‘Sometimes when clinicians prescribe medication, although it does therapeutic good, it creates side effects which need to be addressed by changing a dose or by adding additional medications.’

Just as I clarified last week in my post about certification, the answer to the question “do we need more or less healthcare IT regulation and legislation” is that we need the right amount of the right regulation/legislation.

Sometimes when clinicians prescribe medication, although it does therapeutic good, it creates side effects which need to be addressed by changing a dose or by adding additional medications.

Such is the case with HITECH. It was generally good medicine, but now that we’ve seen the side effects on workflow, clinician burden and efficiency, there needs to be a dose adjustment.

I was recently asked to review the “Improving Health Information Technology Act” introduced by Senator Lamar Alexander, R-Tennessee, in February 2016 and placed on the Senate Legislative Calendar in April 2016. Its intent is good – to refine existing healthcare IT legislation with fixes that enable the right amount of the right regulation.

You’ll find the summary here and the full text of the bill here.

Here’s my analysis, section by section:

“1)  Assisting Doctors and Hospitals in Improving Quality of Care for Patients

Reduces documentation burdens by convening public and private stakeholders to develop goals, a strategy, and recommendations to minimize the documentation burden on providers while maintaining quality.”

This is a good thing. It fixes the language in HITECH which required each stage of Meaningful Use to be more stringent than the last.  That language required regulators to make each update to Meaningful Use more challenging.The Improving Health Information Technology Act enables regulators to better balance benefit and burden.

“Allows and encourages health professionals to practice at the top of their license, allowing non-physician members of the care team to document on behalf of physicians.”

This is a good thing. It encourages more team based care and documentation. Using electronic systems effectively is a team sport and should leverage social networking/groupware ideas to capture electronic data.

“Encourages the certification of health information technology for specialty providers and sites of service, like pediatric care, where more specialized technology is needed.”

As long as the Certification focuses on a few key important ideas, as noted in my previous post, this is a good thing.One set of required functionality does not make sense for diverse software supporting specific specialties.

“2) Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT)

Establishes an unbiased rating system for HIT products to help providers better choose HIT products.”

A government program to do this is unnecessary.The private sector has KLAS and other companies providing such information already.

“Allows HIT users to share feedback on the user experience of specific HIT products related to security, usability, and interoperability, among other concerns.”

A government program to do this is unnecessary. The private sector has KLAS and other companies providing such aggregations already

“3) Information Blocking
a. Gives the Department of Health and Human Services (HHS) Office of the Inspector General the authority to investigate and establish deterrents to information blocking practices that interfere with appropriate sharing of electronic health information”

Although I have not personally experienced information blocking, I hear anecdotally that there are some places in the US where competing systems refuse to share data with each other. Giving the OIG the ability to investigate is reasonable.It’s not clear there will be much to investigate.

“4) Interoperability

Convenes existing data sharing networks to develop a voluntary model framework and common agreement for the secure exchange of health information across existing networks to help foster bridging between networks.”

Convening stakeholders to develop a voluntary framework is reasonable. However, I believe the private sector will do this on its own in 2016.

“Creates a digital provider directory to both facilitate exchange and allow users to verify the correct recipient.”

This is a good thing. CMS could leverage the existing national provider identifier system.

“Requires that HHS give deference to standards developed in the private sector.”

This is a good thing. The private sector is moving very fast to embrace simpler standards such as FHIR.

“5)  Leveraging Health Information Technology to Improve Patient Care

Requires that certified HIT exchange data with registries if registries are certified to use standards endorsed by the Office of the National Coordinator (ONC).”

There are no mature/adopted standards for registry exchange at this time. In the interest of comprehensiveness, ONC has tended to publish/endorse standards that are not yet ready for adoption. Registry participation should be left to the marketplace.

“Includes vendors in Patient Safety Organizations to allow for improvements in the safety and effectiveness of HIT.”

This is very reasonable

“6) Empowering Patients and Improving Patient Access to Their Electronic Health Information
a. Supports the certification and development of patient-centered health record technology so that patients can access their health information through secure and user-friendly software that may update automatically.”

Although patient and family engagement is very important, it is not something that the government should certify.Apple and other consumer companies are innovating at the speed of the market, taking us in new directions that government could not have predicted.

“Encourages the use of Health Information Exchanges to promote patient access by educating providers and clarifying misunderstandings.”

Health information exchanges really do not have a role in patient/family engagement.The new approaches implemented by Apple  and other innovators directly connect the patient and provider.

“Requires HHS to clarify situations where it is permissible for providers to share patient information by providing best practices and common cases where sharing is allowed.”

Clarifying HIPAA through education is a good thing.

“7) GAO Study on Patient Matching
a. Directs the Governmental Accountability Office (GAO) to conduct a study to review methods for securely matching patient records to the correct patient. ”

This is a good thing. We are not going to be able to consolidate records across the care continuum unless we can identify the patient.

There you have it – a dose adjustment for HITECH. Dose adjustments can have their own side effects. Hopefully the bill will be adjusted as suggested above before it is passed. The goal of any new legislation/regulation, just as with medical care itself, should be to first do no harm.

This blog post first appeared on Life as a Healthcare CIO.

Via HealthcareITNews.com »

During a closing keynote presentation last week at the iHT2 Boston Health IT Summit, Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative (MAeHC), debunked certain healthcare interoperability “myths” while offering a positive outlook on the future of data exchange.

The event, from the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group, LLC corporate umbrella), took place at the Aloft Seaport Hotel in Boston on June 23-24, and closed with Tripathi’s Friday keynote on healthcare interoperability.

In addition to his role at MAeHC, a collaboration of Massachusetts provider, payer, and purchaser organizations, Tripathi wears various of other health IT hats: he is chair of the Information Exchange Working Group and co-chair of the Privacy and Security Tiger Team (both of the federal Health Information Technology Policy Committee), a director of the New England Health Exchange Network (NEHEN), and a director and past board chair of the eHealth Initiative. Simply put, when it comes to interoperability and standards, no one in health IT is better well-versed than Tripathi. I compare it to the NBA, when players who consistently can score the basketball are labeled “go-to guys.” For healthcare, Tripathi is the go-to guy for all things interoperability.

Tripathi opened his presentation by asking two questions to the room full of attendees: first, if they believe information blocking significantly exists in healthcare; and second, if they think that the healthcare sector is woefully lagging behind other industries in terms of being interoperable. Predictably, the majority of hands raised in affirmation to both questions. Knowing this would be the likely answer to his two questions, Tripathi moved on in an attempt to debunk these “myths.”

Indeed, looking at other industries, Tripathi noted how he gets Google Calendar invites all the time that don’t sync well in Microsoft Outlook. Or, he said, books purchased at Barnes and Noble don’t play on the Amazon Kindle. He gave several more examples of how in other businesses, companies don’t always “play nice” with one another: Apple isn’t interoperable with anyone; Netflix and Verizon recently had a fight about who should pay for the infrastructure for Netflix consumers, resulting in poor streaming quality; Fitbit has said that it’s not connecting with Google Fit, choosing to create its own network; and finally, consumers can no longer use another coffee cup in a Keurig anymore.

“Interoperability problems are rampant across all industries, public safety included,” Tripathi attested. “I’d argue that [these examples] are no different than what’s happening in healthcare. In some ways, since we have higher expectations in healthcare, we are actually doing better. We need to exchange data; other industries might not have to.” Tripathi then touched on how these interoperability issues get “resolved” in other industries, offering the example of universal product codes (UPC) in grocery stores that adopted them after having problems with inventory control. “Grocery stories created UPCs with a bunch of other grocery stores and vendors. They wanted to all purchase the same machines and get value from them,” Tripathi explained.

Thus, as HIE [health information exchange] matures, it is starting to organize itself like other industries, Tripathi said. Now the question becomes, how are these data exchange networks going to form? The early notions were of a single, federal top-down network, and that collapsed as an idea. But now, networks are starting to form, he said. “It’s not about connecting an EHR [electronic health record] to an EHR, but about being a part of a network and connecting a network to a network. That’s how the rest of the economy has solved the issue in literally every instance.”

Tripathi pointed to several examples of separate networks forming and connecting in healthcare today. He brought up the eHealth exchange for government data, the Mass HIway for local, state-based, lightweight exchange in Massachusetts, Surescripts, for e-prescribing, DirectTrust for secure email, and Carequality as an emerging framework that allows query-based exchange among different participants. “We have so many different ways to communicate with one another based on the kind of communication we want, so we have different networks—just like any other industry. The original notion was to have one way of health information exchange, but there are very few examples where that has worked,” Tripathi said.

He continued, “What type transaction do you want to make? DirectTrust is nationwide interoperability of secure email, and it doesn’t do anything else. But it’s something that has been carved out from the broader picture.” This is different than the all-or-nothing approach, or “HIE 1.0,” in which data would be dumped into a repository for everyone to be able to use for multiple purposes, Tripathi said.

Tripathi then noted how the marketplace is just beginning to see solutions for point-to-point query exchange, so a provider can query someone else’s system to get a record document, and then query another system. Carequality and CommonWell are starting to solve this problem, Tripathi said, adding that pretty much every major vendor except Epic, NextGen and GE are on board. And regarding Epic’s exclusion in these interoperability frameworks, Tripathi reminded folks that while there is not yet interoperability between CommonWell and Epic (Epic’s Care Everywhere product is for Epic users only), looking at other industries as a precedent proves that it will eventually happen in healthcare, too. “These are the beginnings of a nationwide network to solve the point and retrieve issue,” he said.

FHIR is Just a Standard

While Tripathi repeatedly pushed the idea that healthcare is not as in much trouble as people like to say in terms of it users’ ability to exchange data, he did caution that the FHIR (Fast Healthcare Interoperability Resources) standard, while certainly a big part of health IT’s future, is not the magic bullet to solve all interoperability problems. “Have we hit the peak of the hype curve?” Tripathi asked. “FHIR is being talked about as the universal magic bullet. I am amazed by the hype of it. People are looking for an answer, and need a magic bullet,” he said.

But more than that, FHIR is a genuine data-level interface that allows a provider to ask another provider just for allergies for patient X, for example, Tripathi added. Right now, he noted, a provider might receive an entire C-CDA (consolidated-clinical document architecture) document even though he or she just needed the allergies. “With FHIR, you can say ‘here are the allergies.’ So that’s why there’s excitement around it. It gets us closer to the data integration goal that we all want.”

Nonetheless, Tripathi referenced a KLAS interoperability survey from last fall which found that FHIR was the top thing people were excited about. “But I’d bet that 90 percent of those people can’t tell you much about FHIR at all,” he estimated. “I’m a big proponent of FHIR, but people will realize that it’s just another standard, and it won’t solve problems like money, legacy systems, and things like that.”

Tripathi is the project manager of the Argonaut Project—an initiative launched by Health Level Seven International (HL7) to accelerate the development and adoption of FHIR— where leaders there are currently writing app-enabled implementation guides in which a person would be able to take a mobile app or host of applications and be able to have those apps connect in a seamless way. That’s the hope of FHIR, and it’s based on RESTful application program interfaces (APIs), which the rest of the Internet is based on, Tripathi noted. “Once you base it on something like that, you bring in a lot of other brains that are willing to experiment. There is a whole economy of developers out there right now that don’t want to enter healthcare world because they think standards we use are 25 years old. And they’re right.”

One of FHIR’s challenges, Tripathi continued, is that a whole ecosystem has to form. “People get excited about the notion of having apps and just connecting them. Providers want the apps, and EHR vendors also like the idea of apps because they can’t keep up with the demand,” he said. “Medicine is way too complex, so a Cerner or an Epic can’t implement those things. So they like idea of plugging your app into their system. But an ecosystem needs to form around that. How does that work?” He mentioned the Apple store or the Google Play store which act as intermediaries where a user can go find those apps, following basic usability and quality principles, and some security principles. But Tripathi wanted to know where this happens in healthcare and who will ultimately step up to the plate.

He added that there are several options of how this can occur in healthcare, and who the app store pioneer will be is still up for debate.  Possibilities, according to Tripathi, include: Geisinger or a similar health system; major EHR vendors; a third-party company; or the SMART (Substitutable Medical Applications & Reusable Technologies) on FHIR app gallery, which as of today, is the closest we have come to a vendor-neutral app environment. That could be the place that becomes trusted first, Tripathi acknowledged. However, the one organization that the industry cannot afford to do it is the federal government, he said. “There was talk about it, but we absolutely don’t want that. That can go down a bad path, and really quickly.” Tripathi himself is betting on EHR vendors and provider organizations who will lead the way.

Certainly, listening to Tripathi’s keynote was particularly fascinating for me, since I’m mostly told how it will be years before we see true interoperability in healthcare, an opinion that was hammered home at a recent iHT2 event in April. To this end, I wrote a blog earlier this month about how 2015 data exchange numbers amongst U.S. hospitals—particularly the ability of providers to perform all of the core functions of interoperability—were nothing to write home about.

It’s certainly possible that it will take five to 10 years, or perhaps even more, for healthcare interoperability to catch up to other industries. But I don’t think that was Tripathi’s point with his keynote last week in Boston. Rather, he wanted to call out the improvements that we have seen over the years, and prove that healthcare is far from the only sector with system connectivity problems. It was extremely refreshing to hear Tripathi’s expert and balanced take on the topic. Once again, healthcare’s interoperability “go-to guy” delivers.

Via Healthcare Informatics »

When Sylvia Mathews Burwell took the stage as the opening keynote speaker at the 2016 Healthcare Information and Management Systems Society (HIMMS) conference on Feb. 29, it was to deliver the latest deal with the private sector to advance the future of health care.

The Secretary of Health and Human Services had just secured an agreement from some of the industry’s biggest players to openly share information across multiple platforms to make it easier for providers and patients to access their medical histories.

“Sometimes the most important part of our job is to step back and let others take the lead,” she said. “That’s why today, I am very excited to announce that companies that provide over 90 percent of electronic health records used by U.S. hospitals have stepped up and made public commitments to make data work better for consumers and providers.”

The commitment, which included five of the country’s largest health care systems in addition to the industry’s leading developers, was another step toward the elusive grail of putting health care online: interoperability.

The key to the adoption of EHRs and its future in health care rests on the ability of providers to share the data across multiple IT systems and for patients to have more ownership of their medical records to share them.

But drawing up a road map for how to standardize health information and then connect and share it securely across multiple networks through an entire industry of IT products — each with its own proprietary information — has proven to be not only Herculean in scope, but more like a series of mythic tasks to bring together.

HHS’s Office of the National Coordinator for Health Information Technology — which spearheads EHR efforts, regulation and certification of interoperable health IT — released such a road map on Oct. 6, 2015. The plan outlined interoperability goals to be reached by 2024, including encouraging health information sharing.

In effect, ONC wants to help build what it calls a “learning health system” that is both patient-centered and allows health care providers to access patient information on demand and securely, regardless of device or software system.

But part of the challenge facing interoperability efforts is crafting the governance and compelling the industry to develop such a system. The report outlining ONC’s interoperability road map detailed the difficulties of getting providers to adopt information-sharing systems without the value of them being apparent.

“While important progress is being made today, the health care landscape continues to be dominated by fragmentation in care delivery and payment models that are largely based on the volume of services delivered, rather than the delivery of efficient, high-quality care and better patient outcomes,” the report read.

“When providers are rewarded for value, interoperability can be a significant tool to help them meet such requirements, but broad demand for interoperability has lagged and been insufficient to drive connectivity across health care providers.”

Collaboration for innovation

A day after Burwell’s announcement, Karen DeSalvo, National Coordinator for Health Information Technology and Acting Assistant Secretary for Health, announced a draft rule at HIMMS that would allow ONC to have greater oversight in the testing of health IT products.

The goal, DeSalvo said at the time, was twofold: to ensure that the private sector had a framework under which to apply interoperability to its technologies and to give the government more oversight as to which technologies were achieving the information-sharing functionality.

“So we would say that we are going to set goals, we’re going to move forward, we’re going to put all of our weight in one direction as the federal government, and we’ve asked the private sector to come along. They said they would,” she said at the HIMMS conference.

ONC also launched a website listing the health IT developers whose technologies met the certification. But one of the biggest challenges facing the industry when it comes to information sharing is not the achieving ONC certification, but instead the legislation that protects patient information, the Health Insurance Portability and Accountability Act of 1996 or HIPAA.

For patient information to be shared, it still must be both secure and compliant with the law, which places strong restrictions on to whom such information can be disclosed. The interpretations of HIPAA—among other industry issues—and how the information can be shared have varied widely, leading to a practice called information blocking.

Information blocking presents problems for ONC’s interoperability goals because it is built on the fluctuations of HIPPA privacy interpretations by developers and also protections they have for the proprietary information of their IT systems.

Elizabeth Sauve, a marketing and communications executive for Privacy Analytics — a Canadian software company specializing in de-identifying patient data so it can be used for research studies — said at the HIMMS conference that many companies are already sharing data. However, she said the exchange happens through private partnerships rather than building on an interoperability network.

“A lot of companies, they may not have a statistician who would be the one [looking at the data], but they do have a lawyer. So they are using data-sharing agreements, basically confidential disclosures instead of actually making steps. There’s a lot of companies who are using [HIPPA’s] Safe Harbor, because as long as you are compliant with the regulator, who else cares?”

The questions industry was asking at the HIMMS conference largely centered on how HHS planned to make HIPAA compliance clearer for developers to know what they can share.

“There’s been a lot progress on the technical front, with common standard APIs, [Health Level 7]-type formatting for the exchange of information, but then there is the whole piece that HL 7 doesn’t address on security,” said Ken Georgi, General Dynamics’ vice president of health care enterprise systems.

“Once I give you my information, what’s the standard there that we’ve agreed to? Really, it’s around security’s cousin, privacy. If you have my information, what are you allowed to do with it?”

In an effort to educate the public on what level of access HIPPA provides, ONC announced on June 2 a series of instructional videos for patients and a Patient Engagement Playbook for Providers to better explain the patient’s role in controlling their health records.

“Many people are not fully aware of their right to access their own medical records under the Health Insurance Portability and Accountability Act, including the right to access a copy when their health information is stored electronically,” said Lucia Savage, ONC’s chief privacy officer, in a statement. “The videos we released today highlight the basics for individuals to get access to their electronic health information and direct it where they wish, including to third-party applications.”

Programs like instructional videos and provider playbooks are part of ONC’s move to shift the EHR framework to a more patient-centered model, where the public retains ownership and access of its medical records.

“We must engage individuals in order to advance the safe and secure flow of health information,” said Tom Mason, ONC’s chief medical officer, in a statement. “The playbook we’re releasing today provides clinicians with the resources they need to get the most out of their health IT and help patients put their electronic information to work to better manage their health.”

Another move is making sure that the capabilities of the health IT systems being sold to providers are clear. On June 1, ONC began listing transparency specifications to help IT buyers access information about the “costs and limitations they may encounter when implementing and using certified health IT products.”

The strategies afford HHS the opportunity to provide the public more access to the EHR information while encouraging developers to offer more compatible services with their products. Whether those products will be readily adopted is another question.

Plowing the path to interoperability

While HHS and industry are collaborating and influencing interoperability, the next challenge is to ensure the users adopt the technology.

At ONC’s annual meeting on June 1 in Washington, D.C., it showed off data from the American Hospital Association that said 96 percent of hospitals were using certified EHR systems, the lower tier of functionality, while nearly 84 percent use the higher-tied basic EHR systems.

But as the stats noted, “Possession means that the hospital has a legal agreement with the EHR vendor, but is not equivalent to adoption.”

And while 85 percent of non-federal acute care hospitals have sent EHR information to an outside party in 2015, only 65 percent have received information through their IT systems. Overall, only 26 percent of non-federal acute care hospitals were collectively finding, sending, receiving and integrating information through their EHR systems.

Adoption of a new technology can take time, and HHS has new rules in final development to incentivize EHR adoption for Medicaid and Medicare.

So while the federal government encourages and the private sector innovates, the future of interoperability will be determined by the very group it has been built for: the user.

Via Federal Times »

As the Centers for Medicare and Medicaid Services moves to new payment models based on value rather than volume, a lot more will be asked of health IT technology and the vendors who sell them to providers, according to CMS Acting Administrator Andy Slavitt.

Slavitt told the nation’s largest physician group on June 13 that the burden needs to be on the vendors, not the end users, to deliver on the promise of health IT and its potential benefits to transform healthcare.

Speaking before the American Medical Association’s annual meeting in Chicago, he said CMS has heard the calls for “putting more pressure on technology vendors” and less on physicians. The goal, Slavitt asserted, must be to “make healthcare technology a tool” serving clinicians and patients.

“This is particularly true in the area of what many call interoperability,” observed Slavitt, who argued that interoperable health information would enable physicians to do tasks as simple as tracking referrals when a patient sees another specialist or visits a hospital—capabilities that don’t exist today, he contends.

He told the AMA audience about a conversation with a specialist in Chicago who complained that electronic health record systems simply don’t talk to each other, making it impossible to view patient records in those kinds of scenarios.

Besides relief from Meaningful Use requirements, Slavitt said that health IT interoperability is the “number one ask of many physicians.”

To help address these challenges, the CMS chief remarked that EHR vendors—and the providers that use their products—will now be required to open their application programming interfaces (APIs) “so data can move in and out of an application safely and securely.”

APIs, which enable a software program to access the services provided by another software program, are included in the final Meaningful Use Stage 3 rule requiring certified EHR technology to provide an API through which patient information can be viewed, downloaded and transmitted to a third party.

In addition, APIs are included in the 2015 Edition of Health IT Certification Criteria, which requires certified EHRs to demonstrate the ability to provide a patient-facing app access to the Common Clinical Data Set via an API.

“Systems will need to adapt to your needs,” concluded Slavitt. “Long-time frustration won’t disappear right away,” but he said “it is essential that physicians not only participate in but having a leading voice in the change that is ahead.”

In response to Slavitt’s comments, Leigh Burchell, chair of the EHR Association and vice president of government affairs at Allscripts, agrees that physicians must be engaged if the healthcare industry is to achieve health IT’s potential to help transform the healthcare delivery system. However, she contends that technology alone is never going to be the answer for vexing industry issues.

“Interoperability is a critical area of focus for us all. APIs and other tools will certainly move us ahead, but no one stakeholder can resolve all the issues that stand between where we are today and where we want to be in the secure sharing of patient information across provider organizations—issues such as HIE governance, data ownership and privacy agreements, and a consistent patient identity approach across disparate systems,” says Burchell.

Morgan Reed, executive director of ACT|The App Association and acting director of the Connected Health Initiative, said he supports Slavitt’s position.

“The United States is the largest consumer of healthcare services around the globe. But, physicians are unlikely to adopt new technology if it interrupts workflow or puts a patient at risk,” says Reed. “The lack of interoperable health information systems is an impediment to innovation that ultimately harms patients. We agree with Administrator Slavitt that there should be pressure on major vendors to make systems work well together.”

Via information-management.com »

The Office of the National Coordinator for Health Information Technology (ONC) is pinning its latest hopes for interoperability on the cloud, namely with application programing interfaces, or APIs. But is this hope realistic?

Experts feel it will be a close call to get the API standards ready in time for requirements found in the April 27 release of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) proposed rule. The rule makes it a national objective to achieve health data interoperability by December 31, 2018.

A measure in the MACRA proposal called, “View, Download, Transmit (VDT),” calls for eligible clinicians to help patients:

• view, download or transmit their health information to a third party;
• access their health information through the use of an API; or
• a combination of both.

In an April 27 blog, Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services (CMS), gave an indication of ONC’s hopes for APIs, saying they will “open up the physician desktop to allow apps, analytic tools, and medical devices to plug and play.”

Setting apps on ‘fire’

There’s one problem with that. The APIs aren’t ready yet. HL7 (Health Level Seven International), a group that sets standards, formats and definitions for exchanging and developing electronic health records (EHRs), is working on standards for healthcare APIs called Fast Healthcare Interoperability Resources (FHIR). It’s pronounced “fire,” and there are plenty of references to FHIR setting the whole health app world on fire.

Gary Dickinson, co-chair of HL7’s EHR workgroup believes that ONC is maybe putting too much pressure on HL7 to get the APIs completed by 2018. He thinks FHIR will “probably” be ready in time for what is required in the MACRA proposal, but not for broader use. Some companies in the industry may go ahead and use the FHIR standards prior to HL7’s vetting them, he said.

Developing FHIR standards for APIs is not an easy thing to rush. FHIR divides data into “bite-sized chunks” for transmission. These are called resources. FHIR has more than 100 different resources identified. Each of these must be vetted, involving more than 50 workgroups at HL7. Developers rate each resource with a maturity level of zero through five. Most resources today are rated zero or one, Dickinson says.

HL7 is shooting to have the third in a series of trial versions of FHIR ready by Dec 31, but that is likely “pushing it,” he says. The timeframe largely depends on the number and extent of updates required from comments received in the upcoming August FHIR ballot.

John Halamka, MD, chief information officer of the Beth Israel Deaconess Medical Center, Harvard medical professor and co-chair of the HIT Standards Committee says FHIR is key to the future of query/response interoperability, which allows users to pull the data from wherever it resides.
“We’re at a time in history when the private sector–driven by customer demand–is implementing novel solutions to healthcare information exchange,” Halamka says. “FHIR is already in production in many applications and every major HIT vendor will have FHIR application program interfaces in production this year.”

Is ONC pushing too hard?

Justin Barnes, health IT industry advisor and thought leader, doesn’t think ONC is necessarily trying to force the use of APIs in the new MACRA proposal. Barnes has been an advisor to the White House and has worked with Congress and regulatory agencies on health IT issues for more than a decade. His interpretation is that ONC officials are trying to mandate flexibility, usability and interoperability. “I don’t feel they’re pushing for regulatory granularity,” he says. “They want to allow creativity.”

Robert Tennant, director of health information technology policy at the Medical Group Management Association agrees that ONC is not forcing the use of APIs in its MACRA proposal, but “it’s clearly in there.” For Tennant, it all comes down to one thing–“trying to find a balance between what patients want and what doctors can handle.”

“The government would say that interoperability is the seamless flow of information,” Tennant says. “But the question is, does every record need to be interoperable? Probably not.”

David Kibbe, MD, is president and CEO of DirectTrust, a collaborative non-profit association of 145 health IT and healthcare provider organizations in support of secure, interoperable health information exchange via the Direct message protocols. Kibbe is also a senior advisor to the American Academy of Family Physicians. He says with the use of FHIR, APIs will help patients get a fuller picture of their own health information, because the apps will help them access it and see it in new ways. But some aspects of developing FHIR are going to be difficult, especially with cross-organizational use cases.

Of the MACRA proposed API requirements, Kibbe says, “it will be an enormous challenge for both providers and vendors to meet the new objectives and measures within the current time frames, with all the other additional objectives and measures required.”

Bipartisan optimism

At a May 11 House Ways and Means Committee hearing on the MACRA, Slavitt said the proposal is just a starting place for the discussion. “It will take work and broad participation to get it right.”
MACRA was a bipartisan effort, and true to those roots, optimism about the proposal was also bipartisan at the hearing. Rep. Ron Kind (D-Wisc.) said MACRA is “all about finding ways to care for patients.”

Rep. Peter Roskam (R-Ill.) said, “we’re on the verge of good things.”

Via HealthDataManagement.com »