Thursday
Jul302015

Necessity of Payment Reform May Mother Big Data Into Being

Health insurers’ capability to gather and create data far outstrips their ability to analyze the information and put it to use. Progress is being made.

Thomas Reinke

Big data is a big deal, or so the health care IT vendors say. As revenue from the sale of electronic health records falls off and complaints soar about EHRs and CMS’s meaningful use program, health IT vendors have stepped out to tout the power of big data analytics. Slicing and dicing gobs of data stored in EHRs, insurance claims, and external databases such as the Geographic Information System (GIS) database is supposed to transform the health care delivery system.

Here’s the problem: Big data doesn’t exist outside the capabilities built by a few sophisticated organizations. You may have heard of one: the United States, which has 84 big data programs spread over six federal agencies.

In health care, most data are locked up in siloed databases, trapped by electronic medical records that don’t talk to each other. Moreover, the quality of patient data is often questionable. Simple fields such as a patient’s gender may not be usable because some systems may have more choices than male and female. Critical fields like a diagnosis code can be tainted by billing and reimbursement considerations, such as upcoding.

The barriers to creating a big data environment remain despite huge efforts by CMS’s Office of the National Coordinator (ONC), the American Health Information Management Association (AHIMA), myriad IT professional organizations, and many voluntary work groups. The $30 billion in federal EHR incentive payments, which was a bonanza for IT vendors, hasn’t solved the problem.

Big data analytics will require interoperability and aggregation of data across providers, health plans, PBMs, and pharmacies, but that is not widely happening. In March, a Senate committee hearing examined the problems of interoperability and found that there is no business case for EMR vendors to make their systems interoperable—nor do providers have a reason to bear that expense.

The EMR vendors at the hearing said it was too costly for them to standardize their systems and create interfaces. Miffed by what they saw as arrogance on the part of vendors, the senators were not shy in their criticism of the meaningful use program’s failure to achieve interoperability.

“The technology for exchanging information exists, but there are all sorts of disincentives, particularly among competitors, and there are few incentives for them to do so,” says David Kibbe, MD, CEO of DirectTrust, a health care consortium that provides a standardized Internet based data exchange network. “The bottom line is that it will take payment reform to reward providers for exchanging info and penalizing them for hoarding it.”

Pharmacy data gets some respect

Health care analytics is often limited to the data in medical and pharmacy claims. “Claims data rule the world,” says Jonathan Weiner, PhD, a codeveloper of Johns Hopkins University’s Adjusted Clinical Groups (ACG) System, a widely used population-based, case mix/risk adjustment methodology. Weiner is also a member of Managed Care’s editorial board.

Unfortunately, claims have very few truly useful data fields, so insight must be gleaned and inferred. Nevertheless, progress is being made. Pharmacy data plays a central role in analyzing health care services, and health plans, PBMs, and others are working to build and use analytic tools that process it. As pharmacy becomes a larger piece of total health care expenditures, and as new high-cost specialty drugs—like the hepatitis C agents—rattle the system, predicting pharmacy costs and managing pharmacy utilization has emerged as a top priority.

Johns Hopkins gets into the game

Health plans and PBMs recognize that pharmacy data can aid in identifying high risk patients and gaps in therapy. It can also be used in some nifty, reform-minded ways for predicting pharmacy costs in risk-based payment arrangements, supporting population health management in ACOs and modeling medical care for specific diseases.

The ACG system at Johns Hopkins has these capabilities. Its primary inputs are medical and pharmacy data and patient demographics from claims, but it is beginning to incorporate data from other sources. The system organizes patient data into morbidity groups, one based on diagnosis and the other on pharmacy usage.

The ACG system maps more than 90,000 NDCs into a set of 60 pharmacy-based morbidity groups. These morbidity groups are then fed into a predictive model that uses a reference database of millions of health plan enrollees. The predictive model has flexible output parameters, such as predicting pharmacy adherence or hospitalizations. Hopkins is working to focus the ACG system on population health analytics by incorporating data, such as the GIS database.

Data analysis with a purpose

Analysis should never be an end in itself. The acid test for big data analytics in pharmacy services or any other area of health care is how that data is used to improve quality and efficiency.

Earlier this year, Prime Therapeutics won the Pharmaceutical Benefit Management Institute’s 2015 Rx Benefit Innovation Award for an analytic tool it developed that incorporates medical and pharmacy claims. The company’s tool provides early warning and trend forecasting for emerging high-cost or high-utilization drugs.

“It serves as the front end for providing actionable clinical utilization management recommendations to our Blue Cross plans,” says David Lassen, PharmD, chief clinical officer.

Prime Therapeutics provided the Pharmaceutical Benefit Management Institute the results of a case study of the cost and utilization of sofosbuvir (Sovaldi). The tool’s predictive modeling analyzed medical claims for a commercially insured population of 12 million members, looking at the incidence of hepatitis C virus screening as an early indicator of diagnosis and possible treatment. The incidence of screening was quantified for three separate 10-month intervals coinciding with the releases of updated screening and treatment recommendations from the CDC and the U.S. Preventive Services Task Force.

Prime Therapeutics then used screening, diagnosis, and trend data to calculate the number of new members diagnosed with HCV. The results showed an increase in the estimated number of new diagnoses resulting from screening. They estimated that 42,284 of its 14.8 million (0.2%) member base had hepatitis C at the end of 2013.

The Minnesota PBM then updated the estimate of hepatitis C cases to 2015 and modeled its cost trends. The cost of hepatitis C treatments drugs shot up from $0.13 PMPM in 2013 to $4.28 PMPM, a 32-fold increase. By incorporating the approval of additional new HCV agents and other factors, Prime also modeled continuing cost increases that ranged from 20% to 50% for 2015.

Prime Therapeutics’s watch list tool is integrated with its therapy management program, says Lassen. Claims data are fed into software that finds gaps in therapy, drug interactions, overutilization, poor adherence, and other situations. Alerts target providers and patients.

Active Health Management, Aetna’s disease management subsidiary, also has software with capabilities for incorporating pharmacy data and guiding pharmacy management.

The future is now-ish

Narrow, targeted data-networking efforts are producing success, and Aetna’s IT subsidiary, Medicity, is driving some of that success. Medicity provides data networking and exchange services to state health information exchanges, EHR vendors, and other clients.

Health care organizations are coming together to develop custom interfaces. Nancy Ham, Medicity’s CEO, says Medicity is working with more than 100 enterprise clients to develop interfaces that connect data systems and meld data into meaningful databases. The types of data exchange networks that Medicity is developing may provide the vehicle for health plans and PBMs to obtain the expanded data they have been seeking from providers, allowing them to manage care more effectively.

 

 

Ed Emerman

Eagle Public Relations

609-275-5162 (office)

609-240-2766 (cell)

eemerman@eaglepr.com

Thursday
Jul302015

BREAKING: Leidos, Cerner win 'DHMSM', DoD's $11B electronic health record contract

Click here to read original article.

Contract will replace legacy health IT at DoD and advance interoperability with VA's health record

Thursday
Jul302015

Experts cut EHRs some slack on information blocking

Click here to read original article.  July 28, 2015 | By 

Barriers to health information interoperability are largely an unintentional side effect of the healthcare payment system and electronic health record companies are gradually improving information exchange, said several expert panelists during a July 23 Senate hearing.

The testimony contrasts a recent Office of the National Coordinator for Health ITreport to Congress that portrayed the lack of interoperability among EHRs as an intentional tactic – driven by economic and competitive pressure. Last month ONC asked whistleblowers to notify the agency of deliberate health information blocking.

But Paul Black, president and chief executive of EHR vendor Allscripts, told the Senate Committee on Health, Education, Labor and Pensions, that EHRs historically had no incentive to share health information. Black said his company uses open standards and application programming interfaces, or APIs, to promote interoperability with other platforms.

"Sluggish exchange largely stems from one massive gap, the lack of a strong business case for interoperability in healthcare. The payment system that has been in place for decades has not motivated them to create an interconnected healthcare environment," said Black.

Dr. David Kendrick, chair of the department of health informatics at the University of Oklahoma and chief executive of the MyHealth Access Network, said that while many EHR vendors work well with their customers and with his network to establish interoperability, inappropriate data blocking and sub-standard data quality are still a problem.

"I think that it's no secret in the industry that there are two companies in particular – two electronic health record companies, very leading companies, Epic and eClinicalWorks – which both have, over the course of the years even before direct exchange, developed their own proprietary messaging systems," said Dr. David Kibbe, president and chief executive of DirectTrust and Senior Advisor with the American Academy of Family Physicians.

Kibbe said those companies have found it difficult to adopt direct exchange – the data "push" model that enables clinicians to pass health data back and forth no matter what direct exchange network they utilize – because of their proprietary messaging systems.

"Now, I respect that business model, but I also feel that it's important for them not to create the problems in the marketplace that Dr. Kendrick has mentioned," said Kibbe.

He went on to add that eClinicalWorks is a member of DirectTrust and is pursuing solutions to help solve its interoperability problems.

Neither company has a business model based on information blocking, per se. But Epic and eClinicalWorks have, in some cases, implemented direct exchange in a way that benefits their customers but does not necessarily help others in the exchange or those outside of their customer base, said Kibbe.

Better interoperability standards and more incentives to share are helping improve the situation, however, he said.

Kibbe advised Congress and the Health and Human Services Department not to rush into more rules to further information sharing efforts just yet.

"We've got the standards. We have infrastructure for the use of those standards. It's working. It could be better, [but] don't go off and do something entirely new until we've got that job done," he said.

Tuesday
Jul282015

CEO Calls On Government to Take Steps to Overcome Health Information Blocking

Click here to read original article.

 

Testifying before the Senate Committee on Health, Education, Labor & Pensions (HELP), DirectTrust president and CEO David C. Kibbe, MD MBA, urged the federal government to take action to help overcome the problems impeding the sharing of health information between and among parties authorized to access electronic health data, commonly referred to as “information blocking.”

“While the responsibility for assuring secure interoperable exchange resides primarily with the health care provider organizations, and not with the EHR (electronic health record) vendors nor the government, I strongly believe there is a role for government to encourage and incentivize collaborative and interoperable health information exchange,” testified Dr. Kibbe, one of the nation’s foremost authorities on health information exchange security issues.  Dr. Kibbe’s organization, DirectTrust, is a health care industry alliance created by and for participants in the Direct exchange network used for secure, interoperable exchange of health information.

Dr. Kibbe testified at a full Senate HELP committee hearing titled “Achieving the Promise of Health Information Technology:  Information Blocking and Potential Solutions. During his testimony, Dr. Kibbe enumerated the problems with information blocking and offered suggestions to help improve upon the current situation in the near-term. Among the many actions Dr. Kibbe suggests the government take to help overcome information blocking include:

  • Continue to shed light on these problems, and work with trade groups, standards and policies organizations, and others to set expectations for interoperability of EHRs and other applications certified as interoperable, especially those that have been federally subsidized within the meaningful use programs.
  • Bring better and improved EHR certification processes forward beyond the testing laboratory so that the utility and usability of interoperability features of ONC certified EHR products in the field becomes part of the public record, and can be used in purchasing decisions. Collaboration and partnership with non-profit trade groups to achieve this goal would be advisable.
  • Accelerate federal agency use of and demand for open, standards-based interoperable HIE (health information exchange) with private sector providers and provider organizations, thereby removing reliance on paper-based mail, fax, e-fax and courier for these federal programs.

    Examples include Veterans Health Administration referrals to and from private sector medical practices and hospitals; Veterans Benefits Administration health information exchanges with private sector medical practices and hospitals; the use by Medicare, Medicaid, and state agencies of interoperable HIE for communications with private sector providers and provider organizations for limitation of fraud, payment adjudication, claims attachments requests, and other administrative transactions now done via fax and mail.

  • Continue to tie more robust ONC EHR certification and use of certified EHR technology to participation in value-based purchasing programs, wherein interoperability and collaboration across multiple organizations in multiple-vendor environments is financially rewarding to providers and their health IT vendors. Demand for collaboration and interoperability is best driven by underlying business models and business cases supported by regulation and oversight.

 

In closing his testimony, Dr. Kibbe said, “Attempts to redress the root causes of information blocking must address the unwillingness of some providers and their EHR partners to share and exchange data, and not just the specific problems that may be encountered in making exchanges run smoothly and reliably. In my opinion, this unwillingness originates in the current business models of some health care provider organizations, and the health care industry in general, wherein fee-for-service payment creates disincentives for sharing of health information and rewards information hoarding, or at least the delay of timely information exchanges. Changes to these payment incentives could do much to reward business models where collaboration and interoperability are highly valued, and where the technological capabilities, standards, and infrastructure for interoperable health information exchange now in place would be put to much better use.”

Dr. Kibbe’s complete testimony can be found here.

Tuesday
Jul282015

Senate suggests Stage 3 MU delay

Read original article here.

 

After a day spent hearing from health IT experts about information blocking practices, Republican Sen. Lamar Alexander, chair of the Senate Health, Education, Labor & Pensions Committee, said Thursday afternoon that he's asked HHS to consider a delay of Stage 3 meaningful use.

Before that hearing on Capitol Hill, Alexander noted he'd heard from many providers that Stage 1 MU had helped spur adoption, that Stage 2 had been a "mixed blessing" – but that Stage 3 was a "whole 'nother kettle of fish."

As such, his "instinct," was to tell HHS Secretary Sylvia Burwell, "Let's not go backwards on electronic healthcare records, but let's not impose on physicians and hospitals a system that doesn't work, and which they spend most of their time dreading," said Alexander. "We want something physicians buy into, rather than something they dread."

Sen. Lamar Alexander (photo Talk Radio News Service)That morning, Alexander mentioned he was curious to hear from industry stakeholders about their thoughts on putting the brakes on the rush toward Stage 3 – "not with the idea of backing up on it," he said, "but with the idea of, 'Let's get this right.'"

The HELP Committee heard testimony from Allscripts CEO Paul Black, DirectTrust CEO David C. Kibbe, MD, and others on one of healthcare's persistent challenges – and a huge impediment to the industry's efforts to move toward more seamless interoperability: information blocking on the part of vendors and providers alike.

There are several scenarios through which such data blocking could occur, said Alexander.

"My usual hospital refuses to share my information," he said. "The electronic systems at both hospitals don't talk to each other. My usual hospital says it will charge Vanderbilt a huge fee to send my electronic records. My usual hospital says it can’t share them for privacy reasons. Or, my usual hospital won’t send them because they cite concerns about data security."

All of those could cause patient harm, he noted – and none of them are acceptable to a government that has spent some $30 billion dollars so far to spur health IT uptake.

Allscripts' Black testified that, despite the bad rap it so often gets, interoperability among vendors and among providers does happen: "It is important to note that there are many examples of providers who have worked through the process of establishing connectivity and are making it work," he said.

"It is true, however, that today not all stakeholders in the healthcare industry seem to be equally motivated to make information liquidity a reality," said Black. "Clinical data exchange is not where it needs to be."


To get there, he said, there are some big factors that need to be addressed. Among them: an expansion of  the standards development process, "building on the real progress underway with guidance from government and allowing the private sector to continuously develop, adopt and modify new standards."

Also, "key constituencies, such as public health registries, labs, state health information exchange organizations and others who are not following available standards in their work, should be required to do so," he added.

Ultimately, however, "the sluggish progress we’re discussing today most closely stems from one critical deficit," said Black: "the lack of a strong business case or a true market driver for interoperability."

From his perspective, Direct Trust's Kibbe told the HELP Committee that "information blocking by healthcare provider organizations and their EHRs, whether intentional or not, is still a problem for some providers wishing to use Direct exchange, as well as for these providers' clinical partners who want to be able to exchange Direct messages and attachments with them, and sometimes fail."

Still, he said, the fault for poor data sharing practices – and the onus to improve them – lies mostly with the private sector, not with feds.

"In my opinion, the responsibility for assuring secure interoperable exchange resides primarily with the healthcare provider organizations, not the EHR vendors, and not the government," he said. "Healthcare provider organizations must come to realize that acting in the best interest of patients is to assure that health information follows the patient and consumer to whatever setting will provide treatment, even if that means in a competitor’s hospital or medical practice."

One thing the government can do, however, is to help work with "trade groups, standards and policies organizations, and others to set expectations for interoperability of EHRs and other applications certified as interoperable, especially those that have been federally subsidized within the meaningful use programs," said Kibbe.

Perhaps echoing Alexander's comments about the headlong rush to Stage 3, he said: "Let's finish what we started before moving to more complex solutions that may or may not work."

Tuesday
Jul282015

Congress Considers Putting Brakes on Stage 3

Read original article here.

 

Federal lawmakers are noticing some dark clouds surrounding the electronic health records meaningful use program to prod providers to adopt EHRs. With rising recent struggles in the program, lawmakers may be poised to intervene to push back the program’s third stage.

Problems with the current stage are all too apparent. As of mid-June 2015, 11 percent of eligible physicians have participated in Stage 2 of the electronic health records financial incentive program, and 42 percent of eligible hospitals have participated.

Now, there are rumblings in Congress about delaying Stage 3, which is supposed to start with an optional year in 2017 and with all participants moving to the third stage in 2018.

Sen. Lamar Alexander (R-Tenn.), chair of the Senate Health, Education, Labor & Pensions Committee, is broaching the subject of delaying Stage 3, and this month even mentioned the idea to Health and Human Services Secretary Sylvia Burwell. At a committee meeting, Alexander discussed his talk with Burwell and added: “There’s been some discussion about delaying Meaningful Use Stage 3, about whether it’s a good idea, whether it’s a bad idea, whether to delay part of all of it. My instinct is to say to Secretary Burwell, ‘Let’s not go backwards on electronic healthcare records.’ ”

Alexander also said it may be wise to slow down Stage 3, “not with the idea of backing up on it, but with the idea of saying, ‘Let’s get this right.’ ” At the same committee meeting, David Kibbe, MD, president and CEO of DirectTrust, a coalition of 150 organizations supporting the Direct secure messaging protocols, recommended “an immediate moratorium on Stage 3 until Stage 2 is fixed.”

Early Warnings of Problems

When the Centers for Medicare and Medicaid Services issued a proposed rule for Stage 2, many stakeholders protested that the objectives and measures were too burdensome or simply unrealistic. It became clear that CMS should have listened more closely when, in April 2015, the agency was obliged to significantly ease several troublesome objectives, eliminate about a dozen Stage 2 measures that were considered redundant or adequately adopted, and provide more flexibility for meaningful use reporting periods.

At about the same time, CMS issued a proposed rule for Stage 3, and it didn’t get a warm reception from providers concerned that proposed measures are not realistic in real-world settings and that the technology is not going to be mature enough to support the measures.

Other concerns are plaguing EHR technology. For example, the American Medical Association in late 2014 released a framework to prioritize EHR usability woes. The AMA says its members are complaining about usability caused by ill-conceived EHR clinical workflows, time-consuming data entry, interference with face-to-face patient care and overwhelming fatigue with electronic messages and alerts.

Also SeeAMA Wants EHR Designs Overhauled

The plan includes ways to enhance physicians’ ability to provide quality care, support team-based care, promote care coordination, offer product modularity and configurability, reduce cognitive workloads, promote data liquidity, facilitate digital and mobile patient engagement, and expedite user input into product design and post-implementation feedback.

Legislators Take Notice

Congress has taken notice, spurred by the AMA and other trade associations, such as the American Hospital Association, Healthcare Information Management and Systems Society and the Medical Group Management Association. Members of the Senate, in particular, have shown increased interest in the performance of the meaningful use program, in large part because of usability issues that have impeded health information exchange and care coordination, and some members now are questioning whether the program continues to have value and how to fix it.

The Senate HELP Committee recently heard testimony from industry stakeholders on two major barriers to interoperability: exorbitant costs for interfaces, the practice of providers or their EHR vendors in deliberately blocking data exchange.

Lack of exchange and interoperability is not all the fault of EHR companies. At the hearings, vendor Allscripts fired back, with CEO Paul Black telling the committee that many providers aren’t pushing for interoperability because the current healthcare payment system does not provide financial incentives for them to interoperate, meaning the providers would have to absorb costs they cannot afford. In short, there often is a lack of a strong business case to exchange data, Black said.

The College for Healthcare Information Management Executives, which represents information technology leaders, recently sent a letter to the Senate HELP Committee reminding members that Congress itself has seriously impeded health information exchange with some of its policies. CHIME is unleashing its 1,600 members to press Congress to remove the congressionally mandated prohibition on a national patient identifier.

In its letter, CHIME calls the lack of a consistent patient identity matching strategy “the most significant challenge inhibiting the safe and secure electronic exchange of health information. As our healthcare system begins to realize the innately transformational capabilities of health IT, moving toward nationwide health information exchange, this essential core functionality—consistency in patient identity matching—must be addressed.”

The group emphasized that a consistent strategy does not require using a single technology or solution, but a solution must be found. “Robust information exchange and interoperability can flourish only once we can confidently identify a patient across providers, locations and vendors.”

Debate over the value of meaningful use and the ability to exchange health information is critically important as the nation’s healthcare system rapidly shifts to accountable care, which will place high priority on population health management and value-based reimbursement.

Sunday
Jul262015

Pressure Mounting in Senate to Delay Meaningful Use Stage 3

Read original article here.

 

Legislative pressure to delay Meaningful Use Stage 3 appears to be gaining momentum in the U.S. Senate. Sen. Lamar Alexander (R-Tenn.), chairman of the Senate health committee, had breakfast yesterday morning with Health and Human Services Secretary Sylvia Burwell in which he broached the issue.

“There’s been some discussion about delaying Meaningful Use Stage 3, about whether it’s a good idea, whether it’s a bad idea, whether to delay part of it or all of it,” said Alexander, who made the comments during the committee’s Thursday hearing on electronic health records and information blocking. “My instinct is to say to Secretary Burwell ‘let’s not go backwards on electronic healthcare records.’”

He told the committee that the consensus among providers is that MU Stage 1 helped to encourage EHR adoption, Stage 2 has been a mixed bag, and that Stage 3 is a “whole other kettle of fish.” According to Alexander, he spoke to one respected hospital executive who opined that Stage 1 and 2 “worked okay” but that they were “terrified” by Stage 3.

“We might want to slow down the implementation of Stage 3, not with the idea of backing up on it, but with the idea of saying ‘let’s get this right,’” he urged. “Let’s get this right before 500 employees and a billion dollars at the Mayo Clinic is put to work implementing a system that’s not right and then has to be changed in two, three or four years.”

In March, the Centers for Medicare and Medicaid Services released a notice for proposed rulemaking that outlined the third and final stage of the Meaningful Use program slated to begin in 2018.

Testifying on behalf of the American College of Cardiology (ACC), Michael Mirro, M.D., chief academic research officer for the Parkview Mirro Center for Research and Innovation in Fort Wayne, Ind., told the committee that Stage 3 should be delayed in its entirety. Delaying only certain parts of Stage 3 would just cause further confusion around the program, according to a letter ACC sent to Alexander last month.

“Although the Meaningful Use program has brought favorable results within the context of data transfer, many of the requirements set forth in the program are unattainable,” said Mirro, who commented that only 11 percent of physicians have so far attested to Stage 2. “We definitely need to delay Stage 3. We really have to digest the impact of Stage 2 Meaningful Use and continue to strive to simplify the requirements.”

Likewise, David Kibbe, M.D., president and CEO of DirectTrust, recommended to the committee “an immediate moratorium on Stage 3 until Stage 2 is fixed.” According to Kibbe, there are parts of Stage 2 that must be improved so that more eligible professionals and hospitals can participate in the program.

Sunday
Jul262015

Senate panel will push HHS to delay Stage 3 MU rules

Read original article here.

The Senate Health, Education, Labor and Pensions Committee is asking to delay Stage 3 meaningful-use rules, its chairman, Lamar Alexander (R-Tenn.), said during a news conference Thursday.

This will be one of several recommendations his committee will make to the Obama administration in a push to expand the use of electronic health records, which some providers say are costly and time-consuming.

Alexander's staff and Ranking Member Patty Murray (D-Wash.) have been meeting with committee members' staff weekly and meeting regularly with experts and administration officials to relay their policy suggestions. 

The directives are intentionally being drafted as regulations that can be implemented by HHS Secretary Sylvia Matthews Burwell via rule-making versus legislation. This ensures they can be adopted quickly, Alexander said.

If legislation is ultimately needed to get some of the recommendations implemented, they would likely be rolled into the Senate's companion bill to the House's 21st Century Cures legislation, a healthcare innovation bill that Alexander expects to be drafted and voted on early next year.

“We want to keep going forward (with the adoption of EHRs), no one wants to turn back,” Alexander said. 

In March, the CMS issued proposed rules for Stage 3. This final stage requires providers to send electronic summaries for 50% of patients they refer to other providers, receive summaries for 40% of patients that are referred to them and reconcile past patient data with current reports for 80% of such patients.

What's concerning providers is that this stage differs from the others in the degree to which, to fulfill its requirements, a medical provider must depend on others. According to a July 20 policy analysis by Niam Yaraghi, a fellow in the Brookings Institution's Center for Technology Innovation, this means if providers do not send electronic summaries, the medical provider who was supposed to receive them will fail to comply with the rulemaking. 

This is a very likely scenario as only a quarter of physicians say they are compliant with Stage 2 requirements.

“This leads to a situation in which even tech-savvy providers will not be able to fulfill the requirements of the third stage of the meaningful-use program, regardless of their intentions and efforts,” Yaraghi said in the analysis.

Provider groups such as the Medical Group Management Association and the American Medical Association have also been pushing for a delay. As of now, the CMS expects to begin enforcing Stage 3 requirements in 2017.

Other recommendations the committee is likely to make to the Obama administration this fall include standards clarifying that patients own their health data, a greater need for interoperability, heightened security requirements for patient data, and more user-friendly EHR systems, Alexander said. 

The news briefing came after a Senate Health Committee hearing on the practice of “information blocking.” Alexander defined the term. 

“If I found myself suddenly at the Vanderbilt University Medical Center emergency room and the doctors there wanted to get my paperwork from the hospital and doctors I usually use—information blocking means that there is some obstacle getting in the way of my personal health information getting sent to them,” Alexander said at the hearing. 

This could happen in several ways, including a hospital refusing to share information or electronic systems at both hospitals not talking to each other. 

“There is substantial evidence that some organizations are intentionally setting up barriers between their systems and other systems, overcharging or creating technical or legal barriers to providers who wants to access information through the system they've purchased, or both,” Murray said at the hearing.

The witnesses gathered seemed to be generally against any substantial new regulations to address this issue, as the healthcare industry is still trying to comply with all federal rules. 

A couple of witnesses further noted that the issue of data blocking appears to be largely taken care of as the CMS moves away from a fee-for-service to a value-based purchasing system. In April, the Office of the National Coordinator for Health Information Technology issued a report stating that most allegations of information blocking involve provider business practices rather than health IT issues.

“Therefore, attempts to redress the root causes of information blocking must address the unwillingness of some providers and their EHR partners to share and exchange data,” said Dr. David Kibbe, a senior adviser to the American Academy of Family Physicians and CEO of DirectTrust, during the hearing. His group is a not-for-profit working to create a national framework for secure electronic exchange of personal health information. 

“That unwillingness originates in the current business models of some healthcare provider organizations, and the healthcare industry in general, wherein fee-for-service payment creates disincentives for sharing of health information and rewards information hoarding, or at least the delay of timely information exchanges.” 

The greater emphasis on value-based purchasing helps to address this issue as patient satisfaction is a key metric that determines payment, thus disincentivizing the hoarding of patient information, Kibbe and other witnesses argued.

Correction:

This article initially misidentified Alexander's Senate committee.


 

Virgil Dickson

Virgil Dickson reports from Washington on the federal regulatory agencies. His experience before joining Modern Healthcare in 2013 includes serving as the Washington-based correspondent for PRWeek and as an editor/reporter for FDA News. Dickson earned a bachelor's degree from DePaul University in 2007.

Wednesday
Jul222015

DirectTrust President and CEO calls on government to take steps to overcome blocking of electronic health information 

FOR IMMEDIATE RELEASE

WASHINGTON, DC, July 23, 2015 – Testifying before the Senate Committee on Health, Education, Labor & Pensions (HELP) today, DirectTrust President and CEO David C. Kibbe, MD MBA, urged the federal government to take action to help overcome the problems impeding the sharing of health information between and among parties authorized to access electronic health data, commonly referred to as “information blocking.”

“While the responsibility for assuring secure interoperable exchange resides primarily with the health care provider organizations, and not with the EHR (electronic health record) vendors nor the government, I strongly believe there is a role for government to encourage and incentivize collaborative and interoperable health information exchange,” testified Dr. Kibbe, one of the nation’s foremost authorities on health information exchange security issues.  Dr. Kibbe’s organization, DirectTrust, is a health care industry alliance created by and for participants in the Direct exchange network used for secure, interoperable exchange of health information.

Dr. Kibbe testified at a full Senate HELP committee hearing titled “Achieving the Promise of Health Information Technology:  Information Blocking and Potential Solutions.  During his testimony, Dr. Kibbe enumerated the problems with information blocking and offered suggestions to help improve upon the current situation in the near-term.   Among the many actions Dr. Kibbe suggests the government take to help overcome information blocking include:

  • Continue to shed light on these problems, and work with trade groups, standards and policies organizations, and others to set expectations for interoperability of EHRs and other applications certified as interoperable, especially those that have been federally subsidized within the Meaningful Use programs.
  • Bring better and improved EHR certification processes forward beyond the testing laboratory so that the utility and usability of interoperability features of ONC certified EHR products in the field becomes part of the public record, and can be used in purchasing decisions. Collaboration and partnership with non-profit trade groups to achieve this goal would be advisable.
  • Accelerate federal agency use of and demand for open, standards-based interoperable HIE (health information exchange) with private sector providers and provider organizations, thereby removing reliance on paper-based mail, fax, efax and courier for these federal programs. Examples include Veterans Health Administration referrals to and from private sector medical practices and hospitals; Veterans Benefits Administration health information exchanges with private sector medical practices and hospitals; the use by Medicare, Medicaid, and state agencies of interoperable HIE for communications with private sector providers and provider organizations for limitation of fraud, payment adjudication, claims attachments requests, and other administrative transactions now done via fax and mail.
  • Continue to tie more robust ONC EHR certification and use of certified EHR technology to participation in Value Based Purchasing programs, wherein interoperability and collaboration across multiple organizations in multiple-vendor environments is financially rewarding to providers and their health IT vendors. Demand for collaboration and interoperability is best driven by underlying business models and business cases supported by regulation and oversight.

In closing his testimony, Dr. Kibbe said, “Attempts to redress the root causes of information blocking must address the unwillingness of some providers and their EHR partners to share and exchange data, and not just the specific problems that may be encountered in making exchanges run smoothly and reliably.  In my opinion, this unwillingness originates in the current business models of some health care provider organizations, and the health care industry in general, wherein fee-for-service payment creates disincentives for sharing of health information and rewards information hoarding, or at least the delay of timely information exchanges. Changes to these payment incentives could do much to reward business models where collaboration and interoperability are highly valued, and where the technological capabilities, standards, and infrastructure for interoperable health information exchange now in place would be put to much better use.”

Dr. Kibbe’s complete testimony can be found here

About DirectTrust
DirectTrust is a three-year old, non-profit, competitively neutral, self-regulatory entity created by and for participants in the Direct community, including Health Internet Service Providers (HISPs), Certificate Authorities (CAs), and Registration Authorities (RAs), doctors, patients and vendors, and supports both provider-to-provider as well as patient-to-provider Direct exchange. DirectTrust recently received a Cooperative Agreement Award from ONC as part of the Exemplar HIE Governance Program. DirectTrust serves as a forum and governance body for persons and entities engaged in Directed exchange of electronic health information as part of the Nationwide Health Information Network (NwHIN).  DirectTrust's Security and Trust Framework is the basis for the voluntary accreditation of service providers implementing Directed health information exchange. The goal of DirectTrust.org is to develop, promote and, as necessary, help enforce the rules and best practices necessary to maintain security and trust within the Direct community, consistent with the HITECH Act and the governance rules for the NwHIN established by ONC.DirectTrust.org is committed to fostering widespread public confidence in the Direct exchange of health information. To learn more, visit www.directtrust.org.

Contact:  

Ed Emerman

Eagle Public Relations 609.275.5162

eemerman@eaglepr.com

Monday
Jul202015

Dr. Kibbe quoted in "Health IT’s Most Pressing Issues (Part 2)"

Click here for original article.

Health IT’s most pressing issues may be so prevalent that they can’t be contained to a single post, as is obvious here, the second installment in the series detailing some of the biggest IT issues. There are differing opinions as to what the most important issues are, but there are many clear and overwhelming problems for the sector. Data, security, interoperability and compliance are some of the more obvious, according to the following experts, but those are not all, as you likely know and we’ll continue to see.

Here, we continue to offer the perspective of some of healthcare’s insiders who offer their opinions on health IT’s greatest problems and where we should be spending a good deal, if not most, of our focus. If you’d like to read the first installment in the series, go here: Health IT’s Most Pressing Issues. Also, feel free to let us know if you agree with the following, or add what you think are some of the sector’s biggest boondoggles.

Michael Fimin, CEO and co-founder, Netwrix
The largest concern of any healthcare organization is protecting patient personal data. Every year healthcare entities of all sizes become victims of data leaks, fresh examples are both Anthem and Premera Blue Cross, and lose thousands of dollars mainly because of employee misbehave or human error. Being not an easy one to prevent, human factor sets IT pros a number of challenges to cope with:

1. Insider threat. Unfortunately, privilege abuse is a primary root cause for many data breaches. No matter if an employee is breaking bad or his credentials were stolen, sensitive data is put at risk. The only way to prevent insider threats is to have visibility into the IT infrastructure and be able to track any changes made to both security configurations and data. Monitor user activity and establish rigorous control over accounts with extended privileges. Regularly review all access rights to ensure that permissions are granted adequately to employees’ business needs.

2. Security of devices. In 2014 healthcare organizations suffered from physical theft or loss of electronic devices more than any other industry, said the Verizon 2014 DBIR. Without proper identity and authentication management personal data stored on these devices can be easily accessed by adversaries, leading to financial and reputational losses. If your employees’ laptop or tablets end up in the wrong hands, encryption, two-factor authentication and ability to manage the device remotely will protect your data, or at least will make hacker’s job much harder.

3. Employees’ negligence. Deliberate or accidental mistakes pose more danger to data integrity than you might think. A simple email with confidential data sent to the wrong address may lead to a huge data leak. Make sure that your employees are familiar with the company’s security policy and are aware of what they should do to maintain security each person in the company should clearly understand that integrity of information assets is their personal responsibility.

Dr. Barry Chaiken, chief medical information officer, Infor
Healthcare providers organizations invested billions of dollars purchasing and implementing electronic medical records with this investment driven by the economic incentives provided by the HITECH Act. Now that these systems are installed an up and running, organizations struggle to obtain real value from these investments. These systems were implemented with speed in mind rather than clinical transformation that improved quality and reduced costs. Now, organizations must embrace clinical transformation and change management to redo workflows and processes to effectively impact care. Organizations cannot justify their investment in EMRs unless they rework their EMR implementations to obtain true value from their deployment.”

 

Matthew Fisher, co-chair, health law group, Mirick O’Connell

Matthew FisherOne of the top health IT issues that I encounter is meeting compliance requirements with the HIPAA Security Rule. Security is a hot issue for health IT in light of the numerous breaches and other attacks that have occurred in order to gain access to protected health information. Health IT is at the forefront of these issues because the conversion to predominantly electronic data formats has created a number of vulnerabilities. Foremost among the vulnerabilities is the often outdated security systems or measures that may be in place. From a regulatory compliance perspective, particularly HIPAA, organizations must perform a comprehensive risk analysis of their operations. The results of the risk analysis, which should include identification, likelihood and threat level associated with each issue, form the backbone of an organization’s security policies. Under HIPAA, the Security Rule is designed to be somewhat flexible and scalable to each organization’s needs. As the brief description of the risk analysis shows, the results help an organization to determine how to meet the addressable elements of the Security Rule.

All of this places a lot of pressure on health IT to meet demands and protect organizations. As can be seen from breach fallouts, health IT can be at the top of the blame list. However, proactive attention to these issues can help alleviate the pain and put a organization ahead.

Dr. David Kibbe, president and CEO, DirectTrust

For me, the top issue for health IT is interoperability of information exchange: It should be very easy for health care professionals to move data and information across organizational boundaries and IT platforms, without extra effort, and in a manner that is electronic, secure, and identity-validated. Data exchange has to be vendor agnostic. That we don’t have this capability deployed everywhere in health care is less a problem of standards than a problem of business models and culture.

The reason this one issue is on the top of my list is because the lack of interoperable exchange of health information is a by-product of fee-for-service payment to doctors and hospitals; payment for volume not payment for quality. If you get paid by insurers even when tests and procedures need to be duplicated, because the data aren’t readily available to your “silo” of information from someone else’s “silo” of information, why bother to change? But health care payers are moving toward “value-based care” in which quality and efficiency are rewarded, providers are put at some level of risk for the costs of the care they deliver, and those who do poorly on such metrics as readmissions to hospital and patient satisfaction are penalized and paid less.

Value-based payment success requires that providers communicate with one another in a distinctly multi-vendor environment, one in which doctors and hospitals use EHRs from over 300 vendors. Yet many members of care coordination teams, such as those in long-term post-acute care and home health, don’t use EHRs at all.

Providers engaged in value-based payment simply can’t fumble the transitions of care made by their patients as they did under fee-for-service; if they do they’ll fail financially. The challenge they are facing is how to move data and information wherever and to whomever the patient goes to next, and regardless of which vendor’s EHR the next provider organization is using, so that care becomes much more coordinated and outcomes more predictable.

Direct exchange is an example of a standard that is open and available for use in over 40,000 health care organizations that use EHRs certified by ONC; that certification includes that the EHRs are Direct-enabled to both send and receive messages, and file attachments of any kind, and to and from any other certified EHR user. Direct messages are sent encrypted end-to-end, and the relying parties know precisely the identity of one another even before the message is transmitted. Attachments can be in any type of file format, including structured XML, Word, PDF, and in common file image file formats like .jpg and DICOM.

Why don’t we hear more about direct exchange in the media and press? Well, that’s because new technologies take time to become adopted, even when there are federal standards built into certifications. And, as the recent ONC report to Congress on Information Blocking pointed out, “… some [provider and EHR] business practices, though they may arguably advance legitimate individual economic interests, interfere with the exchange of electronic health information in ways that raise serious information blocking concerns.” Put even more simply, there still exist business and cultural incentives in health care to restrict information flows to protect private economic gain, even at the expense of the patients and the public at large.

As the incentives change because of value-based purchasing contracts becoming more widespread, we will see more and more health care providers and hospitals choosing to use interoperable health IT tools.

Tuesday
Jul142015

Three Keys to Improving Privacy and Security Protections

By Dr. David Kibbe

Although the recently reported cyber theft of patient information due to a hack of electronic health record (EHR) vendor Medical Informatics Engineering (MIE) and its subsidiary patient portal, NoMoreClipboard, is the first reported breach of an EHR system, it most assuredly will not be the last. The earlier Anthem and Premera insurance company breaches show that criminals are increasingly seeking out medical data because they often link to financial and insurance information.

Why are healthcare data so vulnerable in the first place? In a word, neglect. Healthcare as an industry has not bothered to take security as seriously as other sectors of the economy, where privacy breaches have occurred for several years and systems have been hardened to protect against intruders. 

more -> Read entire article here.

Wednesday
Jun242015

Direct Messaging Benefits Outweigh Costs, Survey Finds

Click here to read entire original article.

 

About 66% of health information organizations use Direct messaging as their primary method for exchanging data, according a new survey released by the Healthcare Information and Management Systems Society, Health Data Management reports.

The survey, conducted by the HIMSS Interoperability and HIE committees, polled 75 health information exchanges in 27 states. Of the respondents:

  • 83% were part of a health information service provider; and
  • 67% were part of a scalable trust network.

Survey Findings

According to the survey, the top instances in which respondents used Direct messaging were:

  • Transitions of care;
  • Admission, discharge or transfer notifications;
  • Patient communications;
  • Secure email for other purposes; and
  • Consult requests among physicians.

Meanwhile, the survey found that the top benefits of Direct messaging included:

  • Faster access to information;
  • Reduced paper handling; and
  • More accurate and comprehensive patient information.

However, respondents cited several barriers to implementing Direct messaging tools, such as:

  • Changing workflows;
  • Other physicians not being ready to interface; and
  • High costs.

Still, 51% of health information organizations said the cost of Direct messaging technology was worth the benefits (Slabodkin, Health Data Management, 6/23).

Reaction

In a blog post about the survey, HIMSS Director of Informatics Mari Greenberger and Sean Kennedy, director of health information exchange at the Mass eHealth Institute, wrote, "From our perspective, we see significant progress and optimism in several areas, signaling that HIE is maturing in the marketplace and beginning to deliver the intended value to their providers and communities" (HIMSS blog, 6/22).

Meanwhile, DirectTrust President and CEO David Kibbe in a statement said the survey  "provides strong proof that standards-based interoperable health information exchange is catching on, finally." He added, "Direct exchange -- which is easy, secure and gets the job done -- is now a permanent technology in the landscape for health information exchange, gaining ground over fax and e-fax, as well as replacing one-off proprietary connectivity solutions for linking providers that are so expensive and complex" (DirectTrust release, 6/23).

Tuesday
Jun232015

Current market view of the usage, value and future of Direct Messaging

Click here for original article.

by: Mari Greenberger, Director of Informatics, HIMSS, and Sean Kennedy, Director, HIE, Mass eHealth Institute

Recently the FY15 HIMSS Interoperability and HIE Committees conducted a nationwide survey on Direct messaging to learn how the marketplace is using Direct to facilitate health information exchange (HIE). Direct messaging was intended to increase interoperability, and this survey was intended to provide visibility on the use and value of Direct.

 

While Health Information Organization (HIO) participation in the survey is not statistically significant compared to the entire HIO population, we believe the responses serve a broad and diverse representation of the HIO market.  With 75 responses representing 27 states, the 2015 Direct Messaging Survey has provided essential information for the HIMSS Interoperability & HIE Committee to assess current trends and refocus their efforts to deliver better value to our interoperability and health information exchange stakeholders.

We have identified the following themes from the survey results which indicate:

  • substantial use of Direct in support of care coordination use cases,
  • broad availability to a provider directory but great variability in the method of access,
  • continued challenges incorporating structured data into the EHR,
  • extensive membership in a HISP,
  • some knowledge of the availability of Direct messaging among the clinician community, and
  • that most participating organizations support Direct as the method choice for exchanging data.

From our perspective, we see significant progress and optimism in several areas, signaling that HIE is maturing in the marketplace and beginning to deliver the intended value to their providers and communities. The survey reports on feedback gathered across five categories of questions: (i) hosted and integrated Direct mechanics, (ii) training and education, (iii) workflow, (iv) interoperability and standards, and (v) HISP.

To access the entire 2015 Direct Messaging Survey results, please click here, but here are a few key takeaways to consider:

  • The top five reported uses of Direct include: (i) transitions of care, (ii) ADT notifications, (iii) patient communication, (iv) secure email for other purposes and (v) consult requests between physicians
  • The top three reported benefits of using Direct include (i) improved speed of info access, (ii) reduce paper handing, more accurate and (iii) complete patient information
  • Major challenges impacting Direct implementations include: (i) high cost, (ii) changing workflows and (iii) other providers not ready to interface
  • 60% of respondents report use of hosted webmail accounts (available via a browser)
  • 76% of respondents reported access to a provider directory, further 64% report they can access internal providers from that directory from within their EHR, whereas 52% report they can access external providers within their EHR
  • 28% report their EHR offers an integrated directory, whereas 28% report they pull in the directory via web services and 17% perform a manual download
  • 83% of respondents are part of a HISP; 85% of HISPs can route information to another HISP
  • 85% of HIOs are part of a scalable trust network (e.g., DirectTrust, NATE, HealtheWay) and most respondents report it extremely important their HISP is part of such a network
  • 51% agree that the cost of using Direct is worth the benefit of information exchange
  • There remains no standard provider directory format – 14% report using LDAP, 14% use IHE HPD, 18% have no plans to adopt a standard, 18% are considering their options, while others use another proprietary standard or simply a relational database.
  • Incorporating C-CDA data, identifying trading partners and funding implementations are reported as modestly challenging; completing the directory is reported as prohibitively challenging,
  • In the absence of MU, respondents reported the following technical preferences for sending electronic health information: CONNECT (27%), SMTP/S-MIME (23%), Direct + XDR/XDM (15%), SOAP+XDR/XDM (6%)
Thursday
Jun042015

Interoperability via Direct Exchange: A Brief Update Mid-2015

Over the past three years it has been my good fortune to work with talented individuals and organizations dedicated to making sharing of health information ubiquitous, secure, inexpensive, and easy to use. Quietly and without much fanfare, they have built both technical and trust infrastructures that reach almost 40,000 health care organizations, interoperably connecting users of over 200 EHRs and PHRs from different vendors. What follows is a brief update of the current status of interoperability in health IT via Direct exchange.

 

Direct is a standards-based method for sending messages and attachments (files) from any application, such as an EHR or a web app, to an individual end-point using any other application. To accomplish this, both sender and receiver need to have Direct addresses of the typename@direct.healthcareorganization.com. These are assigned by a Health Information Service Provider, or HISP, which also encrypts the message/attachment and validates the identity of the receiver and sender. Unlike other secure messaging services, there is no single hub or central server handling all the messages of its members. Instead, in Direct a sender uses the services of a HISP, which passes the encrypted content over the Internet to any receiver’s HISP, and then on to the receiver’s application. Because the messages and attachments are encrypted during their entire journey, and the end-users’ identities validated cryptographically, Direct exchange is a secure HIPAA-compliant way for personal health information to be exchanged electronically peer-to-peer.

 

As of 2014, the ONC required all EHR technology certified for use within Meaningful Use programs to be capable of sending and receiving messages and attachments according to the Direct protocols. This means that Direct is a method for interoperable exchange of health information that is available to virtually all eligible providers attesting to Meaningful Use. Today, roughly half the U.S. health care system is capable of connecting and using Direct to replace fax, efax, and mail transport of health data and information. So far, about 27 million Direct messages have been sent and received, primarily for care coordination associated with providers meeting the Meaningful Use Transitions of Care objectives.

The hardest parts of Direct exchange have not been its technical aspects, but establishing the uniform conditions of privacy, security, identity, and trust necessary for Direct exchanges to take place at scale. If you think about it, each party of the exchange takes a risk when it sends or receives Direct messages and attachments – e.g. patient files, images, etc. – over the Internet, an inherently insecure network. Exchange partners may try to contractually mitigate that risk by specifying security practices that each will follow, but these typically are expensive, difficult to negotiate, and produce only a single two-party agreement. Nor are they applicable to the next HISPs and their customers. Attaining scale, i.e. repeatability, in a system of exchange, requires a network of trusted relationships.

This has been the major accomplishment of the members of DirectTrust, a non-profit trade alliance. DirectTrust’s membership determined early on to bring scale and federation to trust relationships. First, it created a framework of policies and practices that all parties agreed to abide by. Second, it created an accreditation and audit program based on this framework. HISP accreditation transparently signals that these entities have met the uniform benchmark of the security and trust framework, and are thus trustworthy exchange partners. Additional costly one-off contracts are unnecessary.

Currently, 36 HISPs have been accredited by DirectTrust in partnership with EHNAC, the Electronic Healthcare Network Accreditation Commission. These HISPs are contracted with over 200 certified EHRs, bringing Direct exchange capability to the EHRs’ provider and hospital customers, and increasingly to organizations not involved in Meaningful Use, such as home health agencies, hospices, and long term care facilities. To date, over 750,000 Direct addresses have been assigned, creating a very large and growing trust network for Direct exchange.

There is much hard work still to be done. As the recent ONC Report to Congress on Health Information Blocking pointed out, the availability of a standards-based network for interoperable exchange of health information is not sufficient to motivate actual exchange. Some EHRs and their customers have business models opposed to the exchange of patient data with competitors, even those caring for the same patients. According to the Report, page 29:

While some types of information blocking may implicate these technical standards and capabilities [certified by ONC], most allegations of information blocking involve business practices and other conduct that interferes with the exchange of electronic health information despite the availability of standards and certified health IT capabilities that enable this information to be shared.

Huge variation exists between the usability of EHRs’ Direct user interfaces; some have made Direct easy to use, while others have made Direct exchange capability opaque to users by hiding it deep within the software, or by leaving out key components such as an “in box” or attachment generator.

What is clear is that the tide is turning, and health IT interoperability is here to stay. Medicare, the Veterans Administration, the US Postal Service, and the Indian Health Services are all working with DirectTrust’s private sector alliance to advance Direct exchange. New technologies for interoperability, notably FHIR and open APIs, that will rely on fundamental aspects of the work done to date by DirectTrust on scaling of security and trust relationships, are on the way and receiving enthusiastic support from most health IT vendors.

Perhaps most importantly, the trends away from fee-for-service and toward value-based purchasing are breaking down the incentives to silo health information. Care coordination and management of transitions of care are becoming health care business imperatives that can’t be done well without communications that can cross barriers of organizations and health IT systems.

David C. Kibbe, MD, MBA is the President and CEO of DirectTrust.

Friday
Apr102015

EHNAC and DirectTrust to Conduct a Pilot of a PHR HIPAA Compliance Accreditation Program for Personal Health Record and Patient Portal Vendors

Call for Beta Organization Participants Now Open

FARMINGTON, Conn., April 10, 2015 (GLOBE NEWSWIRE) -- The Electronic Healthcare Network Accreditation Commission (EHNAC), a non-profit standards development organization and accrediting body for organizations that electronically exchange healthcare data, and DirectTrust, a non-profit trade alliance that advances secure, health information exchange via the Direct Protocol, announced today they are developing an accreditation program for personal health record (PHR) and patient portal vendors.

This pilot accreditation program will assess these organizations and their ability to meet or exceed HIPAA privacy and security rules based upon the areas of security, privacy, and confidentiality, technical and personnel resources, best practices and compliance with HIPAA and the HITECH Omnibus Rule that updated HIPAA. In 2012, EHNAC and DirectTrust partnered to develop the existing Direct Trusted Agent Accreditation Programs (DTAAPs) for health information service providers (HISP), registration authorities (RA) and certificate authorities (CA) supporting Direct Exchange. The new pilot program for personal health record vendors will be similar to those programs in that it will recognize excellence in health data processing and transactions, and confirm compliance with industry-established standards for privacy and security that are equivalent or exceed HIPAA.

"Personal health record and patient portal vendors are the fastest growing new membership group within DirectTrust – and they deserve a rigorous accreditation program that recognizes the same level of data security and privacy as other organizations accredited by EHNAC-DirectTrust," said DirectTrust President and CEO David C. Kibbe, MD. "The program that DirectTrust and EHNAC is piloting will provide assurance equivalent to and possibly beyond what HIPAA requires. For example, we're looking into incorporating an encryption component for stored data, as well as two-factor authentication to further protect the customers of both PHR vendors and EHR vendors looking to develop their own portals."

EHNAC Executive Director, Lee Barrett added, "We're in an environment of increased angst over security and privacy issues – and with good reason. Today's healthcare providers not only have access to a patient's protected health information including financial data, but also insights into diagnoses, treatment plans, medications, etc. As patients take greater control over their own healthcare decisions and transition their health information to personal health records, they need to have confidence in all healthcare stakeholders that their data will remain secure and confidential. EHNAC and DirectTrust are working collaboratively to close that gap."

PHR vendors looking to participate as a pilot organization and contribute to the development of the program are encouraged to contact info@ehnac.org for more information.

About EHNAC

The Electronic Healthcare Network Accreditation Commission (EHNAC) is a voluntary, self-governing standards development organization (SDO) established to develop standard criteria and accredit organizations that electronically exchange healthcare data. These entities include accountable care organizations, electronic health networks, EPCS vendors, eprescribing solution providers, financial services firms, health information exchanges, health information service providers, management service organizations, medical billers, outsourced service providers, payers, practice management system vendors and third-party administrators.

EHNAC was founded in 1993 and is a tax-exempt 501(c)(6) nonprofit organization. Guided by peer evaluation, the EHNAC accreditation process promotes quality service, innovation, cooperation and open competition in healthcare. To learn more, visit www.ehnac.org, contact info@ehnac.org, or follow us onTwitterLinkedIn and YouTube.

About DirectTrust

DirectTrust.org, Inc. is a non-profit, competitively neutral, self-regulatory entity created by and for participants in the Direct community, including HISPs, CAs and RAs, doctors, patients, and vendors, and supports both provider-to-provider as well as patient-to-provider Direct exchange. The goal of DirectTrust.org is to develop, promote and, as necessary, help enforce the rules and best practices necessary to maintain security and trust within the Direct community, consistent with the HITECH Act and the governance rules for the NwHIN established by ONC.DirectTrust.org is committed to fostering widespread public confidence in the Direct exchange of health information. To learn more, visitwww.directtrust.org.

Wednesday
Apr082015

DirectTrust Announces TASCET as Platinum Sponsor of the 2nd Annual DirectTrust Networking Reception at HIMSS15

TASCET serves as Platinum Sponsor for DirectTrust Networking Reception at HIMSS

Washington, D.C. (PRWEB) April 08, 2015

DirectTrust, a non-profit trade alliance that advances secure standards-based health information exchange (HIE) via the Direct Protocol, is proud to announce TASCET, Inc. as a Platinum Sponsor for the 2nd Annual DirectTrust HIMSS15 Reception.

TASCET is a digital enterprise risk management company, providing software that enables enterprises to proactively manage risk, prevent fraud and protect consumers. In healthcare, TASCET issues a Standard Patient Number™ (SPN), which overcomes the flaws in existing methods of matching patients to medical records and solves the need to identify patients across disparate medical systems during electronic exchange. SPNs solve enterprise risks ranging from medical identity fraud, out of network providers and internal and external patient record sharing while protecting patients in the event of a data breach.

Larry Aubol, CEO TASCET stated, “Everything is digitized, except the most important thing; the customer, the patient, the employee. They remain stuck in the sixteenth century of paper and ink. When we rely on documents and information to identify the people we do business with, we inadvertently promote fraud and threaten the enterprise."

“We are pleased to have TASCET as a valued member of DirectTrust and a Platinum Sponsor for our upcoming event. TASCET and its collaborating peer organizations in the DirectTrust network will continue to have a tremendous impact on patient identity and matching," said Dr. David C. Kibbe, President and CEO of DirectTrust.

About DirectTrust 
DirectTrust is a nonprofit, competitively neutral, self-regulatory entity created by and for participants in the Direct community – including health information service providers (HISPs), certificate authorities, registration authorities, doctors, patients, and vendors. It supports both provider-to-provider, as well as patient-to-provider Direct exchange. The goal of DirectTrust is to develop, promote and, as necessary, help enforce the rules and best practices needed to maintain security and trust within the Direct network, consistent with the HITECH Act and the governance rules for the NwHIN established by the ONC. DirectTrust is committed to fostering widespread public confidence in the Direct exchange of health information. DirectTrust is the recipient of a two-year Cooperative Agreement with the Office of the National Coordinator for Health IT, ONC, under the Exemplar HIE Governance Program, and has been supported in part by a grant associated with the Cooperative Agreement. To learn more, please visit http://www.DirectTrust.org.

Wednesday
Mar182015

DirectTrust Interoperability Report Suggests Best Practices, Improvements

DirectTrust releases its Report on DirectTrust Interoperability Testing and Recommendations to Improve Direct Exchange.

Washington, D.C. (PRWEB) March 18, 2015

DirectTrust, a non-profit trade alliance that advances secure standards-based health information exchange (HIE) via the Direct Protocol, will present its Report on DirectTrust Interoperability Testing and Recommendations to Improve Direct Exchange during the DirectTrust Mini-Conference co-located at the 12th Annual World Health Care Congress on Sunday, March 22, 2015 at 2 pm at the Washington Marriott Wardman Park in Washington, D.C. Last year there were nearly 23 million Direct exchange transactions, and the report is the compilation of two years of best practices and observations on how to efficiently implement interoperability within the context of Stage 2 Meaningful Use.

"The infrastructure for Direct exchange is robust and exchanges are going quite smoothly for most people and organizations attesting to Stage 2 MU 'transitions of care' objectives," said DirectTrust President and CEO David C. Kibbe, MD, MBA. “The report's goal is to get HISPs, EHRs, PHRs, and their customers up to speed using Direct even more quickly, and also to improve the network's processes and policies for more consistent, reliable end-to-end data transfers via Direct."

The challenge-solution format is designed to help Direct service providers and end-users avoid potential stumbling blocks and trouble-shoot any issues that may arise. In addition, it includes a number of recommendations to the Office of the National Coordinator for Health Information Technology (ONC), the health exchange community, electronic health record (EHR) vendors, as well as members of Congress. The focus is improving interoperable communications among providers using EHRs for Meaningful Use programs.

Among the recommendations are: 

  •     Changes to the Applicability Statement, which is the technical description of the Direct standard
  •     Acceptance within the industry of new guidance that will remove ambiguity through best practices
  •     Adding ONC certification proving EHR interoperability in the field, not just in testing labs

Although parts of the report are highly technical in nature so as to benefit engineers implementing interoperability, the report will also prove valuable to CIOs, CTOs, doctors and others in healthcare operations who need specific guidance on solving business problems and managing different scenarios.

"The network is a collaborative community of more than 35,000 healthcare organizations," said EMR Direct CEO Julie Maas. "The report is really a consolidation of shared experiences on overcoming growing pains that are common in such a dynamic system. Solutions evolve and issues resolve. That's what happens when a group is dedicated to finding answers instead of placing blame."

Dr. Kibbe pointed to the report's accounts of a growing number of health information service providers (HISPs) that have successfully implemented Direct exchange. Despite initial, and understandable, skepticism, as well as a number of technical variables — compatibility of systems, claims specifics, etc. — HISPs are demonstrating proof of interoperability between systems.

"Interoperability is hard work, but DirectTrust's skeptics are becoming extinct," he said. "Our hope is that this report provides near term and actionable steps that can be taken to realize the goals for Direct as a first step in interoperability on a national scale, equally vital to patients and consumers as it is to providers and provider organizations."

DirectTrust-EHNAC accreditation means that strict privacy, security, and trust-in-identity controls are in place to ensure that messages and attachments sent over the Internet remain encrypted end-to-end, and that senders and receivers are identity-proofed. In addition to medical practices, clinics, hospitals, pharmacies and laboratories, DirectTrust technology is also being adopted by a growing number of federal agencies, such as the Veterans Administration, U.S. Postal Service, and Indian Health Services.

The interoperability report is the latest in a series of advances made by DirectTrust. Their network grew nearly 970 % last year, and it recently launched a pilot program to create a national directory of Direct email addresses – about 660,000 accounts – for accredited members and their customers.

Those interested in attending DirectTrust's conference presentation or attaining accreditation are advised to visit http://www.DirectTrust.org.

About DirectTrust 
DirectTrust is a nonprofit, competitively neutral, self-regulatory entity created by and for participants in the Direct community – including health information service providers (HISPs), certificate authorities, registration authorities, doctors, patients, and vendors. It supports both provider-to-provider, as well as patient-to-provider Direct exchange. The goal of DirectTrust is to develop, promote and, as necessary, help enforce the rules and best practices needed to maintain security and trust within the Direct network, consistent with the HITECH Act and the governance rules for the NwHIN established by the ONC. DirectTrust is committed to fostering widespread public confidence in the Direct exchange of health information. DirectTrust is the recipient of a two-year Cooperative Agreement with the Office of the National Coordinator for Health IT, ONC, under the Exemplar HIE Governance Program, and has been supported in part by a grant associated with the Cooperative Agreement. To learn more, please visit http://www.DirectTrust.org.

Wednesday
Mar112015

DirectTrust Pilot Program to Connect Providers via Private, National Directory

DirectTrust launches a pilot program to create a directory of Direct email addresses for providers.

Washington, D.C. (PRWEB) March 11, 2015

DirectTrust, a non-profit trade alliance that advances secure standards-based health information exchange (HIE) via the Direct Protocol, has launched a pilot program to create a directory of Direct email addresses for providers in its trusted, national network. The network, which grew nearly 1,000% last year, would not only become more efficient, but participants will find it easier to meet 2015 Stage 2 Meaningful Use “transitions of care” requirements.

“We’re exploring ways to enhance our services in order to match our growth and ensure secure, interoperable health information exchange,” said DirectTrust President and CEO David C. Kibbe, MD, MBA. “Although we’re starting this as a pilot program, our vision is to scale our Provider Directory to enable our entire network of health professionals – about 660,000 accounts – to find their peers’ Direct addresses through their EHRs. The goal is to facilitate care coordination efforts with the utmost security, confidence and efficiency.”

Dr. Kibbe emphasized that the Directory would be available only to DirectTrust accredited members and their customers, is being built according to widely accepted directory standards, and the information therein will not be sold, rented or shared with third parties.

Currently, each health information service provider (HISP) is responsible for providing its own network with a directory of addresses. Different HISPs and electronic health records (EHRs) use different formats, gather different information, and follow different protocols. Consequently, if a provider wants to send a Direct message to another provider who uses a different HISP or EHR, they have to call the provider and request their address.

Last year, there were nearly 23 million Direct exchange transactions.

“There’s a great demand for streamlined communication, and we realize that given the size of our network, we need to crawl before we can walk, then walk before we run,” said Med Allies CEO and DirectTrust Board Chairman John Blair III, MD. “There are more than 35,000 healthcare organizations in our network, so we anticipate that spots in the pilot program will fill up quickly. If this pilot is successful it could eventually have a strong impact on interoperability”

DirectTrust-EHNAC accreditation means that strict privacy, security, and trust-in-identity controls are in place to ensure that messages and attachments sent over the Internet remain encrypted end-to-end, and that senders and receivers are identity-proofed. In addition to medical practices, clinics, hospitals, pharmacies and laboratories, DirectTrust technology is also being adopted by a growing number of federal agencies. HISPs from the Veterans Administration, United States Postal Services, and Indian Health Services have applied for DirectTrust-EHNAC accreditation.

For details on participating in the Directory pilot program or attaining accreditation, please visithttp://www.DirectTrust.org.

About DirectTrust

DirectTrust is a nonprofit, competitively neutral, self-regulatory entity created by and for participants in the Direct community – including health information service providers (HISPs), certificate authorities, registration authorities, doctors, patients, and vendors. It supports both provider-to-provider, as well as patient-to-provider Direct exchange. The goal of DirectTrust is to develop, promote and, as necessary, help enforce the rules and best practices needed to maintain security and trust within the Direct network, consistent with the HITECH Act and the governance rules for the NwHIN established by the ONC. DirectTrust is committed to fostering widespread public confidence in the Direct exchange of health information. DirectTrust is the recipient of a two-year Cooperative Agreement with the Office of the National Coordinator for Health IT, ONC, under the Exemplar HIE Governance Program, and has been supported in part by a grant associated with the Cooperative Agreement. To learn more, please visit http://www.DirectTrust.org.

Friday
Jan302015

DirectTrust Grows Almost 970%, Nears 23-Million-Messages Record in 2014

DirectTrust announced that in 2014, the organization expanded its trusted, national network to include 38 Direct exchange HISPs, which now provide Direct exchange services to more than 35,000 health care organizations with more than 660,000 individual Direct accounts and addresses nationwide.

Washington, D.C. (PRWEB) January 30, 2015

DirectTrust, a non-profit trade alliance that advances secure, health information exchange (HIE) via the Direct Protocol, announced today that last year’s growth far exceeded projections. In 2014, the organization expanded its trusted, national network to include 38 Direct exchange health information service providers (HISPs), which now provide Direct exchange services to more than 35,000 health care organizations with more than 660,000 individual Direct accounts and addresses nationwide. In all, there were nearly 23 million Direct exchange transactions in support of Meaningful Use transitions and other use cases for care coordination.

That translates into the following performance: 
Healthcare Organizations: Up 969% 
Accounts and Addresses: Up 797% 
Direct Transactions: Up 794%

“We’ve experienced stunning growth on every level,” DirectTrust President and CEO David C. Kibbe, MD, said. “We’re talking about nearly a 10-fold increase in the number of health care organizations signed on to Direct. The word is spreading quickly, not just about the ease of implementation and use, but also about the considerable potential for quality improvements and cost savings as electronic Direct exchange replaces paper, mail, fax, and e-fax transmissions. We are starting to see the business case for use of Direct for clinical and administrative information exchanges between federal- and private-sector providers and their organizations, as well.”

DirectTrust-EHNAC accreditation signals strict privacy, security, and trust-in-identity controls are in place to ensure that messages and attachments sent over the Internet remain encrypted end-to-end, and that senders and receivers are identity-validated. Used within electronic health record (EHR) software, this empowers providers and hospitals to communicate with HIPAA-compliance across organizational boundaries and proprietary software platforms. It also qualifies them for the federal government’s meaningful-use incentive programs.

More than 300 certified EHRs now rely upon DirectTrust HISPs for their Direct exchange capability.

“Cerner believes our industry needs interoperability to offer patients the improved continuity of care they deserve,” said Andy Heeren, director, network IP, Cerner. “By partnering with DirectTrust, we’re making it easier for health care organizations to utilize an open, yet secure, communication infrastructure that will help shape the future of health information exchange.”

Despite somewhat disappointing numbers of providers and hospitals participating in Stage 2 Meaningful Use in 2014, expansion is expected to continue during 2015 among its current core users – including medical practices, clinics, hospitals, pharmacies and laboratories. The technology is also being adopted by a growing number of federal agencies. HISPs from the Veterans Administration, United States Postal Services, and Indian Health Services have applied for DirectTrust-EHNAC accreditation so as to provide interoperable and secure Direct exchange between their own and private sector providers and their EHRs.

Other organizations interested in details on attaining accreditation may visit http://www.DirectTrust.org.

About DirectTrust 
DirectTrust is a nonprofit, competitively neutral, self-regulatory entity created by and for participants in the Direct community – including health information service providers (HISPs), certificate authorities, registration authorities, doctors, patients, and vendors. It supports both provider-to-provider, as well as patient-to-provider Direct exchange. The goal of DirectTrust is to develop, promote and, as necessary, help enforce the rules and best practices needed to maintain security and trust within the Direct network, consistent with the HITECH Act and the governance rules for the NwHIN established by the ONC. DirectTrust is committed to fostering widespread public confidence in the Direct exchange of health information. DirectTrust is the recipient of a two-year Cooperative Agreement with the Office of the National Coordinator for Health IT, ONC, under the Exemplar HIE Governance Program, and has been supported in part by a grant associated with the Cooperative Agreement. To learn more, please visit http://www.DirectTrust.org.

About Cerner 
Cerner’s health information technologies connect people, information and systems at more than 14,000 facilities worldwide. Recognized for innovation, Cerner solutions assist clinicians in making care decisions and enable organizations to manage the health of populations. The company also offers an integrated clinical and financial system to help health care organizations manage revenue, as well as a wide range of services to support clients’ clinical, financial and operational needs. Cerner’s mission is to contribute to the improvement of health care delivery and the health of communities. Nasdaq: CERN. For more information about Cerner, visit cerner.com, read our blog at cerner.com/blog, connect with us on Twitter at twitter.com/cerner and on Facebook at facebook.com/cerner.

Friday
Dec122014

Direct: 5 Years Of Simplifying Health Information Exchange

David McCallie, father of the Direct protocol, discusses the state of interoperability in healthcare with Georgia Tech informaticist Mark Braunstein.

Five years ago today, Gartner Group HIT expert Wes Rishel posted a guest article on his blog entitled "Simplifying Interop," written by David McCallie, Jr., MD.

In his introduction, Rishel said, "I am advocating a layered approach to standards that cherry-picks the easy cases and approaches them using Internet standards that are widely used and, if necessary, easily adapted." He identified Dr. McCallie as a co-conspirator. I interviewed McCallie to recognize the key result of that post exactly five years ago: Direct, the first example of health information exchange using current Internet standards.

McCallie joined Cerner in 1991 and now serves as the company's senior vice president of medical informatics. He is responsible for a research and development team focused on developing innovations at the intersection of computer science and clinical medicine. His current work targets applications of semantic content extracted from the clinical record using natural language parsing techniques. He currently is a member of the Office of the National Coordinator's HIT Standards Committee, where he serves on numerous workgroups, including the JASON Task Force (co-chair); the Architecture, Services, and API WG (co-chair); the Privacy and Security WG; and the Interoperability and HIE WG.

[Nurturing a standard: DirectTrust Delivers Interoperable Messaging To Healthcare.]

Prior to joining Cerner, McCallie was director of research computing at Children's Hospital in Boston, where SMART on FHIR was developed. He earned a bachelor's degree in electrical engineering at Duke University and an MD at Harvard Medical School. He has published numerous articles and presents frequently on the subject of healthcare informatics.

Mark Braunstein: David, I'm afraid it is not as widely known as it should be that you were one of the innovative thinkers behind Direct. Can you explain how you came to see the need for a simpler, secure email-based means of sharing health information?

 

David McCallie, Jr.
David McCallie, Jr.

 

David McCallie, Jr.: We (the ONC HIT Standards Committee, or HITSC) were just getting started selecting the standards for Meaningful Use, and I was concerned that we didn't have a national standard for simple encrypted email-like exchange between providers. It occurred to me that starting with a simple "push" model of exchange would greatly simplify the governance and policy decisions necessary for what we wanted -- universal exchange -- as ubiquitous as the fax machine.

At that time, there were numerous proprietary secure messaging systems, but nothing that could be used for national-scale exchange. I pointed this out to Wes Rishel one evening before an upcoming standards committee meeting. Wes agreed with me and asked me to write about it on his Gartner blog. Clearly a lot of other people had been thinking about this problem, and so we had terrific response to the proposal, leading to numerous experts from around the country volunteering to help design and build a secure email system, based on existing Internet standards (SMTP, S/MIME.)

Eventually, due in large part to the ONC-sponsored coordinating work of Arien Malec and the volunteer efforts of dozens of experts (including Sean Nolan, Greg Meyers, Brett Peterson, Umesh Madan, Nagesh Bashyam, Paul Tuten, Janet Campbell, Rich Elmore, Mike Davis, and many others), the Direct standard emerged.

MB: For readers not familiar with the specifics of Direct, can you briefly explain what it is and how it works?

DM: Sure. Direct is a specific set of profiles on how to use Internet email (SMTP) and standard message encryption (S/MIME) to send secure messages from one provider to another.

Direct leverages well-known open source standards but adopts them for healthcare specific uses. The main thing that Arien's team did was to specify exactly how to manage the complex S/MIME encryption algorithms such that implementation challenges would be minimized, while still guaranteeing that the messages would be securely transmitted. Direct is managed on a local or regional basis by a special service provider called a Health ISP, or HISP. Among other things, providers are registered in the HISP after a verification process to establish "trust" -- that they are who they say they are -- and are issued special email addresses for use only for sending/receiving Direct messages.

MB: Today, of course, Direct is being increasingly used. Are you satisfied with Direct adoption levels?

DM: I am glad to see the rapidly growing availability of Direct users, but I am frankly surprised at how hard it has been to get close to our original notion of universal connectivity. It turns out that building a national-scale "trust framework" is harder than we had anticipated. We didn't think we could force Direct on everyone via a top-down government mandate, so we settled on a federated trust model: Each HISP would have to determine which other HISPs to trust. This has been slower and harder than expected, but we are now seeing lots of progress.

MB: What things do you see that still need to be done to increase Direct adoption and ease of use by providers?

DM: I see two major challenges. The first is the establishment of the trust framework that I mentioned before. The work of DirectTrust has been very important in addressing the creation of such a national-scale trust framework. The second major challenge is for EHR vendors to do a better job of integrating Direct-based secure messages into the clinical workflow. Meaningful Use Stage 2 has perhaps an overly specific use case for Direct, and ironically, that over-specification may have slowed overall adoption.

MB: I note with interest that the first response to your Gartner blog post was by Dr. David Kibbe, who now leads DirectTrust, the organization you just mentioned. Can you explain the need for that effort?

DM: David Kibbe has been a major advocate of Direct from the very earliest discussions. Trust, from a national perspective, is the ability of HISPs to be comfortable that other HISPs have properly vetted everyone who is assigned a special Direct email address to ensure they are who they say they are and that they are managing their encryption keys properly. David and some of his colleagues stepped up to the challenge of building a national trust framework by founding DirectTrust a few years ago, when they realized that federated trust models don't just spontaneously emerge.

DirectTrust works by allowing participating HISPs to undergo a rigorous certification process that proves to the other HISPs that security is being handled according to industry best practice standards. Once a HISP has passed the certification and is added to the DirectTrust "trust bundle," then all of the other participating HISPs can immediately trust the new member. This process is now scaling rapidly, since most of the major HISPs are participating in DirectTrust.

MB: Previously, I've discussed the JASON Report and the recent advice on adopting it that was provided by the JASON Task Force (JTF) convened by CMS and ONC. You co-chaired that task force, so what can you tell us about the likely future of the JASON recommendations?

DM: The original JASON report called for (among other things) the establishment of a "public API" that would be deployed by all major participants in the HIT infrastructure. The JTF agreed with that JASON recommendation and fleshed out some specific suggestions for how the HIT industry could indeed deploy the "public API."

The key is to understand that the public API consists of two things. The first is a standards-based API (likely HL7's FHIR) that all participants could implement, and the second is an expectation that everyone would deploy the API in a fair and non-discriminatory way.

We wrestled with the question of the government's role in ensuring adoption of the public API and settled on a recommendation that, once the public API is piloted and well tested, it should become part of the ONC EHR Certification program (CEHRT). We also suggested that ONC could speed the readiness of the vendor community to implement the public API by simplifying some of the proposed Meaningful Use Stage 3 (MU3) recommendations. In other words, trade off some of the current MU3 complexity for the increased power of a generic API.

We are now awaiting the release of the ONC Interoperability Roadmap, due out very soon, and we'll see how they have responded to these recommendations.

MB: Cerner has become a strong advocate for FHIR, another Internet-based technology that is rapidly receiving attention. I've interviewed Graham Grieve previously, but I'm sure our readers would be interested in getting a perspective on FHIR from a major vendor. What might we see from Cerner in the coming years in the way of FHIR support, for example?

DM: We believe that FHIR is the best candidate for becoming the public API that I mentioned earlier. FHIR is very well-designed, and it leverages many of the design principles (such as HTTPS) that have led to the success of the Internet. Cerner believes that many EHR vendors will come to see themselves as "platform" vendors more than just as product vendors.

The idea of a platform is that your customers can access the API to extend the product on their own -- to add in capabilities that the vendor might not have addressed. This could also lead to an ecosystem of "app developers" who utilize the public API to create "plug-in" apps much like we take for granted in our smartphones, etc. Cerner is working closely with the SMART on FHIR group (from Boston Children's) to create the open standards and specifications to make this vision a reality. Our early pilots in this space have been very well-received. We plan to deploy production versions of SMART and FHIR later into 2015.

MB: Interoperability has been for decades arguably the grand challenge facing health informatics. We've both been in the field for most -- in my case, nearly all -- of that time. I never thought I'd see the level of attention to the problem we're seeing now, nor did I feel I'd see an actual potential solution with a real chance of succeeding. Are you optimistic that we'll achieve interoperability, and can you take out your crystal ball and tell us how you think things may unfold over the coming years?

DM: As an engineer by training, I am always optimistic, but I agree that movement in the last year or so bodes very well for future improvements in interoperability. As you might expect, I think FHIR and specifications like SMART on FHIR will go a long way towards radically increasing the options we have to get our systems to have smarter interactions.

The use of a generic API like FHIR opens the door to innovative new interactions -- the kind that were not possible with the static, "bespoke" interface standards of the past. For example, FHIR will enable us to move past the reliance on document exchange via the complicated CDA approach and allow just the needed clinical data to be requested and received. This should lead to more satisfying interactions for the clinicians who use our systems.

This transition will take years to play out, but I am optimistic that we are indeed at a turning point in the industry's approach to interoperability.

Apply now for the 2015 InformationWeek Elite 100, which recognizes the most innovative users of technology to advance a company's business goals. Winners will be recognized at the InformationWeek Conference, April 27-28, 2015, at the Mandalay Bay in Las Vegas. Application period ends Jan. 16, 2015.

 

Mark Braunstein is a professor in the College of Computing at Georgia Institute of Technology, where he teaches a graduate seminar and the first MOOC devoted to health informatics. He is the author of Contemporary Health Informatics (AHIMA Press, 2014) as well as Health ... View Full Bio