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HL7, IHE Renew Agreement for Interoperability, FHIR Collaboration

June 21, 2016
by Heather Landi
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Health Level Seven International (HL7) and Integrating the Healthcare Enterprise (IHE) have renewed their cooperation agreement to advance the goal of interoperability of health information.

In a joint statement of understanding, IHE and HL7 agreed to communicate and better coordinate schedules and projects to expedite the development and adoption of HL7 Fast Healthcare Interoperability Resources (FHIR) standard.

“These two organizations have worked in complementary roles over more than 15 years and have been essential to advancing interoperability in health IT,” Michael McCoy, M.D., co-chair of the IHE International board, said in a statement. “HL7 is the leading developer of health IT standards, and IHE has put in place a process to help drive the adoption of standards by the health IT industry.”

IHE committees and participants provide frequent feedback based on IHE implementation and testing experience to relevant HL7 work groups. HL7 and IHE collaborate on testing events and public demonstrations. Additionally, many stakeholders in health IT participate in both organizations.

“We’ve recognized a need to impart more clarity about our mutual roles for the community and the marketplace,” HL7 International CEO Charles Jaffe, M.D., said in a statement in the press release. “With the development of FHIR, HL7 has introduced new processes that may seem to overlap with IHE. Therefore, we will seek to clarify how each organization uses terms such as profile and connectathon, and most importantly, the respective roles our organizations play.”

Going forward, IHE will continue to work to identify specific clinical and operational interoperability use cases and document an implementation of existing standards to address them. The organization will incorporate standards from many different standards organizations, including HL7, W3C, DICOM, CDISC, IEEE and others.

As a platform specification, FHIR is used in many different contexts in healthcare. FHIR profiles adapt the standard for specific uses and localizations, defining the resource elements and extensions, API features, terminologies and conformance rules for targeted implementation guides (IGs). HL7 intends for implementer communities, including IHE, to use the FHIR platform to create other IGs that use FHIR, according to the release.

IHE committees have already published several profiles that reference FHIR, such as the IHE Mobile Access to Health Documents (MHD) profile that extends health information exchange to mobile platforms. The MHD profile builds on the widely adopted IHE Cross-enterprise Document Sharing (XDS) profile for exchanging medical documents (notably documents based on the HL7 Clinical Document Architecture (CDA) standards).

Similarly, to foster the rapid evolution and adoption of FHIR, HL7 FHIR connectathons visibly assess the readiness of FHIR resources, profiles and IGs among multiple stakeholders. One key innovation of the FHIR standard is its rapid development cycles, and FHIR connectathons are a prerequisite for resources and IGs progressing up the FHIR Maturity Model.

“Since 1999, IHE connectathons have provided supervised peer-to-peer testing of vendor systems for compliance with IHE profiles and are intended to speed the adoption of interoperability standards in commercially available health IT systems,” the organizations said in the press release.

To meet the challenge of FHIR’s rapid publication and review cycles, both organizations are improving coordination of roadmaps and release plans so that IHE profiles can reference the latest available release of FHIR for IHE connectathon testing.

HL7 and IHE also agreed to seek opportunities to jointly promote education and the adoption of interoperability standards to the health IT community at industry events.

 

 

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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.

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“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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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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