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Top Ten Tech Trends 2017: Blockchain’s Promise Has Healthcare Innovators Eager

March 24, 2017
by Rajiv Leventhal
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Blockchain’s budding use in healthcare can potentially solve age-old problems, but there is lots to still be worked out

Across the healthcare ecosystem, IT leaders at patient care organizations are still grappling with the critical issues of seamlessly exchanging health data across systems and also being able to properly secure it. Indeed, although the healthcare industry is behind most other sectors when it comes to interoperability and security, newfound optimism has emerged in the form of a technology that potentially can help solve both of these challenges—blockchain.

Recent momentum around blockchain in healthcare spurred Healthcare Informatics’ editors to name it as one of our Top Tech Trends for healthcare IT in 2017, despite applications of the technology still being at a nascent level, industry-wide. For a reminder, blockchain technology is most commonly associated with digital currency, and is a data structure that can be time-stamped and signed using a private key to prevent tampering.

Applied to healthcare, blockchain would offer the potential of a shared platform that decentralizes health data without compromising the security of protected health information. Chris Kay, chief innovation officer at the Louisville, Ky.-based Humana, offers a specific example of its prospective use in healthcare: “Imagine that you go to the doctor today and get a blood test, but you need to see a specialist, so a referral is made. But your health records don’t come with you; you show up to the specialist as a new patient. Here, you get a poor customer experience with a lot of friction in that system. But what will it look like in a distributed ledger world where there is cryptography and trust built in such that you as a consumer has a note on the blockchain that contains your health records? The provider who was contracted with an insurance company has the payments and scheduling on separate notes. As that provider makes a note, or does a procedure or a surgery, that becomes an indelible block on the ledger. You are building your health history over time.”

Just as importantly, noted Micah Winkelspecht, founder and CEO of Gem, a Venice, Calif.-based startup developing a blockchain application platform, in an interview with Healthcare Informatics last summer, when the interaction happens, “It becomes your integrity layer, in terms of keeping a time-stamped registry of every document, so no document can be modified without others knowing. And it provides the authenticity layer because every action is authenticated and recorded on the blockchain, so you know who is doing what with the data and at what time.” Winkelspecht, whose company is now focusing more on healthcare and has partnered with the Philips Blockchain Lab, refers to blockchain as the “universal source of truth” and “the interoperability model for how EHRs [electronic health records] should work.”


Advancements in Healthcare: Interoperability, Data Exchange, and More

Micky Tripathi, President and Chief Executive Officer of the Massachusetts eHealth Collaborative, is one of the most well-informed and well-respected healthcare IT leaders in the U.S. Tripathi has...

Micah Winkelspecht

In a more recent interview, Winkelspecht notes that this shared ledger “is not owned or controlled by any one company, but instead acts like a public utility for the entire industry.” The end result is the patient’s complete medical history, with each transaction linked together by a ledger—but not in a centralized place such as a health information exchange (HIE). In fact, this is what separates blockchain from an HIE, some experts say—there is no one organization holding all of the data in one place, but rather separate entities each holding a “token” on the chain.

“Blockchain effectively takes out the middle man; conceptually you would not have these health information exchanges that have struggled to get to mainstream,” explains Vince Vickers, KPMG’s healthcare technology leader. “There have been a lot of good efforts in certain states, and some HIEs have done well, but in relative terms, [compared] to the financial services industry—where I can go to an ATM, no matter where I am in the world, and get my money—patient data obviously is very limited in that way. And the HIEs are very slow moving. So blockchain is a really interesting disruptor. When you put it in those terms, that it could potentially, not necessarily eliminate HIEs, but at least change them structurally and provide a new value proposition, I see it as potentially picking up a lot of steam,” Vickers says.

Blockchain has recently caught the attention of federal healthcare leaders as well. The Office of the National Coordinator for Health Information Technology (ONC) last year held a “Use of Blockchain in Health IT and Health-Related Research” challenge, which involved soliciting whitepapers on blockchain’s use in healthcare. The agency named 15 winners spanning across the industry, and one key lesson learned from the whitepapers, according to Steve Posnack, director, Office of Standards and Technology at ONC, is that blockchain can complement, enhance and supplement existing infrastructure. “In these types of explorations with its use, there is potential to automate certain things that are routine transactions that otherwise involve human adjudication right now. This [includes] clinical health data exchange or administrative transactions such as financial payments on the claims side,” Posnack says.

To this end, Humana’s Kay says he sees two paths that blockchain can and should take in healthcare: one is figuring out how to flatten that supply chain; and the second is putting the customer in control of his or her health data, and allowing for a seamless exchange of interactions. By far the more inspirational path, he says, is the latter. “If the industry views the potential of blockchain to solve the problems of the industry such as claims cost management and contracting, it won’t reach its potential,” he says. “The real opportunity is to figure out, in the context of the need for us to have better integration and better experiences of better care, how can we enable more seamless care, connect people to the right providers at the right time, and do that in a safe and secure way. That’s where the majority of the value will come from, and it’s the more transformational vision [of blockchain].”

Chris Kay

Blockchain Creating Buzz at HIMSS17

At this year’s HIMSS conference in Orlando, blockchain was one of the most highly-discussed conversation pieces in regards to up-and-coming technology in healthcare. In the conference’s opening keynote, Ginni Rometty, president, chairman, and CEO of IBM, said that IBM has many blockchains in production and that “the productivity, authenticity, and transparency you can get through the data is unbelievable,” while predicting that it will “have a profound impact on healthcare.”

Meanwhile, the conference held a day-long blockchain event in which industry experts discussed possible use cases in healthcare and current challenges. The general consensus was that health IT leaders are bullish about the technology’s potential, but equally are hesitant to call it the “magic bullet” for interoperability and security.

During one of the day’s sessions, David McCallie Jr., M.D., senior vice president of medical informatics at the Kansas City-based Cerner Corporation, compared the blockchain hype level to what the industry was saying years ago about the Direct standard for secure email exchange. McCallie noted that the talk about Direct at the time was that nothing could go wrong as the technology part was settled, as was the vendor buy-in part, and the open source implementation, too. But “everything else” other than the IT created problems, including a lack of trust.

Also at HIMSS, Mac McMillan, co-founder and CEO of consulting firm CynergisTek, agreed with Cerner’s McCallie, noting that blockchain “will require real investment and adoption. And people will have to trust it.” McMillan, a notable healthcare data security expert, said that blockchain has the capability and the potential to be transformative in healthcare, and then added, “Here’s something interesting: why did Bitcoin fail? Because people didn’t trust it. It worked great—in fact, it worked so well that all the bad guys got into it. But [because of well-publicized incidents involving fraud and wrongdoing], people lost confidence in the technology, and it failed.”

McMillan, implying that investment in blockchain is not a given, continued, “Here’s an example around investment: all vendors of all kinds [restaurants, grocery stores, department stores, all retail vendors, etc.] are required by law to use electronic credit card readers. But there are still small vendors, like restaurants, that are using those little manual machines that take the physical impression of credit cards. They’re not supposed to do it, but who’s going to crack down on that? So that’s an example of where not everyone has adopted a technology.”

The Road Ahead

In the end, significant challenges remain. For one, it’s still very early on in the process. KPMG’s Vickers says, “If I went out and asked my innovative CIO friends if they know about blockchain in the healthcare industry, eight out of ten wouldn’t know what I’m talking about.” And, beyond the technical side of it, Kay points to the behavioral challenges and the ability of ecosystem partners to get together and start to work together on proof of concepts. “Healthcare is a very siloed industry with stakeholders who have not viewed radical transparency as a way to build their business,” Kay says. “We are early on as an industry, but the speed of change will be driven by learnings from financial services; so we won’t have the same trajectory as they had,” he says. Vickers and Posnack both estimate that blockchain is probably a few years away from becoming “real” in healthcare.

Winkelspecht believes that the hype is not about blockchain itself, but rather “about creating a whole new data paradigm that blockchain enables.” He notes, “While the technology will ultimately unlock trillions of dollars of efficiency currently locked in data silos, we can’t boil the ocean. Vendors must start with simpler projects that deliver clear, immediate and measurable ROI, and then we can scale to the ultimate vision.”

Kay notes that most companies are indeed still in the awareness phase right now, all the way from senior leadership down to software engineering teams, so organizations will continue to build their expertise in this space. CIOs and chief innovation officers will try to figure out how to understand and create a point-of-view about how blockchain will impact existing business models and set more tangible goals that are more action-oriented, Kay says, looking ahead to the next 12 months. “There is a lot of good work happening with blockchain, but we will see more proof of concepts this year in terms of how they are being framed and what problems they are trying to solve—[primarily] that we as consumers will be the master and owner of our own health.”

But Winkelspecht predicts that healthcare will adopt this technology, “first at the fringes in highly specific use cases with new sources of data that don’t currently fit into the existing EHR paradigm, but these use cases will [then] become proving grounds for broad adoption in the industry.”  He adds, “I think it will happen faster than finance. I would expect to see the first production healthcare blockchain application go live by the end of the year.”

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CommonWell Officials: Carequality Connection Now “Generally Available” for Members

November 16, 2018
by Rajiv Leventhal, Managing Editor
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CommonWell’s executive director said this latest step “breaks down another interoperability barrier”

Connection capabilities to the Carequality framework, by members of the CommonWell Health Alliance, are now “generally available,” according to officials who made an announcement today.

CommonWell, a trade association providing a vendor-neutral platform and interoperability services for its members, announced in August that it had started a limited roll-out of live bidirectional data sharing with an initial set of CommonWell members and providers and other Carequality Interoperability Framework adopters. This marked a key step in a collaborative effort to increase health IT connectivity across the country by enabling CommonWell subscribers to engage in health data exchange through directed queries with Carequality-enabled providers, and vice versa.

In just the first two weeks of a few CommonWell-enabled providers being connected, Jitin Asnaani, CommonWell Health Alliance executive director, said there were more than 4,000 documents bilaterally exchanged with Carequality-enabled providers.

Since then, by leveraging the technological infrastructure built by CommonWell service provider Change Healthcare, members Cerner and Greenway Health successfully completed a focused rollout of the connection with a handful of their provider clients, who have been exchanging data daily with Carequality-enabled providers, officials stated today.

Now, since the connection went live in July, officials noted  that CommonWell-enabled providers have bilaterally exchanged more than 200,000 documents with Carequality-enabled providers locally and nationwide.


Advancements in Healthcare: Interoperability, Data Exchange, and More

Micky Tripathi, President and Chief Executive Officer of the Massachusetts eHealth Collaborative, is one of the most well-informed and well-respected healthcare IT leaders in the U.S. Tripathi has...

“We are proud to break down yet another barrier to interoperability by making this much-anticipated connection available to our members and their clients,” Asnaani said in a statement today. “This increased connectivity will serve to empower providers with access to patient health data critical to their healthcare decision-making.”

In December 2016, CommonWell and Carequality, an initiative of The Sequoia Project, announced connectivity and collaboration efforts with the aim of providing additional health data sharing options for stakeholders. Officials said that the immediate focus of the work between Carequality and CommonWell would be on extending providers’ ability to request and retrieve medical records electronically from other providers. In the past two years, teams at both organizations have been working to establish that connectivity.

Together, CommonWell members and Carequality participants represent more than 90 percent of the acute EHR market and nearly 60 percent of the ambulatory EHR market. More than 15,000 hospitals, clinics, and other healthcare organizations have been actively deployed under the Carequality framework or CommonWell network.

Carequality is a national-level, consensus-built, common interoperability framework to enable exchange between and among health data sharing networks. It brings together electronic health record (EHR) vendors, record locator service (RLS) providers and other types of existing networks from the private sector and government, to determine technical and policy agreements to enable data to flow between and among networks and platforms.

CommonWell Health Alliance operates a health data sharing network that enables interoperability using a suite of services aiming to simplify cross-vendor nationwide data exchange. Services include patient ID management, advanced record location, and query/retrieve broker services, allowing a single query to retrieve multiple records for a patient from member systems.

Following the August announcement of the limited bi-directional data sharing capabilities, Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative said, “This is the ‘golden spike’ moment, connecting the two big railroads, like when AT&T and Verizon finally got connected. This is building that bridge.” Tripathi, who also directly observes and participates in conversations with Carequality and CommonWell, added, “It will take a while for all of the production sites and different vendors to get up and running. That will probably take a couple of years. But you have to have the bridge to connect them to begin.”

One key element in this progression is that currently, EHR giant Epic is not a member of CommonWell, despite other major EHR vendors pushing Epic in that direction. “Because sharing among Epic customers is already universal, when CommonWell connects to Carequality, the entire Epic base will become available, creating instant value for most areas of the country,” a recent KLAS report on interoperability stated.

Interestingly, Tripathi noted in August that once there is “general availability” of the data sharing services for all Carequality and CommonWell members, the competition factor will become less important. “It makes both networks more valuable,” Tripathi said at the time.

It appears as if that “general availability” time has now come. “Thanks to the CommonWell-Carequality connection, our patients can have access to their medical records regardless of the EHR a health care facility uses,” said David Callecod, president and CEO of Lafayette General Health, a Cerner client located in Lafayette, La. “When data is made readily available, providers can make diagnostic and treatment decisions more quickly, and patients can recover sooner. Better data means better communication with our patients and providers, better care and better outcomes. This is a very powerful tool!”

Officials also noted that with the connection officially in production, additional CommonWell members, including Brightree, Evident and MEDITECH, are in the process of subscribing to the connection and taking it live with their provider clients.

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Advancements in Healthcare: Interoperability, Data Exchange, and More

Tuesday, December 4, 2018 | 3:00 p.m. ET, 2:00 p.m. CT

Micky Tripathi, President and Chief Executive Officer of the Massachusetts eHealth Collaborative, is one of the most well-informed and well-respected healthcare IT leaders in the U.S. Tripathi has an inside look at the most significant interoperability trends that are happening nationwide and will discuss varying interoperability and data exchange efforts fit together in the bigger picture of U.S. healthcare.

Tripathi will also discuss the future of data exchange, advancements of standards such as FHIR, the reality of information blocking challenges, and more in this latest Healthcare Informatics webinar, which gives a high-level view on the many market forces that impacting nationwide interoperability.

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Epic Lowers App Orchard Program Fees, Introduces New Low-Cost Tier

November 1, 2018
by Heather Landi, Associate Editor
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Verona, Wis.-based Epic plans to lower program fees for health IT developers participating in its App Orchard program, and will launch a new entry-level program tier, called Nursery.

Epic announced the App Orchard updates at its App Orchard conference last week at its Verona headquarters, according to reporting from Politico published Oct. 26.

In an email statement, Brett Gann, App Orchard director, confirmed the company is reducing and simplifying the costs associated with participating in the app developer program. The three tiers of the program will see program fee reductions ranging from 33 to 80 percent as part of the update, Gann said.

Epic launched its App Orchard in 2017 as an online marketplace for third-party developers with 13 applications.

To date, more than 350 companies in the healthcare industry participate in Epic’s app developer program, where they have access to hundreds of application programming interfaces (APIs), documentation, testing tools, individual technical support, training, conferences, and integration with the Epic community, Gann said,

Gann also said the program updates announced last week at the annual App Orchard Conference in Verona will “engage a broader community of developers and increase access to APIs through simplified and reduced costs.”

The updates will help drive healthcare innovation as interested developers have the opportunity to build on top of Epic’s health record platform, using emerging industry standards such as FHIR (Fast Healthcare Interoperability Resources), Gann said.

Epic also announced a new program tier, Nursery, that will enable early-stage startups to enroll in the app developer program to access Epic’s public API documentation, tutorials, and sandboxes. Early-stage startups also will have access to FHIR, SMART on FHIR, and CDS Hooks, Gann said.

Enrolling in the Nursery program tier will cost participants $100 per year, Gann said, and when a company is prepared to go to market with its product, it may graduate to one of the other three tiers.

Nursery members will have access to Epic’s FHIR sandboxes, classroom and online learning opportunities, and the ability to engage with the online community of Epic, health system, and vendor developers and experts.

In addition to the program fee reductions, as part of the update, Epic will offer new program benefits to participants in the other three tiers, such as additional training opportunities, developer events, support services, sandboxes, and program accounts.

Gann also said Epic has simplified the pricing model for API-based integrations, eliminating the minimum fees, and reducing the cap. “It’s our expectation these updates will be a price reduction for nearly all program members,” he said.

Some developers, particularly smaller developers, have complained in the past that the fees to participate in the vendor app store are too steep.

Earlier this year, Politico reported the experiences of Rick Freeman, CEO of Interopion. Freeman told Politico that a family planning questionnaire app he developed for HHS’s Office of Population Health could have cost him up to $750,000 to run on Epic or Cerner for a year.

As reported by Politico in its October 26 report, in response to the program updates, Freeman said he is “very happy with the changes.”

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