HHS ups its efforts to foster interoperability

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 »

Slavitt: Vendors Bear Burden to Deliver On Promise of Health IT Connectivity

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 »

Is ONC putting too much hope on the cloud?

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 »

Internet of Things impacts hospitals, health care facilities

The Internet of Things will continue to grow at hospitals as data become easier to share


by Jeff Ferenc

It may be tempting to dismiss it as just another buzz phrase in a field bursting at the seams with jargon, but the Internet of Things (IoT) is here to stay in the health care facilities world. And it’s likely to continue to grow in popularity as hospitals leverage technologies in multiple ways to increase efficiency.

In basic terms, IoT gives things from cars to medical devices to building systems the ability to store and share valuable information through the use of data-capturing sensors and radio-frequency identification (RFID).

To varying degrees, many, if not most, hospitals have utilized the IoT for purposes from asset management to controlling temperature and humidity in operating rooms for a number of years. And health care technology and facility experts interviewed for this article expect that the IoT will only expand.

“IoT really is about connectivity, about trying to ensure if there’s a piece of information available to trigger an action, that the action can happen,” says Paul Currie, assistant vice president of enterprise architecture, HCA (Hospital Corporation of America), Nashville, Tenn.

“For instance, I’m thinking about situations in patient rooms where you want a specific temperature if the room is occupied and, if it’s not occupied, that temperature will change. That absolutely is the IoT,” he says.

Another example of how IoT can promote efficiency is a sensor collar for fire extinguishers that remotely detects the condition of a device and whether it needs to be replaced, Currie says. The shared data replace manual checks.

Brendon Buckley, health care technology director, North America, Johnson Controls, Milwaukee, says that the use of sensors leveraging data transmitted from machine to machine has existed for some time in uses such as building automation and environment optimization. “It just wasn’t called IoT,” he notes.

The phrase “Internet of Things” was coined in 1999 in response to a supply chain challenge that was solved through the use of a microchip and a radio receiver that tracked a popular cosmetic product’s inventory status.

Perhaps the highest level of the IoT found in health care today is represented by the Mercy Virtual Care Center, Chesterfield, Mo., says Ted Hood, senior vice president and chief operating officer, GBA, a health care technology consulting firm in Franklin, Tenn.

Opened in 2015, the $50 million virtual care center delivers around-the-clock care through audio, video and data connections by clinical and support staff to remotely monitor patients in four states. Hood expects a growing number of health care systems to incorporate some of the benefits offered by the virtual care center.

IoT expansion poses challenges. Expanded use of data sharing may strain data centers for one.

“As patient monitoring expands to the home and use of wearable devices, clinicians’ monitoring of chronic conditions and incorporation of predictive analytics will increase demands on facility infrastructure and data center requirements,” he says.

The inability of proprietary medical devices to share data with each other will require development of a plug-and-play platform with a standard language. The Center for Medical Interoperability, Nashville, has undertaken that issue as its mission.

Security concerns likely will increase as the level of shared data rises with the growth of IoT. “The volume of data is going to grow substantially along with maintaining security to ensure there are no HIPAA violations or cyberattacks,” Hood says.

As challenges are met and managed, which sources say they are confident will occur in good time, the IoT will create the promise of improved health care.

“All these systems are going to have an incredible impact on care efficiency and without spending a lot of extra money,” according to Andrew Quirk, senior vice president, health care center of excellence, Skanska USA, Nashville. “We just need to be intelligent about how we integrate them.”

Via hfmmagazine.com»

FCC auction will complicate patient-monitor airwaves

By Adam Rubenfire  | March 18, 2016

Despite objections by hospitals, the Federal Communications Commission is proceeding with an airwave auction next week that will force unlicensed wireless devices onto a channel previously reserved for patient monitors.

The FCC will sell licenses for much of the 600 MHz spectrum, allowing only unlicensed use on Channel 37, which has so far been blocked off exclusively for Wireless Medical Telemetry Systems, which allow vital-sign sensors to communicate with patient monitors and nurse station monitors. Allowing unlicensed devices onto the channel could cause interference with equipment that is critical to patient care, hospitals and advocates say.

Although the FCC has established 380-meter zones around hospitals where use of unlicensed devices will be prohibited, those zones are inadequate, said Erik Rasmussen, vice president of legislative affairs for the American Hospital Association. The AHA is calling for a standard buffer zone of at least three kilometers around hospitals. The FCC has said the zones can be extended at the request of a facility if needed.

“Hospitals need to continue using dedicated bands free of interference for patient monitoring,” Rasmussen said in a statement. “We are concerned that the protection zones for hospitals are not large enough, and once unlicensed devices begin operating nearby, patient safety may be endangered.”

While unlicensed devices still need to be certified by the FCC, new devices will likely have a more powerful signal than WMTS, which could make it easier for them to interfere with patient monitoring, said Mitchell Ross, a wireless health expert at the Center for Medical Interoperability. Staff at hospitals are relatively inexperienced in the telecommunications area, so they’ll have to flag problems to administrators who might then have to sue to stop interference, he said.

Electronics manufacturers have argued that freeing up the channel will allow for innovation in health gadgets and remote patient monitoring. But Ross said those kind of devices can use Wi-Fi or cellular networks – they don’t need to take space from WMTS.

“Patient care needs its own allocated frequencies,” Ross said. “600 MHz was a great stage for it to be until somebody said, hmm, I’d like to make money off that.”


LHC in DC: Waiting for the Insure TN stars to align

Group also hears about rise in interoperability, impact of Trump

authors Staff Reports

Editor’s note: This is the first post from the Nashville Health Care Council’s 2016 Leadership Health Care Delegation to Washington. Look for more content in the coming days and click here for other entries from past years’ visits.

Leadership Health Care kicked off its two-day delegation to Washington, D.C., on Monday afternoon with a series of speakers focused on Medicaid policy, the interoperability of health care technology systems and — of course — the 2016 presidential race.

With the presidential primary season heating up, the delegation gathered in the W Hotel, adjacent to the White House grounds, and heard first from Politico Congressional Reporter Jake Sherman, who provided a look at what’s happening on the campaign trail and how members of Congress are responding to the seeming inevitability that Donald Trump will become the Republican Party’s nominee.

“This is probably one of the most surreal, unreal political moments we’ve ever been in,” Sherman said, giving the delegates a recent history of Republican politics to provide some rationale for the rise of Trump and providing an inside look into how Congressional Republicans are positioning themselves ahead of a Trump nomination.

“You’re going to see members of Congress all over the country distance themselves from Trump and (try to) save themselves from losing in what could be a very bad year for Republicans,” Sherman said.

Regardless of who is in the White House, TennCare Director Darin Gordon said he doesn’t see the tension between the federal government and state Medicaid programs changing any time soon. Gordon, who was interviewed by Matt Salo, executive director of the National Association of Medicaid Directors, said Tennessee and all states struggle to get the flexibility they need to be successful within the Centers for Medicare and Medicaid Services’ “homogeneous” approach to Medicaid policy.

With that need for flexibility in mind, Gordon talked about Tennessee’s failed attempt to earn legislative approval for the state’s own approach to expanding Medicaid under the Affordable Care Act.

“Part of what people don’t realize is we expanded (TennCare) in 1994, greater than anybody in the entire country ever has or probably ever will. It was greater than what the ACA contemplated by far,” he said. But the unsustainability of that expansion created an impossible uphill battle for Insure Tennessee, despite the program’s approval by CMS.

He said he thinks Tennessee will eventually join the 30 states that have already expanded Medicaid under the ACA, but “it’s going to be some time before we can get all the stars aligned.”

Later in the afternoon, a panel of experts discussed the state of interoperability of health care systems. Dr. Vindell Washington, principal deputy national coordinator of the Office of the National Coordinator for Health Information Technology, explained how the meaningful use program spurred the rapid adoption of electronic medical records over the past few years — to a point where 96 percent of all hospitals and three-quarters of physician practices have implemented EMRs.

But the industry has not yet figured out how to achieve true interoperability of information systems to support the overarching goal of delivering patient-centered care. Jitin Asnaai, executive director of CommonWell Health Alliance, said one of the several barriers to achieving interoperability is a cultural one — that during decades of moving toward greater and greater specialization, the health care industry hadn’t thought about how data flows between providers. And, perhaps worse, many physicians have come to assume that you just “won’t get the data.”

The nonprofit Center for Medical Interoperability is one of the organizations trying to chip away at this problem. Kerry McDermott, the organization’s vice president of public policy and communications, explained how health systems are working together through the Center to develop a “reference architecture” that is a blueprint for how medical devices should connect to share data. The organization — with board members including leaders from Community Health Systems, Vanderbilt, Ascension Health, LifePoint and HCA — is based in Nashville because the city has the “right culture in driving collaboration,” she said.

Via» Nashville Post

The Patient Safety Movement Announced 49 Medical Technology Companies Have Signed the Pledge to Share Data

IRVINE, Calif.–(BUSINESS WIRE)–The Patient Safety Movement Foundation announced today that 49 healthcare technology companies have signed the Patient Safety Movement’s Open Data Pledge, a public pledge to share their data to promote patient safety.

The pledge is designed to foster a marketplace of data analytics to encourage entrepreneurs to develop novel uses of health data that will improve patient safety and reduce preventable deaths. If enough medical technology companies share the data their products are purchased for, it allows engineers and researchers to develop predictive algorithms that notify clinicians and patients of dangerous trends. The pledge does not ask any company to share protected or proprietary data or not follow all the privacy laws. Companies can make their pledge online at http://patientsafetymovement.org/commitments/medical-technology-company-commitments/.

“From 9 companies in 2013 to now, 49 companies have made the pledge to share their data with whomever can use the data to create analytics and algorithms that may detect the ailment of the patient, and predict the patient’s health and direction of health to help caregivers prevent harm before it happens,” said Joe Kiani, Founder of the Patient Safety Movement Foundation. “We thank each and every one of these companies who are leading the way to safer patient care by giving their data. With data sharing, we will hopefully also unlock the mysteries behind cancer and heart disease and help identify therapies that are most likely to work. So what we’ve started here to treat the third leading cause of death – preventable patient harm, may one day even help the first and second causes of death.”

“I lost the love of my life to an information coordination error event that could have and should have been prevented,” said Brent Nibarger. “Had the data sharing pledge happened 5 years sooner, the types of algorithms the Patient Safety Movement speaks about likely would have saved my wife’s life. It’s important to remember that every preventable death statistic represents someone’s wife, husband, father, mother, brother, sister, or child and thus the resulting emotional, financial and family implications of these events reach far, far beyond what the reported numbers reflect. The caliber of companies that have stepped forward to join in this initiative to put patient safety first is incredible and it gives me hope for a safer patient care environment in the future.”

“The Patient Safety Movement was the first organization to connect the dots between data sharing and patient safety and then do something about it,” said Richard A. Packer, CEO of ZOLL. “We signed the pledge in 2013 with a handful of other companies. The movement has come a long way. We look forward to continuing to work closely with the Patient Safety Movement Foundation in eliminating preventable patient deaths.”

Ed Cantwell, Executive Director of the Center for Medical Interoperability, said, “We launched the Center shortly after the first press release from the Patient Safety Movement announcing nine companies had signed the pledge to share data. The Center as a provider-led centralized R&D lab, will drive plug and play interoperability from the point of care to and from enterprise systems. With 49 companies making the pledge and the launch of the Center, we know that we are very close to making patient care safe and effective systematically, in addition to our extraordinary caregivers. We will work with the Patient Safety Movement to make patient data help save patients’ lives by making the Patient Data Superhighway faster and fully interoperable.”

To date, the following 49 companies have made a pledge to share data:

Admetsys LiDCO Group
AirStrip Masimo
ATL Technology, LLC Medical Intelligence

BrainStem Biometrics

Medical Simulation

Modulated Imaging

Cerner Monarch Medical
Certa Dose NeurOptics
Codonics Oracle
CorCardia Group Inc. Patient Valet
CRISI Medical Systems, Inc. PerceptiMed
CrossChx Philips Healthcare
Data Diagnostix Predixion
DebMed RGP Healthcare
Deltex RightPatient

S.E.A. Medical Systems, Inc.

Dynalabs Securisyn Medical
EarlySense Smiths Medical
ExCor Technologies, LLC SonoSite Inc.
GE Healthcare Sotera Wireless
Hyginex SurgiCount Medical, Inc.
IBM Watson Health True Process
ICUcare LLC Welch Allyn
Innara Health Zoex
Iradimed ZOLL Medical
Kolkin Corp

About The Patient Safety Movement Foundation

More than 3,000,000 people worldwide, and 200,000 people in the US die every year in hospitals in ways that could have been prevented. The Patient Safety Movement Foundation was established through the support of the Masimo Foundation for Ethics, Innovation, and Competition in Healthcare, to reduce that number of preventable deaths to 0 by 2020 (0X2020) in the US and dramatically worldwide. Improving patient safety will require a collaborative effort from all stakeholders, including patients, healthcare providers, medical technology companies, government, employers, and private payers. The Patient Safety Movement Foundation works with all stakeholders to address the problems and solutions of patient safety. The Foundation also convenes the annual World Patient Safety, Science and Technology summit. The Summit presents specific, actionable solutions to meet patient safety challenges, encouraging medical technology companies to share the data for which their products are purchased, and asking hospitals to make commitments to implement Actionable Patient Safety Solutions. Visit www.patientsafetymovement.org.

Via Business Wire » 

Center for Medical Interoperability Statement Supporting Commitments to Improve the Flow of Health Information

NASHVILLE, Tenn. (March 1, 2016) –

“We are encouraged by the pledges to make health information easily and securely accessible. The public and private sectors must work together to advance this national priority, and we appreciate HHS’s leadership and commitment to our shared goals. The Center is engaging in its capacity as a cooperative R&D arm for health systems, guiding innovation and providing a vendor-neutral focal point to work with solution providers,” said Michael M. E. Johns, MD, founding chairman of the Center for Medical Interoperability and emeritus executive vice president for health affairs, president, CEO and chair, Emory Healthcare.

“The need for health information begins at the patient bedside. It’s a complex, challenging environment for nurses and we must create real-time records that are complete and consistent. This means breaking down proprietary silos at all levels of exchange and making it easier to share clinically rich data across medical devices and IT systems. The Center looks forward to collaborating on this,” said Michael Schatzlein, MD, vice chairman of the Center for Medical Interoperability and senior vice president and group ministry operating executive of Ascension Health.

Read the Center’s Interoperability Shared Commitment Pledge »

About the Center for Medical Interoperability

The Center for Medical Interoperability is a 501(c)(3) organization led by health systems to change how medical technologies work together. We aim to improve real-time information flow and make technology function seamlessly in the background so we can achieve the best possible outcomes for patients. Our members are committed to compelling change and improving patient safety, care quality and outcomes, and reducing clinician burden and waste. Learn more at www.center4mi.org.

HHS announces major commitments from healthcare industry to make electronic health records work better for patients and providers

Health information technology developers that provide 90 percent of electronic health records used by U.S. hospitals and five largest healthcare systems agree to implement three commitments to improve the flow of health information

Today, U.S. Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell announced that companies that provide 90 percent of electronic health records used by U.S. hospitals, the nation’s five largest private healthcare systems, and more than a dozen leading professional associations and stakeholder groups have pledged to implement three core commitments that will improve the flow of health information to consumers and healthcare providers. Secretary Burwell made the announcement at the Health Information Management Systems Society conference attended by more than 40,000 health IT professionals, clinicians, executives, and vendors from around the world. The three commitments are:

  • Consumer Access: To help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community. Many of the biggest health IT developers have committed to using standardized application programming interfaces and a single shared standard for communicating with one another, Health Level 7 – Fast Health Care Interoperability Resources (FHIR®), so that user-friendly resources, like smartphone and tablet apps, can quickly be made market-ready and compatible with one another. These advances will make it easier for consumers to access their test results, track progress in their care, and communicate with their providers.
  • No Information Blocking: To help providers share individuals’ health information for care with other providers and their patients whenever permitted by law, and not block electronic health information (defined as knowingly and unreasonably interfering with information sharing). The report to Congress by the Office of the National Coordinator for Health IT (ONC) discussed the prevalence of information blocking.
  • Standards: Implement federally recognized, national interoperability standards, policies, guidance, and practices for electronic health information, and adopt best practices including those related to privacy and security. Many of these market leaders are embracing ONC’s Interoperability Standards Advisory—a coordinated catalog of existing and emerging standards and implementation specifications. This guidance is updated annually in order to keep pace with developments in the health IT industry. By identifying current best practices in standards, this advisory will assist healthcare providers to more easily collaborate with one another and share data across “interoperable” electronic health records.

“These commitments are a major step forward in our efforts to support a healthcare system that is better, smarter, and results in healthier people,” HHS Secretary Sylvia M. Burwell said. “Technology isn’t just one leg of our strategy to build a better healthcare system for our nation, it supports the entire effort. We are working to unlock healthcare data and information so that providers are better informed and patients and families can access their healthcare information, making them empowered, active participants in their own care.”

Currently, electronic health information flows only in pockets of the healthcare system and business practices can inhibit data sharing. Even when electronic health information is shared, it can be underutilized and difficult to access due to hard-to-use technology or the use of different standards. The commitments by health IT developers who provide electronic health records to the vast majority of the inpatient market, healthcare systems who serve patients in 46 states, and leading professional associations and stakeholder groups will help lead to a future where electronic health data is shared seamlessly and is easily accessible when and where it matters most to providers and consumers. To see a full list of individual organizations that have made commitments and their pledges, visit www.healthit.gov/commitment.

“The future of the nation’s health delivery system is one where electronic health information is unlocked and shared securely, yet seamlessly, to put patients at the center of their own care,” said Karen B. DeSalvo, M.D., M.P.H., M.Sc., national coordinator for health information technology. “The broad agreement by leaders in health and health IT across the nation brings us much closer to our vision for a truly learning, connected health system.”

The commitments announced today, together with the Federal Health IT Strategic Plan 2015-2020 and final Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap , are designed to put the nation on a path to real, sustainable progress in the near-term to achieving better care for patients as a result of better information flow. As of 2014, nearly all hospitals and three-quarters of physicians use certified electronic health records. Today’s announcement is a major milestone in assuring those systems talk to one another—a critical foundation for precision medicine and a healthcare system where providers are paid for quality and collaboration.

Via HHS.gov »

Interoperability: Why is it so hard?

Most everyone agrees that interoperability — enabling healthcare information to flow seamlessly between disparate devices and IT systems — would improve patient care and reduce costs. Yet despite all the new technologies and gadgets, there’s still a disconnect when it comes to actually being able to share health data.

One of the factors driving the interoperability challenge is that the different medical device and health IT manufacturers each have their own proprietary interface technology, so there’s no way to connect the disparate parts, said Kerry McDermott, vice president for public policy and communications at the Center for Medical Interoperability. Without a common interface — something akin to a USB cord — hospitals are forced to spend scarce time and money setting up each technology in a unique way.

Adding to the problem that there is no overarching architecture for creating interoperability. “In healthcare, we don’t have that blueprint for how the different pieces should fit together,” McDermott said.

Another problem has been the lack of standards. Unlike a two-by-four that really never varies, in healthcare you don’t always know what you’re getting. This is beginning to change, though, with groups like Integrating the Healthcare Enterprise. “IHE came up with all these standards and we adopted them,” said Daniel Pettus, vice president for IT sales for BD’s Medical Management Group.

BD has been working with Epic and Cerner to facilitate information flow between its infusion pumps and EHRs. “We haven’t seen any reluctance in the IT community to share information in order to expand the capability” said Pettus. The biggest barrier to interoperability, he said, is alignment — getting devicemakers and IT companies to talk with one another.

Pettus cited, by way of example, a medication order. In the past, clinicians would generate an order in the IT system and that order was filtered down to the nurse who interpreted it based on information in an infusion pump, creating the potential for errors to occur, he explained. With connectivity, every single order that’s generated in the IT system must match the information in the infusion pump. “It’s a wonderful thing when it happens because, for the first time, you can guarantee that the order generated upstream by the doctor really matches” the information at the point of care, he said, adding, “That’s just not the case today.”

EHR vendors have also expressed frustration with the lack of interoperability, made more glaring with the shift to electronic health records. According to one study, 70% of physicians are spending less time with patients because of the demands of electronic record entry. The problem spurred athenahealth to launch a ‘Let Doctors Be Doctors’ campaign last October.

McDermott understands that frustration. “Hospitals and health systems don’t want to pay for things that don’t work together in a plug-and-play way, because it’s not good for patients,” she said. “There are absolute implications for patient safety, clinical care outcomes, clinician fatigue. We’re exhausting our workforce because they have to spend so much time troubleshooting the technology instead of having it function seamlessly in the background.”

CMI spun out of the West Health Institute early last year with the goal of creating a space for health systems and other stakeholders to meet and solve their interoperability challenges. The nonprofit is assembling a technology coalition of providers, devicemakers and IT vendors to develop the reference architecture for an interoperability platform, as well as medical device and enterprise interfaces to the platform.

In addition, CMI is establishing a centralized laboratory where engineers and other technical experts can work on shared challenges around getting medical devices, EHRs and IT systems to work in a plug-and-play way. The lab, located in Nashville, will also test and certify that devices and IT systems conform to the standardized architecture.

The goal is to ensure that the architecture is vendor-neutral and supports real-time one-to-many communications, two-way data exchange, plug-and-play integration of devices and systems, the use of standards and the highest level of security, McDermott said.

“At the end of the day, we’re trying to make it easier and less expensive for devices to talk to each other, for devices to talk to EHRs and to other systems that support patient care and clinical decisionmaking, not to mention consumer access to information,” she said.

For Cerner, interoperability involves working with competitors and industry partners to achieve more “meaningful connectivity using available standards and creating new ones where there are gaps,” said Cerner VIce President of Interoperability Bob Robke. “Our ongoing innovation includes an open platform that strengthens scope and service along the continuum of care, making it easier and faster for developers to create apps that meet the needs of people and their healthcare providers,” he said.​

The federal government has also been involved in the press for greater health interoperability. Last October, the Office of the National Coordinator for Health Information Technology released its final roadmap on interoperability. Guiding it are three overarching themes: the need to move to a value-based healthcare system that enables consumers to access and share personal health data; the need to eliminate obstacles, whether intentional or inadvertent, to data sharing across organizational boundaries; and the need for federally recognized interoperability standards.

And on Jan. 26, the Food and Drug Administration released draft guidance on design considerations for manufacturers of  interoperable medical devices. Testing of devices should focus on the risks associated with interoperability, the potential for misuse and likely scenarios of events that could compromise patient safety.

In addition, the Senate’s Health, education, Labor & Pensions Committee last month unveiled legislation aimed at enhancing overall use and development of health IT. Among its proposals is the creation of a “trusted exchange network” for information sharing across health systems, EHR vendors and consumers. The bill would also create a set of “standardized data elements,” so that information could be easily entered and shared in patient registries.

The Improving Health Information Technology Act, S. 2511, is one of seven bills the Senate plans in answer to the House of Representative’s sweeping 21st Century Cures healthcare reforms bill.

Such initiatives notwithstanding, moving interoperability forward is a slow process and will take a concerted effort by the provider community, EHR vendors and devicemakers working together to tackle the obstacles. CMI hopes to provide that space. “You really need a place for all parties to say we should work with this architecture within the platform it creates, and everyone has access to the data in that platform and we can all compete on top of that,” McDermott said.

Via HealthcareDive »