenge from the technology side of healthcare, but it also presents new challenges to health IT security and privacy.



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