Interoperability, MU and What Lies Beyond Is the Future of Health Data Exchange on FHIR? November 14, 2014

Transcription

1 Interoperability, MU and What Lies Beyond Is the Future of Health Data Exchange on FHIR? November 14, 2014 Hosted by: Sponsored by:

2 Today s Webinar is Sponsored By 15 years experience in operationalizing clinical information networks Unsurpassed expertise in solving for wide variety of use cases (public and private) Last mile connectivity Most contemporary architecture This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at:

3 Today s Agenda Introduction of Moderator Panelists Presentation by Each Panelist Moderated Q&A Follow Up Post Event

4 Moderator Brian Ahier Director of Standards and Government Affairs at Medicity A renowned expert on health information technology, specifically health data exchange and analytics, Ahier has provided consulting services to a variety of clients including the Office of the National Coordinator (ONC). He serves on the Interoperability & HIE Workgroup of the HIT Policy Committee which will make recommendations to the ONC that focus on policies that can help address implementation challenges and that promote a business and regulatory environment supportive of widespread information exchange in support of patient and population care. Examples of issues the Workgroup may consider include health information exchange infrastructure, governance, and technology. The Workgroup will also be making recommendations and provide input on the development of the Nationwide Interoperability Roadmap. Follow him on

5 Panelist Keith Boone Standards Geek at GE Healthcare Keith Boone is a Standards Geek working at GE Healthcare. He represents GE Healthcare to various standards organizations, develops standards used in Healthcare, and teaches and promotes those standards in the Healthcare industry. He has been working in Healthcare IT for more than a decade, and as a software developer and implementer of standards for more than 25 years. Keith is currently a member of the board of HL7 International, and past co-chair of the HL7 Structured Documents workgroup and the IHE Patient Care Coordination planning and technical committees in Integrating the Healthcare Enterprise. He is the author of The CDA Book (published by Springer), and has authored or edited more than a dozen standards and implementation guides using the HL7 Clinical Document Architecture standard. He contributed to the development of the HL7 CDA standard, and was one of the editors of the HL7 Continuity of Care Document (CCD) during his tenure as co-chair of the Structured Documents workgroup in HL7. He also co-chaired the Care Management and Health Records committee in ANSI/HITSP and was an editor for the HITPS C32 Summary Documents using the HL7 CCD, and the HL7 CCDA specification, both required by US Meaningful Use regulations. He also sits on the US HIT Standards Clinical Quality Workgroup and the NwHIN Power Team. Keith writes a daily blog on Healthcare Standards topics, and he is also contributor to blogs on Healthcare IT News, GE Health IT Views and Hospital Impact. He enjoys teaching his children arcane mathematics, and riding his motorcycle. He can be found on twitter

6 HL7 Version 2

7 HL7 CDA

8 HL7 CDA

9 HL7 Version 3

10 HL7

11 is Easy to Create This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at:

12 is Easy to License This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at:

13 is Easy to Code function createdisclosureevent(context, response, event) { var theresult = JSON.parse(response); // TBD Fix this if (theresult.feed) theresult = theresult.feed; var from = getfrom(theresult); var thesender = createlocation(from, true); var thereceiver = createlocation(context, false); var thepatients = getpatients(theresult); var thedata = { "type" : { "value" : "4 }, "role" : { "value" : "24" // 3 = Report, 4 = Resource, 24 = Query }, "lifecycle" : { "value" : "11 }, "query" : { "value" : btoa(from.what) // TBD: Safely Base64 encode this puppy } }; if (event == null) { var thereason = { "type" : {"value" : "4" }, "role" : { "value" : "13" // 13 = Security Resource (Reason for Disclosure) }, "name" : { "value" : context.why } }; var thearray = new Array(); thearray.push(thereason); var securityevent = { "SecurityEvent" : { "text" : { "status" : { "value" : "generated }, "div" : "<div xmlns=\" by who to where of whos data what</div>" }, "event" : { "type" : { "coding" : [ { "system" : { "value" : " }, "code" : { "value" : " }, "display" : { "value" : "Export } } ] }, This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at: "subtype" : [ { "coding" : [ { "system" : { "value" : "HIPAA }, "code" : { "value" : "Disclosure" }, "display" : { "value" : "HIPAA disclosure } } ] } ], "action" : { "value" : "R }, "datetime" : { "value" : context.when }, "outcome" : { "value" : "0 } }, "participant" : [ thesender, thereceiver ], "source" : { "identifier" : { "value" : "John and Keith's Accounting of Disclosures Application" } }, "object" : thearray } }; event = securityevent; msg = "Disclosure by " + thesender.userid.value + " at " + thesender.network.identifier.value + " to "; msg += thereceiver.userid.value + " at " + thereceiver.network.identifier.value + " of " + from.what + " for "; msg += patientlist(thepatients) + " because " + context.why; msg = msg.replace(/&/g,"&"); msg = msg.replace(/</g,"<"); msg = msg.replace(/>/g,">"); msg = "<div xmlns=' + msg + "</div>"; event.securityevent.text.div = msg; } var thearray = event.securityevent.object; event = securityevent; event.securityevent.object = thearray.concat(thepatients); event.securityevent.object.push(thedata); return event; }

14 is Easy to Use Open Source Client Libraries Health Intersections (Grahame Grieve, Australia) Delphi, Windows, MS SQL SMART on FHIR (Josh Mandel, USA) Java/Groovy Furore (Ewout Kramer, Netherlands).Net, MongoDB, WebAPI 2.0 University Health Network (James Agnew, Canada) Java/HAPI.Net Java JavaScript Swift/IOS and OS X Others This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at:

15 is Easy to Read This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at:

16 Panelist Janet Campbell Senior Software Architect, Janet Campbell is a senior software architect at Epic, which creates enterprise medical records for mid-size and large medical groups, hospitals, and integrated healthcare organizations. In her eleven years at Epic, Janet has led the creation of several successful products: Stork (for Obstetrics), Lucy personal health record, and MyChart Bedside, a shared record for hospitalized patients. She represents Epic in national conversations on interoperability, usability, meaningful use, and patient engagement. She is Chair of the Electronic Health Record Association s Clinical Experience Workgroup.Most recently, Janet launched open.epic, a plug & play initiative to smooth and simplify the process of connecting externally developed applications to Epic. Check the FHIR sandbox at:

17 Why I m excited about FHIR, and what we need to do next. Janet Campbell Research & Development Epic

18 This is my job This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at:

19 This is my job This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at:

20

21 My job is to disappoint people.

22 The Promise of FHIR 3 keys to success simple atomic objects a common agreement of meaning a common, modern transport This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at:

23 The FHIR Triangle 3 things we need AUDITING This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at:

24 Where do we go from here? VS Power Simplicity

25 Where do we go from here? VS Power Simplicity

26 FHIR: the Potential And more!

27 Panelist John D. Halamka, MD CIO of Beth Israel Deaconess Medical Center John D. Halamka, MD, MS, is a Professor of Medicine at Harvard Medical School, Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), co-chair of the national HIT Standards Committee, co-chair of the Massachusetts HIT Advisory Committee and a practicing Emergency Physician. As Chief Information Officer of Beth Israel Deaconess Medical Center, he is responsible for all clinical, financial, administrative and academic information technology serving 3000 doctors, employees and two million patients. As Chairman of NEHEN he oversees clinical and administrative data exchange in Eastern Massachusetts. As co-chair of the HIT Standards Committee he facilitates the process of electronic standards harmonization among stakeholders nationwide. As co- Chair of the Massachusetts HIT Advisory Committee, he engages the stakeholders of the Commonwealth to guide the development of a statewide health information exchange. He can be found on twitter

28 JASON Report Independent group of scientists which advises the United States government on matters of science and technology. Created in 1960 as a way to get a younger generation of scientists involved in advising the government. Administratively run through the MITRE corporation which contracts with the Defense Department Their work is typically classified ONC Convened a Task Force to respond to the report

29 Industry-based Ecosystem Recommendation: A market-based exchange architecture should be defined by industry and government to meet the nation s current and future interoperability needs based on the following key concepts: Coordinated architecture. A loosely couple architecture with sufficient coordination to ensure that a market-driven ecosystem emerges for API-based exchange. Data Sharing Network (DSN). An interoperable data sharing arrangement whose participants have established the legal and business frameworks necessary for data sharing. Conform to the Coordinated Architecture and use the public API. Could include, but is certainly not restricted to, existing networks such as those run by vendors or providers or health information exchange organizations. Public API. A standards-based API that is to be implemented with certain obligations and expectations governing public access to the API. Core Data Services. Fundamental, standards-based data services that implementations of the Public API are expected to provide. Note: Our use of the term "HIE" is generic in nature and refers to general interoperability functions and should not be confused with health information exchange organizations, which are often called "HIEs" or "health information exchanges.

30 Industry-based Ecosystem (continued) The Coordinated Architecture Should not be single, top-down architecture Loosely coupled based on scalable internet principles to accommodate implementation heterogeneity Leverage and build upon existing networks, while encouraging new networks Do not envision that the Coordinated Architecture is necessarily an entity or actual implementation, but rather, standards and principles based on internet principles and building blocks

31 Data Sharing Networks in a Coordinated Architecture Recommendation: The nationwide exchange network should be based on a Coordinated Architecture that "loosely couples" market-based Data Sharing Networks The Data Sharing Networks Data sharing arrangements that provide facilitating policy and infrastructure to support use of Public APIs Within the DSN: Facilitating API-based exchange among entities. This has a technical component (e.g., what technologies are used to identify patients or authenticate users across entities?), and a policy component (e.g., what data or documents are accessible through a Public API, and what are the allowed purposes for data or documents accessed through a Public API?) Across DSNs: Implementing services to be used to bridge across different DSNs, when this is deemed necessary. This will have cross-network technical components (e.g., which standards and protocols are used for different DSNs' patient-matching or authentication technologies to interact with each other?), and policy components (e.g., how are "out of network" entities authorized, and what data or documents are accessible to authorized "out of network" entities?) Clinical and financial systems that expose the Public API will have the ability to exchange data without needing a DSN

32 Panelist Arien Malec VP, Data Platform Product Line, RelayHealth Arien Malec is the VP, Data Platform Product Line for RelayHealth Clinical, the leading cloud-based HIE, patient engagement and identity services platform. He has been with RelayHealth since 2004, where he has also had leadership positions in Product Management and Strategy, and co-developed the key ideas behind the CommonWell Health Alliance. During that time, he served an 18 month leave of absence with the Office of the National Coordinator, where he led the Direct Project and started the Standards and Interoperability Framework, which convened work on key standards included in ONC Edition 2014 certification. He previously had 10 years in Life Sciences clinical informatics for data management and pharmacovigilance. Follow him on

33 Public API as Basic Conduit of Interoperability Recommendation: The Public API" should enable dataand document-level access to clinical and financial systems in accordance with Internetstyle interoperability design principles and patterns. The Coordinated Architecture and Data Sharing Networks create an ecosystem to facilitate use of the Public API. The Public API Comprises two components an implementation of certain technical standards (the API ) an agreement to meet certain obligations governing "public" access to the API What makes an API a Public API is a set of conventions defining public access to the API A Public API does not imply that data is exposed without regard to privacy and security. However, there are legal and business considerations that must be addressed before any given healthcare provider and/or vendor would allow another party to use the API to access information. What is public in a public API is that the means for interfacing to it are uniformly available, it is based on nonproprietary standards, it is tested for conformance to such standards by trusted third parties, and there are welldefined, fairly-applied, business and legal frameworks for using the API.

34 Priority API Services Recommendation: Core Data Services and Profiles should define the minimal data and document types supported by all Public APIs. HITECH should focus initially on Clinician-to- Clinician Exchange and Consumer Access use cases. The Core Data Services Read/write access to both clinical documents (e.g., CCDA, discharge summary, etc.) and discrete clinical data elements (e.g., problems, medications, allergies, etc.) Initial focus areas for the industry: Clinician-to-clinician exchange (including ancillary service providers) Consumer access "Pluggable" apps for consumers and for clinicians Population health and research Administrative transactions

35 Priority API Services (continued) The Core Data Profiles Initial recommended focus of HITECH Tightly specify data elements and formats used in Core Data Services Priority profiles should be developed for Clinician-to- Clinician Exchange and Consumer Access Clinician-to-Clinician Exchange Complement current document-centric approaches that exist in the market today Consumer access Natural extension of View/Download/Transmit and Blue Button Leverage account services already provided by entities hosting patient portals and patient applications Could open wide avenues of growth from mhealth and pluggable app companies who are not tied to legacy software

36 Moderated Q&A Moderator Brian Ahier Panelist Keith Boone Panelist Janet Campbell Panelist John Halamka, MD, MS Paelist Arien Malec

37 Follow Up A copy of the power point and recording link will be ed in the next 24 hours.submitted questions during this event will be addressed by .

38 Thank You to Our Sponsor 15 years experience in operationalizing clinical information networks Unsurpassed expertise in solving for wide variety of use cases (public and private) Last mile connectivity Most contemporary architecture This event is hosted by HITECH Answers and is sponsored by Medicity. Visit them online at: