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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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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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