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Partners HealthCare, Persistent Systems Collaborate on Digital Platform for Clinical Care

April 25, 2017
by Rajiv Leventhal
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Boston-based Partners HealthCare has announced a strategic collaboration with Persistent Systems to develop a new industry-wide open-source platform with the goal of bringing digital transformation to clinical care.

Persistent, a software developer for various industries, based in India, will look enable the digital transformation of clinical care at Partners and, together with Partners, “develop an open-source platform to lower the barriers for knowledge exchange across healthcare providers and enable a new generation of decision support apps in the clinical environment,” according to an announcement from the organizations. This four-year collaboration will bring together clinicians and researchers at Partners HealthCare with Persistent’s healthcare technology and product engineering knowhow.

The co-developed digital platform will be based on SMART (open, standards-based technology platform) along with FHIR (Fast Healthcare Interoperability Resources). “The platform will enable provider systems across the country to rapidly and cost effectively deploy industry-leading best practices in clinical care across their ecosystems,” the press release stated.

“Making innovative clinical tools available to our physicians at Partners and across the country relies on strong collaborations between academia and industry,” said Anne Klibanski, M.D., chief academic officer at Partners HealthCare, an integrated health system founded by Brigham and Women’s Hospital and Massachusetts General Hospital. “The co-development of this platform should yield a new set of tools that integrates applications directly into the clinical workflow -- ultimately improving patient care.”

Sudhir Kulkarni, president of digital at Persistent Systems, noted in statement that the collaboration serves as “a powerful example of how healthcare visionaries and leaders in technology can create positive disruption. By combining forces with Partners HealthCare to design this platform, we’re bringing continuous transformation to the very essence of the healthcare experience. We’re confident this is just the start.”

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ONC Releases Interoperability Standards Advisory Reference 2019

January 15, 2019
by Heather Landi, Associate Editor
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The Office of the National Coordinator for Health IT (ONC) has released the 2019 Interoperability Standards Advisory (ISA) Reference Edition, which serves as a “snapshot” view of the ISA.

The 2019 Interoperability Standards Advisory represents ONC’s current assessment of the heath IT standards landscape. According to ONC, this static version of the ISA won’t change throughout the year, while the web version is updated on a regular basis. The ISA contains numerous standards and implementation specifications to meet interoperability needs in healthcare and serves as an open and transparent resource for the industry.

The Interoperability Standards Advisory (ISA) process represents the model by which ONC coordinates the identification, assessment, and public awareness of interoperability standards and implementation specifications that can be used by the healthcare industry to address specific interoperability needs including, but not limited to, interoperability for clinical, public health, research and administrative purposes. ONC encourages all stakeholders to implement and use the standards and implementation specifications identified in the ISA as applicable to the specific interoperability needs they seek to address. Furthermore, ONC encourages further pilot testing and industry experience to be sought with respect to standards and implementation specifications identified as “emerging” in the ISA.

The newest ISA reference edition includes improvements made based on comments provided by industry stakeholder during the public comment period, which ended Oct. 1, according to a blog post written by Steven Posnack, executive director of ONC’s Office of Technology, Chris Muir, standards division director, Office of Technology, and Brett Andriesen, ONC project officer. ONC received 74 comments on the ISA this year, resulting in nearly 400 individual recommendations for revisions.

According to the blog post, the ISA contains “a variety of standards and implementation specifications curated by developers, standards gurus, and other stakeholders to meet interoperability needs (a term we use in the ISA to represent the purpose for use of standards or implementation specifications – similar to a use case) in healthcare.”

“The ISA itself is a dynamic document and is updated throughout the year, reflecting a number of substantive and structural updates based on ongoing dialogue, discussion, and feedback,” Posnack, Muir and Andriesen wrote.

The latest changes to the reference manual include RSS feed functionality to enable users to track ISA revisions in real-time; shifting structure from lettered sub-sections to a simple alphabetized list; and revising many of the interoperability need titles to better reflect their uses and align with overall ISA bets practices. According to the ONC blog post, the updates also include several new interoperability needs, including representing relationship between patient and another person; several electronic prescribing-related interoperability needs, such as prescribing weight-based dosing and request for refills; and operating rules for claims, enrollment and premium payments.

The latest changes also include more granular updates such as added standards, updated characteristics and additional information about interoperability needs.

The ONC officials wrote that the ISA should be considered as an open and transparent resource for industry and reflects the latest thinking around standards development with an eye toward nationwide interoperability.

The ISA traditionally has reflected recommendations from the Health IT Advisory Committee and its predecessors the HIT Policy Committee and HIT Standards Committee and includes an educational section that helps decode key interoperability terminology.

 

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ONC Report: Health IT Progress Stifled by Technical, Financial Barriers

January 15, 2019
by Heather Landi, Associate Editor
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While progress has been made in the adoption of health IT across the U.S. healthcare industry, significant interoperability hurdles remain, including technical, financial and trust barriers, according to a report from the Office of the National Coordinator for Health Information Technology (ONC).

Currently, the potential value of health information captured in certified health IT is often limited by a lack of accessibility across systems and across different end users, the ONC report stated.

The annual report from the U.S. Department of Health and Human Services (HHS) and ONC to Congress highlights nationwide health IT infrastructure progress and the use of health data to improve healthcare delivery throughout the U.S.

The report, “2018 Report to Congress: Annual Update on the Adoption of a Nationwide System for the Electronic Use and Exchange of Health Information,” also reflects progress on the implementaions of the Federal Health IT Strategic Plan 2015-202 and the Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap.

In the report, ONC notes that most hospitals and health care providers have a digital footprint. As of 2015, 96 percent of non-federal acute care hospitals and 78 percent of office-based physicians adopted certified health IT. The increase in health IT adoption means most Americans receiving health care services now have their health data recorded electronically.

However, hurdles to progress still remain. For example, ONC notes that many certified health IT products lack capabilities that allow for greater innovation in how health information can be securely accessed and easily shared with appropriate members of the care team. “Such innovation is more common in other industries. Also, lack of transparent expectations for data sharing and burdensome experiences for health care providers limit the return on investment for health care providers and the value patients are able to gain from using certified health IT,” the report authors wrote.

While health information is increasingly recorded in a digital format, rather than paper, this information is not always accessible across systems and by all end users—such as patients, health care providers and payers, the report authors note. Patients often lack access to their own health information, healthcare providers often lack access to patient data at the point of care, particularly when multiple healthcare providers maintain different pieces of data, own different systems or use health IT solutions purchased form different developers, and payers often lack access to clinical data on groups of covered individuals to assess the value of services provided by their customers.

Currently, patients electronically access their health information through patient portals that prevent them from easily pulling from multiple sources or health care providers. Patient access to their electronic health information also requires repeated use of logins and manual data updates, according to the report. For healthcare providers and payers, interoperable access and exchange of health records is focused on accessing one record at a time. “Without the capability to access multiple records across a population of patients, healthcare providers and payers will not benefit from the value of using modern computing solutions—such as machine learning and artificial intelligence—to inform care decisions and identify trends,” the report authors wrote.

Looking at the future state, the report authors contend that certified health IT includes important upgrades to support interoperability and improve user experience. Noting ONC’s most recent 2015 edition of certification criteria and standards, these upgraded capabilities will show as hospitals and healthcare provider practices upgrade their technology to the 2015 edition, the report authors state.

“As HHS implements the provisions in the Cures Act, we look forward to continued engagement between government and industry on health IT matters and on the role health IT can play to increase competition in healthcare markets,” the report authors wrote, noting that one particular focus will be open APIs (application programming interfaces). The use of open APIs will support patients’ ability to have more access to information electronically through, for example, smartphones and mobile applications, and will allow payers to receive necessary and appropriate information on a group of members without having to access one record at a time.

Healthcare industry stakeholders have indicated that many barriers to interoperable access to health information remain, including technical, financial, trust and business practice barriers. “In addition, burden arising from quality reporting, documentation, administrative, and billing requirements that prescribe how health IT systems are designed also hamper the innovative usability of health IT,” the report authors wrote.

The report also outlines actions that HHS is taking to address these issues. Federal agencies, states, and industry have taken steps to address technical, trust, and financial challenges to interoperable health information access, exchange, and use for patients, health care providers, and payers (including insurers). HHS aims to build on these successes through the ONC Health IT Certification Program, HHS rulemaking, health IT innovation projects, and health IT coordination, the report authors wrote.

In accordance with the Cures Act, HHS is actively leading and coordinating a number of key programs and projects, including “continued work to deter and penalize poor business practices that lead to information blocking,” for example.

The report also calls out HHS’ efforts to develop a Trusted Exchange Framework and a Common Agreement (TEFCA) to support enabling trusted health information exchange. “Additional actions to meet statutory requirements within the Cures Act including supporting patient access to personal health information, reducing clinician burden, and engaging health and health IT stakeholders to promote market-based solutions,” the report authors wrote.

Moving forward, collaboration and innovation are critical to the continued progress on the nationwide health IT infrastructure. To that end, the HHS report authors recommend that the agency, and the health IT community overall, focus on a number of key steps to accelerate progress. Namely, health IT stakeholders should focus on improving interoperability and upgrading technical capabilities of health IT, so patients can securely access, aggregate and move their health information using their smartphones, or other devices, and healthcare providers can easily send, receive and analyze patient data.

The health IT community also should focus on increasing transparency in data sharing practices and strengthen technical capabilities of health IT, so payers can access population-level clinical data to promote economic transparency and operational efficiency, which helps to lower the cost of care and administrative costs, the report authors note.

Health IT developers and industry stakeholders also needs to prioritize improving health IT and reducing documentation burden, time inefficiencies and hassle for healthcare providers so clinicians and physicians can focus on their patients rather than their computers.

 

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HL7 Publishes Release 4 of FHIR Standard

January 3, 2019
by Heather Landi, Associate Editor
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Standards organization Health Level Seven (HL7) has published Release 4 of its Fast Healthcare Interoperability Resources (FHIR) Standard, marking the first release with normative content.

 “R4 is the culmination of 18 months of extensive work to finalize the base parts of the specification, and incorporate changes and enhancement requests received from implementation partners across the world,” Grahame Grieve, HL7 FHIR Product Director, wrote in a blog post.

FHIR is a standards framework that leverages the latest Web standards and applies a tight focus on implementation. FHIR includes a RESTful application programming interface (API), which is an approach based on modern Internet conventions and widely used in other industries. FHIR can be applied to mobile devices, Web-based applications, cloud communications, and EHR data-sharing using modular components. The FHIR Maturity Model helps implementers understand how the various parts of the standard are advancing through the standards development lifecycle.

FHIR Release 4 marks a significant milestone with the introduction of a normative base. “This new maturity will help support our very active and growing community,” Grieve wrote in the blog post.

“What we have now is a solid foundation which provides a framework for implementers to rely upon and that they know they can use it, and implementers should have more confidence in using the tool moving forward,” says Wayne Kubick, HL7’s chief technology officer. “Our expectation is that this will sort of diffuse some of the arguments and some of the fence-sitters who kept saying that FHIR is still in development, and while that’s true, it’s widely in use in thousands of applications and countries all around the world now. With FHIR R4, implementers should have confidence that it’s going to be around a long time and it’s going to be stable.”

Between release 3 and release 4, there have been nearly 3,000 change proposals applied to the specification, including more than 1,000 substantive changes, according to the organization.

The most significant change in FHIR Release 4 is that the base platform of the standard has passed a normative ballot, and will be submitted to ANSI as a normative standard. This means that future changes should be backward compatible, so that applications that implement the normative parts of R4 no longer risk being non-conformant to the standard, the organization said.

“The message to the community is that we are asserting they should not expect breaking changes in the future; if they adopt this version, they should expect whatever they build off this version to be supported for the foreseeable future. That should give implementers the confidence to invest more of their time and effort in using the FHIR standard,” says Wayne Kubick, HL7’s chief technology officer.

The following portions of the standard are now normative:

  • The RESTful API, the XML and JSON formats, and the basic datatypes
  • The Terminology layer (CodeSystem and ValueSet)
  • The Conformance Framework (StructureDefinition and CapabilityStatement)
  • The key resources Patient and Observation

Creating and publishing normative content is critical for allowing health IT developers to implement FHIR consistently and uniformly, according to HL7 officials.

Recent data from the Office of the National Coordinator for Health Information Technology (ONC) found that adoption and implementation of the HL7 FHIR standard in health IT is steadily progressing. Approximately 32 percent of certified health IT vendors said that they are using FHIR, specifically the “FHIR Release 2” API (application programming interface) standard. Nearly 51 percent of health IT developers appear to be using a version of FHIR combined with the OAuth 2.0 standard, according to ONC.

Kubick notes that with the publication of FHIR release 4, not all of FHIR is normative. “The features that have been defined as normative and submitted for approval as normative are essentially the infrastructure pieces—the pieces that determine how to use terminologies, how to build APIs, as well as resources around defining about how you recognize a patient and how you record observations about a patient. That’s a lot of the data you collect in healthcare, but by no means all of it,” he says.

The plan is to release FHIR, new releases on an 18- to 24-month release cycle. “We’ll expect to see another version of FHIR coming out around 2020. With the next release, we expect more of these medical content-type pieces, working on the resources defining drug products, for example,” Kubick says.

Moving forward, the HL7 FHIR working group will likely focus on fleshing out clinical content, Kubick says. “We will be building up more of the content resources that we currently have, as well as broadening capabilities for interacting with devices and images. We want to be able to get, with R5, a more complete view of as much of the types of health information necessary in place. We’ve got the Infrastructure solid and pretty much in place now with R4, and now we want to focus more on content, which is a much more complex issue, because we’re trying to move to a more structured, consistent way of representing health information, as recorded by doctors,” he says, adding, “The content is the tricky part, there is still a lot of variation in place. Reaching the level where the definition of the clinical content is much more consistent, we help us to get closer to interoperability, and that is really our next horizon.”

 

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