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Is It Time To Put FHIR-Based Development Front And Center?

Posted on August 9, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I like to look at questions other people in the #HIT world wonder about, and see whether I have a different way of looking at the subject, or something to contribute to the discussion. This time I was provoked by one asked by Chad Johnson (@OchoTex), editor of HealthStandards.com and senior marketing manager with Corepoint Health.

In a recent HealthStandards.com article, Chad asks: “What do CIOs need to know about the future of data exchange?” I thought it was an interesting question; after all, everyone in HIT, including CIOs, would like to know the answer!

In his discussion, Chad argues that #FHIR could create significant change in healthcare infrastructure. He notes that if vendors like Cerner or Epic publish a capabilities-based API, providers’ technical, clinical and workflow teams will be able to develop custom solutions that connect to those systems.

As he rightfully points out, today IT departments have to invest a lot of time doing rework. Without an interface like FHIR in place, IT staffers need to develop workflows for one application at a time, rather than creating them once and moving on. That’s just nuts. It’s hard to argue that if FHIR APIs offer uniform data access, everyone wins.

Far be it from me to argue with a good man like @OchoTex. He makes a good point about FHIR, one which can’t be emphasized enough – that FHIR has the potential to make vendor-specific workflow rewrites a thing of the past. Without a doubt, healthcare CIOs need to keep that in mind.

As for me, I have a couple of responses to bring to the table, and some additional questions of my own.

Since I’m an HIT trend analyst rather than actual tech pro, I can’t say whether FHIR APIs can or can’t do what Chat is describing, though I have little doubt that Chad is right about their potential uses.

Still, I’d contend out that since none other than FHIR project director Grahame Grieve has cautioned us about its current limitations, we probably want to temper our enthusiasm a bit. (I know I’ve made this point a few times here, perhaps ad nauseum, but I still think it bears repeating.)

So, given that FHIR hasn’t reached its full potential, it may be that health IT leaders should invest added time on solving other important interoperability problems.

One example that leaps to mind immediately is solving patient matching problems. This is a big deal: After all, If you can’t match patient records accurately across providers, it’s likely to lead to wrong-patient related medical errors.

In fact, according to a study released by AHIMA last year, 72 percent of HIM professional who responded work on mitigating possible patient record duplicates every week. I have no reason to think things have gotten better. We must find an approach that will scale if we want interoperable data to be worth using.

And patient data matching is just one item on a long list of health data interoperability concerns. I’m sure you’re aware of other pressing problems which could undercut the value of sharing patient records. The question is, are we going to address those problems before we began full-scale health data exchange? Or does it make more sense to pave the road to data exchange and address bumps in the road later?

Bringing EHR Data to Radiologists

Posted on December 2, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the most interesting things I saw at RSNA 2016 in Chicago this week was Philips’ Illumeo. Beside being a really slick radiology interface that they’ve been doing forever, they created a kind of “war room” like dashboard for the patient that included a bunch of data that is brought in from the EHR using FHIR.

When I talked with Yair Briman, General Manager for Healthcare Informatics Solutions and Services at Philips, he talked about the various algorithms and machine learning that goes into the interface that a radiologist sees in Illumeo. As has become an issue in much of healthcare IT, the amount of health data that’s available for a patient is overwhelming. In Illumeo, Philips is working to only present the information that’s needed for the patient at the time that it’s needed.

For example, if I’m working on a head injury, do I want to see the old X-ray from a knee issue you had 20 years ago? Probably not, so that information can be hidden. I may be interested in the problem list from the EHR, but do I really need to know about a cold that happened 10 years ago? Probably not. Notice the probably. The radiologist can still drill down into that other medical history if they want, but this type of smart interface that understands context and hides irrelevant info is something we’re seeing across all of healthcare IT. It’s great to see Philips working on it for radiologists.

While creating a relevant, adaptive interface for radiologists is great, I was fascinated by Philips work pulling in EHR data for the radiologist to see in their native interface. Far too often we only talk about the exchange happening in the other direction. It’s great to see third party applications utilizing data from the EHR.

In my discussion with Yair Briman, he pointed out some interesting data. He commented that Philips manages 135 billion images. For those keeping track at home, that amounts to more than 25 petabytes of data. I don’t think most reading this understand how large a petabyte of data really is. Check out this article to get an idea. Long story short: that’s a lot of data.

How much data is in every EHR? Maybe one petabyte? This is just a guess, but it’s significantly smaller than imaging since most EHR data is text. Ok, so the EHR data is probably 100 terabytes of text and 900 terabytes of scanned faxes. (Sorry, I couldn’t help but take a swipe at faxes) Regardless, this pales in comparison to the size of radiology data. With this difference in mind, should we stop thinking about trying to pull the radiology data into the EHR and start spending more time on how to pull the EHR data into a PACS viewer?

What was also great about the Philips product I saw was that it had a really slick browser based HTML 5 viewer for radiology images. Certainly this is a great way to send radiology images to a referring physician, but it also pointed to the opportunity to link all of these radiology images from the EHR. The reality is that most doctors don’t need all the radiology images in the EHR. However, if they had an easy link to access the radiology images in a browser when they did need it, that would be a powerful thing. In fact, I think many of the advanced EHR implementations have or are working on this type of integration.

Of course, we shouldn’t just stop with physicians. How about linking all your radiology images from the patient portal as well? It’s nice when they hand you a DVD of your radiology images. It would be much nicer to be able to easily access them anytime and from anywhere through the patient portal. The great part is, the technology to make this happen is there. Now we just need to implement it and open the kimono to patients.

All in all, I love that Philips is bringing the EHR data to the radiologists. That context can really improve healthcare. I also love that they’re working to make the interface smarter by removing data that’s irrelevant to the specific context being worked on. I also can’t wait until they make all of this imaging data available to patients.

Mount Sinai Uses AI To Manage CHF Cases

Posted on October 31, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

New York-based Mount Sinai Hospital has begun a project which puts it in the vanguard of predictive analytics, working with a partner focused on artificial intelligence. Mount Sinai plans to use the Cloud Medx Clinical AI Platform to predict which patients might develop congestive heart failure and care better for those who’ve already done so.

As many readers will know, CHF is a dangerous chronic condition, but it can be managed with drugs, proper diet and exercise, plus measurement of blood pressure and respiratory function by remote monitoring devices. And of course, hospitals can mine their EMR for other clinical clues, as well as rifling through data from implantable medical devices or health tracking bands or smartwatches, to see if a patient’s condition is going south.

But using AI can give a hospital a more in-depth look at patterns that might not be visible to the unaided clinician. In fact, CloudMedx is already helping Sacramento-based Sutter Physician Services improve its patient care by digging out unseen patterns in patient data.

To perform its calculations, CloudMedx runs massive databases on public clouds such as Amazon Web Services and Microsoft Azure, then layers its specialized analytics and algorithms on top of the data, allowing physicians or researchers to query the database. The analytics tools use natural language processing and machine learning to track patients over time and derive real-time clinical insights.

In this case, the query tools let clinicians determine which patients are at risk of developing CHF or seeing their CHF status deteriorate. Factors the system evaluates include medical notes, a patient’s family history, demographics and past medical procedures, which are rolled up into a patient risk score.

In moving ahead with this strategy, Mount Sinai is rolling out what is likely to be a common strategy in the future. Going forward, expect to see other providers engage the growing number of AI-based healthcare analytics vendors, many of whom seem to have significant momentum.

For example, there’s Lumiata, a developer of AI-based productive health analytics whose Risk Matrix tool draws on more than 175 million patient-record years. Risk Matrix offers real-time predictions for 20 chronic conditions, including CHF, chronic kidney disease and diabetes.

Risk Matrix bases its predictions on its customers’ datasets, including labs, EHR data claims information and other types of data organized using FHIR. Once data is mapped out into FHIR, Risk Matrix generates output for more than 1 million records in less than three hours, the company reports. Users access Risk Matrix analyses using a FHIR-compatible API, which in turn allows for the results to be integrated into the output of the existing workflows.

But Lumiata is just the tip of the iceberg. CB Insights has identified more than 90 companies applying machine learning algorithms and predictive analytics to important problems in healthcare.

While many startups have flocked into the imaging and diagnostics space, expect to see AI-related activity in drug discovery, remote monitoring and oncology. Also, market watchers say companies founded to do AI work outside of healthcare see many opportunities there as well.

Now, at least at this stage, high-end AI tools are likely to be beyond the budget of mid-sized to small community hospitals. Nonetheless, they’re likely to be deployed far more often as value-based reimbursement hits the scene, so they might end up in use at your hospital after all.

Hospitals, Groups Come Together To Create Terminology For Interoperability

Posted on August 5, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A health IT trade coalition dedicated to supporting data interoperability has kicked off an effort providing fuel for shareable health IT app development.

The Healthcare Services Platform Consortium, whose members include Intermountain Healthcare, the American Medical Association, Louisiana State University, the Veterans Health Administration and the Regenstrief Institute, is working to increase interoperability by defining open, standards-based specifications for enterprise clinical services and clinical applications.

Its members came together to to create a services-oriented architecture platform that supports a new marketplace for interoperable healthcare applications, according to Healthcare Informatics. Stan Huff, MD, CMIO of Intermountain, has said that he’d like to see more shareable clinical decision support modules developed.

Now, in furtherance of these goals, HSPC members are throwing their support behind an initiative known as SOLOR, which calls for integrating SNOMED CT and Laboratory LOINC, as well as selected components of RxNorm. According to the group, SOLOR will provide a terminology foundation for CIMI (Clinical Information Modeling Initiative) efforts, as well as FHIR profile development.

“We hope SOLOR can serve as a foundation to deliver sharable clinical decision-support capability both within the VA and ultimately throughout the nation’s healthcare system,” said Veterans Health Administration deputy CMIO for strategy and functional design Jonathan Nebeker, M.S., M.D., in a prepared statement.

Ultimately, HSPC hopes to create an “app store” model for plug-and-play healthcare applications. As HSPC envisions it, the app store will support common services and models that vendors can use to shorten software development lifecycles.

Not only that, the evolving standards-oriented architecture will allow multiple providers and other organizations to each deliver different parts of a solution set. This solution set will be designed to address care coordination, gaps in workflow between systems and workflows that cut across acute care, ambulatory care and patient-centered medical home models.

Industry players have already created a small selection of apps built on the SMART technology platform, roughly three dozen to date. The apps, some of which are experimental, include a tool estimating a patient’s cardiac risk, a SMART patient portal, a tool for accessing the Cerner HIE on SMART and an app called RxCheck offering real-time formulary outcomes, adherence data, clinical protocols and predictive analytics for individual patients.

Now, leaders of the HSPC – notably Intermountain’s Huff – would like to scale up the process of interoperable app development substantially. According to Healthcare Informatics, Huff told an audience that while his organization already has 150 such apps, he’d like to see many more. “With the budget we have and other constraints, we’ll never get from 150 to 5,000,” Huff said. “We realized that we needed to change the paradigm.”

HIMSS Social Media Ambassador Debate: FHIR and Patient Focus

Posted on June 8, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at HIMSS, I had a chance to do a “debate” with my good friend, partner and fellow HIMSS Social Media Ambassador, Shahid Shah. This was facilitated by Healthcare IT News, and the debate was moderated by Beth Jones Sanborn, Managing Editor of Healthcare Finance. Shahid and I had a good debate on the topics of healthcare interoperability and FHIR. Plus, we talked about the need for healthcare IT companies to focus on the patient and whether they deserve the bad rap they get or not. Enjoy the video debate below:
Read more..

Health IT Software Must Be Meaningful and Pleasurable

Posted on April 27, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the most dynamic healthcare CIO’s is Shafiq Rab, MD, MPH, Vice President and CIO at Hackensack UMC. Healthcare Scene was lucky enough to talk with him at the DataMotion Health booth during HIMSS 2016. Dr. Rab talked with us about Hackensack UMC’s approach to healthcare IT innovation. He offered some great insights into how to approach any healthcare IT project, about Hackensack University Medical Center’s “selfie” app, and their efforts to use Direct and FHIR to empower the patient.

I love that Dr. Rab leads off the discussion with the idea that healthcare IT software that they implement must be meaningful and pleasurable. Far too many health IT software miss these important goals. They aren’t very meaningful and they’re definitely not pleasurable.

Dr. Rab’s focus on the patient is also worth highlighting. Health IT would be in a much better place if there was a great focus on the patient along with making health IT software meaningful and pleasurable. Thanks Dr. Rab and DataMotion Health for doing this interview with us.

Working to Understand FHIR

Posted on April 9, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Ever since I’d heard so many good things about FHIR, I’ve been slowly trying to learn more about it, how it will be implemented, what challenges it faces, and what’s the pathway for FHIR to have widespread adoption.

So, it was no surprise that the Corepoint Health sessions on FHIR caught my eye and will be part of my HIMSS 2015. As part of that education they sent me their FHIR whitepaper which they’ll be handing out at their booth along with their sessions on FHIR. As with most things, the more I learn about FHIR, the more I realize I need to learn.

One example of this comes from the FHIR whitepaper linked above. It talks about defining resources for FHIR:

Resources are small, logically discrete units of exchange. Resources define behavior and meaning, have a known identity and location, are the smallest possible unit of transaction, and provide meaningful data that is of interest to healthcare. The plan is to limit resources to 100 to 150 in total. They are sometimes compared to an HL7 V2 segment.

The resources can be extended and adapted to provide a more manageable solution to the healthcare demand for optionality and customization.
Source: Corepoint Health

This section reminded me of a comment Greg Meyer tweeted during an #HITsm chat about FHIR’s biggest challenge being to define profiles. When he said, that I made a note to myself to learn more about what made up profiles. What Greg called profiles, it seems Corepoint Health is calling resources. They seem to be the same thing. This chart from the whitepaper does a great job summarizing why creating these resources (or profiles if you prefer) is so challenging:

FHIR Resource Examples
Source: Corepoint Health

I still have a lot more to learn about FHIR, but it seems like it does have really good founding principles. We’ll see if the powers that be can keep it pure or try and corrupt and modify its core principles. Not to mention take it and make it so complex that it’s not usable. I’ll be learning more about FHIR at HIMSS and I’ll be sure to report back. Until then, this FHIR whitepaper provides a pretty good historical overview of FHIR versus the other healthcare IT standards.

FHIR Adoption Needs Time to Mature

Posted on January 7, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In John Halamka’s look at Health IT in 2014 he offered some really great insight into how regulators should look at standards and adoption of standards.

Here’s one section which talks about the lesson learned from meaningful use stage 2:

“Stage 2 was aspirational and a few of the provisions – Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist. The goals were good but the standards were not yet mature based on the framework created by the Standards Committee.”

Then, he offers this money line about FHIR and how we should handle it:

“We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption”

There’s no doubt that FHIR is on Fire right now, but we need to be careful that it doesn’t just go down in flames. Throwing it into a regulatory program before it’s ready will just smother it and kill the progress that’s being made.