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CIO Survey: FHIR is a Potential Game Changer, Blockchain Overhyped

January 23, 2018
by Heather Landi
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When it comes to IT innovation at healthcare organizations, change is happening at a very uneven pace and hospitals and health systems are approaching it in different ways, a new report finds. While a handfl of surveyed CIOs said their organizations are aggressively moving foward with formalized IT innovation efforts, other organizations are not putting more structure at all behind IT innovation right now, according to a report from Impact Advisors.

Impact Advisors surveyed College of Healthcare Information Management Executives (CHIME) CIO members to examine the current state of providers’ IT innovation efforts and to better understand future efforts. The results, provided in the report “IT Innovation Efforts at Hospitals and Health Systems,” underscores some important realities in the market right now about providers’ efforts to expand and formalize IT innovation internally.

As the report notes, traditionally, IT innovation at hospitals and health systems has been fairly ad-hoc and small in scale, often narrowly targeted on a specific problem or use case. However, given the increasingly competitive health delivery landscape, the report notes that there is no growing interest among some provider organizations to expand, and formalize, internal IT innovation efforts.

One of the key report findings is that change is happening at a very uneven pace, and there is significant divergence among hospitals and health systems in terms of plans for IT innovation. Only 14 percent of CIOs said their organization has established a dedicated IT Innovation Center. Just one-third of all CIOs said their organization has an “internal committee/working group that meets regularly about IT innovation.” Less than 20 percent have a defined portion of their IT budget formally dedicated to innovation and only 12 percent have hosted internal contests or competitions focused on IT innovation.

“At one end of the spectrum, a handful of industry leaders are putting structure and discipline behind innovation efforts, established dedicated IT ‘Innovation Centers’ and forming strategic partnerships with a variety of stakeholders, including IT vendors from other industries,” the report authors wrote. “At the same time, other hospitals and health systems are not thinking about IT innovation at all, focusing instead on just keeping up with cumbersome regulatory requirements, increasingly sophisticated cyber threats and general market uncertainty.”

Many CIOs indicated they are looking externally to drive IT innovation. Thirty-six percent of CIOs cited partnerships with enterprise electronic health record (EHR) vendors, while a quarter of CIOs said their organizations have formed partnerships focused on innovation with a healthcare IT startup. Twenty—three percent cited a partnership with a health IT vendor other than an EHR vendor, and 16 percent cited a partnership with an IT vendor from outside healthcare. Overall, close to two-thirds of respondents indicated their organizations have established strategic partnerships focused on IT innovation with at least one identified stakeholder, and more than a third cited at least two of the stakeholders.

Gauging CIOs’ perspectives on emerging technologies, HL7’s FHIR (Fast Healthcare Interoperability Resources) was seen as the technology with the most potential to make a tangible, positive impact in the next two years (chosen by half of CIO respondents). Only 16 percent cited natural language processing, 14 percent cited cloud computing and 12 percent cited machine learning.

Conversely, CIOs view blockchain as the most overhyped emerging technology (cited by 48 percent of respondents). Cloud computing also was viewed as overhyped by 23 percent of CIOs.

When CIOs were asked which area of IT innovation was their highest priority, the top response was “increasing internal operational efficiencies,” which was cite by almost half of CIOs. However, the survey takes a closer look at CIOs with the most structure currently in place around IT innovation (those organizations that have established a dedicated IT Innovation Center), and, among those CIOs, the most common response about top priorities was “enhancing the consumer/patient experience.”  That was cited by 27 percent of all CIOs as a top priority, followed by driving knowledge and discovery (14 percent).

CIO respondents also identified a number of challenges that represent significant barriers to being able to drive more IT innovation within their organization. More than two-thirds of CIOs (68 percent) said other priorities are currently more important and 59 percent cited resource capacity as a significant barrier. Funding is also viewed as a significant barrier to IT innovation, cited by 55 percent of CIOs. As the report notes, only a quarter of CIOs cited “lack of governance/structure to support innovation” as a barrier, which perhaps underscores the fact that many formalized IT innovation efforts are still in the early stages.

Thirty-four percent of CIOs also identified “lack of formal sponsorship from operational leaders” as a barrier, and 27 percent cited “resource skills” as a top challenge.

The survey also asked CIOs about future plans, and the results indicate that IT leaders are sharply divided about their plans for driving IT innovation moving forward. Over the next two years, 43 percent of CIOs said they plan to form new strategic partnerships focused on IT innovation, and 36 percent plan to create more structure internally. Other responses indicated plans to increase the number of internal staff focused on IT innovation, increasing the share of the budget dedicated to innovation, and investing in one or more healthcare IT startup companies.

However, one-third of CIOs (34 percent) said their organization has no plans to take any of the actions listed in the survey question over the next 24 months.

The report authors conclude that the uneven pace of change could lead to further separation in the health delivery market. “Provider organizations that are able to put structure behind IT innovation and set up the right strategic partnerships will get access to technology sooner, learn faster and have many more market leading opportunities with digital health than provider organizations that struggle with IT innovation,” the report authors state.

What’s more, the report authors contend that successful IT innovation requires organizational commitment, experienced leadership, a defined methodology and the right partnerships. “Starting now is essential for keeping up with industry leaders and gaining access to emerging technologies,” the report states.

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Epic Plans Meeting for Non-Epic Users on Data Sharing Capabilities

August 16, 2018
by Heather Landi
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Verona, Wis.-based Epic is inviting healthcare provider organizations that don’t use Epic’s electronic health record (EHR) to its “un-Users Group Meeting” at its Verona headquarters to learn how to exchange data with Epic.

The event, planned for September 26, will provide information to healthcare provider organizations about how to exchange charts with providers in their community who use Epic, even if providers use a different EHR— or no EHR at all.

According to Epic’s unUGM website, the event is for “executives and strategic leaders of provider organizations who want to learn and discuss how to exchange with providers in their community who use Epic.”

“Access to a patient’s information, regardless of where he or she has been seen, helps providers deliver the best patient care. The first Un-Users Group Meeting (unUGM) is another way we’re reaching out to the leaders of health systems using other EHRs—or even no EHRs—to help them get connected to the Epic users in their communities,” Dave Fuhrmann, Epic’s vice president of interoperability, said in a prepared statement.

According to the event agenda, topics of discussion include options for exchanging patient data with providers through Carequality, Care Everywhere, health information exchange (HIE) and Direct messaging, as well as patient-directed options, including MyChart, Share Everywhere, Lucy, and Blue Button.

There will also be discussion about interoperability success stories, using both non-Epic and Epic EHRs, and the current state of coordinated care in the U.S. and the use of existing tools to close care gaps, improve communication, and reduce costs.

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Amazon, Google, IBM and Other Tech Giants Pledge to Remove Barriers to Interoperability

August 14, 2018
by Heather Landi
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Six of the world's biggest technology companies, including Microsoft, Google, IBM and Amazon, made a joint pledge at the White House Monday to remove interoperability barriers and to make progress on adoption of health data standards.

The announced came during the Blue Button 2.0 Developer Conference in Washington, D.C. where Microsoft joined with Amazon, Google, IBM, Salesforce and Oracle to jointly commit to support healthcare interoperability by advancing healthcare standards such as HL7 (Health Level Seven International), FHIR (Fast Healthcare Interoperability Resources), and the Argonaut Project. They also pledged to remove interoperability barriers, particularly as it relates to the adoption of technologies enabled through the cloud and artificial intelligence (AI).

Dean Garfield, president and CEO of the Information Technology Industry Council, said in a statement, “Today’s announcement will be a catalyst to creating better health outcomes for patients at a lower cost. As transformative technologies like cloud computing and artificial intelligence continue to advance, it is important that we work towards creating partnerships that embrace open standards and interoperability.

“We commend the White House Office of American Innovation for their leadership in being a catalyst for moving health care beyond siloed systems and varied data standards. As well, we celebrate Amazon, Google, IBM, Microsoft, Oracle, and Salesforce for their commitment to helping to advance open healthcare standard. The opportunity to unleash greater innovation in health care is here and working together we can seize it,” Garfield said.

In a joint statement, the technology companies made a commitment to remove barriers to “frictionless data exchange,” noting that they share “the common quest to unlock the potential in healthcare data, to deliver better outcomes at lower costs.”

The commitment specifically states:

“In engaging in this dialogue, we start from these foundational assumptions: The frictionless exchange of healthcare data, with appropriate permissions and controls, will lead to better patient care, higher user satisfaction, and lower costs across the entire health ecosystem.

Healthcare data interoperability, to be successful, must account for the needs of all global stakeholders, empowering patients, healthcare providers, payers, app developers, device and pharmaceuticals manufacturers, employers, researchers, citizen scientists, and many others who will develop, test, refine, and scale the deployment of new tools and services.

Open standards, open specifications, and open source tools are essential to facilitate frictionless data exchange. This requires a variety of technical strategies and ongoing collaboration for the industry to converge and embrace emerging standards for healthcare data interoperability, such as HL7 FHIR and the Argonaut Project.

We understand that achieving frictionless health data exchange is an ongoing process, and we commit to actively engaging among open source and open standards communities for the development of healthcare standards, and conformity assessment to foster agility to account for the accelerated pace of innovation.”

Gregory J. Moore M.D., Ph.D., vice president of healthcare, Google Cloud, said in a statement, “We are pleased to join others in the technology and healthcare ecosystem in this joint commitment to remove barriers and create solutions for the adoption of technologies for healthcare data interoperability. This will enable the delivery of high quality patient care, higher user satisfaction, and lower costs across the entire healthcare ecosystem.”

Patients should have access to their data, said Mark Dudman, head of global product and AI development, IBM Watson Health, in a statement following the announced commitment. Patients also should have the flexibility to use products and services across different healthcare systems, with confidence that they all are working seamlessly for their care, he said. “We are proud to participate in this pledge and look forward to working with industry and the developer community to ensure appropriate access to data and the use of that data to support vibrant communities and solve health challenges for people everywhere.”

In a blog post, Josh Mandel, chief architect, Microsoft Healthcare, notes that interoperability is an overlapping set of technical and policy challenges, from data access to common data models to information exchange to workflow integration – and these challenges often pose a barrier to healthcare innovation.

Mandel, who previously worked at Google Life Sciences and on the research faculty at Boston Children’s Hospital where he worked on the SMART Health IT Platform, notes that support for the Meaningful Use Common Clinical Data Set grows and it is becoming easier to plug new tools into clinical workflows, analyze clinical histories, collect new data, and coordinate care.” Many of these technical capabilities have been available within small, tight-knit health systems for a long time – but developing these capabilities has required complex, custom engineering and ongoing maintenance and support. Driving toward open architecture makes adoption faster, easier and cheaper,” he wrote.

True interoperability in healthcare requires end-to end solutions, rather than independent pieces, which may not work together, Mandel wrote. “Transforming healthcare means working together with organizations across the ecosystem. Today’s joint interoperability statement reflects the feedback from our healthcare customers and partners, and together we will lay a technical foundation to support value-based care.”

 

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Industry Stakeholders Urge ONC to Move Forward on Information Blocking Rules

August 8, 2018
by Heather Landi
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In a strongly worded letter to National Coordinator Donald Rucker, M.D., several healthcare and health IT industry groups expressed frustration with the Office of the National Coordinator for Health IT’s lack of progress in publishing information blocking regulations, as required in the 21st Century Cures Act.

“It has been 601 days since the 21st Century Cures Act was signed into law. Every day that the administration delays implementation of these critical provisions places patients at risk of harm,” the letter states. Stakeholders including Health IT Now, Research!America, Oracle, the American Medical Informatics Association (AMIA), the American Academy of Family Physicians, Cambia Health Solutions and Claim Your Health Data Coalition signed the letter dated August 6.

In the letter, addressed to both Dr. Rucker and Daniel Levinson, inspector general of the Department of Health and Human Services (HHS), the stakeholder groups note that the 21st Century Cures Act, which was enacted in December 2016, requires the HHS Secretary to “issue regulations to prevent information blocking and to also identify reasonable and necessary activities that do not constitute information blocking.” Further, the law requires ONC to implement a standardized process for the public to submit reports on claims of health information technology products or developers of such products not being interoperable or resulting in information blocking and actions that result in information blocking. “The Office of the Inspector General (OIG) has enforcement authority over vendors and providers who are found to engage in information blocking,” the letter states.

The stakeholder groups also contend that “information blocking poses a significant risk to patient safety and greatly contributes to increased costs and waste in the health care system.”

According to reporting from Politico, during ONC’s 2nd Interoperability Forum this week in Washington, D.C., Rucker told the form audience that ONC is still working on the rule. The rule’s release has been delayed several times and is not expected to be released in September.

“Rucker emphasized Monday that his goal is to make protocols and standards that would let large amounts of health data flow easily between health providers, not just individual patient charts. He and other officials emphasized that ONC’s work is all being done within the confines of HIPAA,” the Politico article stated. Rucker also noted that properly defining which behaviors do and don’t constitute information blocking is “hard to sort out,” and the rule is a “work in progress,” Politico reported.

In a separate statement regarding ONC's delay in issuing an information blocking proposed rule, Douglas Fridsma, M.D., Ph.D., AMIA president and CEO, said, "Information blocking is the absence of interoperability, and there are numerous reasons why information may not flow as intended. Some of these reasons are technical, others for business or policy reasons. The socio-technical interoperability stack is complex and so too is the task of identifying which among its layers is responsible for information blocking. This rule must be critically calibrated to account for these layers, and it must be part of a larger conversation about how we will address other aspects of the socio-technical interpretability stack. Now is the time to initiate this broad conversation through release of the proposed information blocking rule."

In the letter, the industry groups also cautioned that “information blocking impedes provider access to the most current, accurate or complete information on their patients. As the administration proposes and implements new rules related to open APIs and interoperability in Medicare’s payment rules for hospitals and doctors, the lack of clear rules of the road needlessly creates uncertainty for vendors and providers alike.”

“We understand the nuance required but feel that it is past time for a proposal to be made,” the stakeholder groups wrote in the letter.

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