• Interoperability
  • Intermountain Healthcare integrates telehealth and mHealth in a connected care platform

    Information silos are huge obstacles to integrated healthcare. And integrated care is the kind most of us want for ourselves and for our loved ones. It's a key eHealth challenge.

    In a report in Research Information, research platform outfit Dimensions says they’re usually created unintentionally, and are a phenomenon to “escape” from.

    Intermountain Healthcare, based on Salt Lake City, US, seems to be free of these troubles. A report in mHealth Intelligence says it’s integrated 35 different telehealth and mHealth services into Connect Care Pro, a single connected care platform. Objectives are to improve care coordination and keep care in communities, both of which could be good for patients and health systems. It took five years to plan. 

    The services it supports include: 

    Virtual or tele-programmesTelestrokeTelehealth programmes for behavioural healthTelehealth programmes for newborn critical careTelepharmacy serviceseHealth services using connected health devices.

    The legacy was a history of launches of several telehealth and mHealth programs and pilots that didn’t integrate easily. Intermountain sees their integration initiative as the next telehealth phase.

    The initiative has valuable lessons for our African countries' mHealth and telehealth programmes. It makes sense to start constructing equivalent platforms without delay. It’ll be easier and cheaper than waiting until more silos need integrating. Even more important, it’ll bring extra patient and healthcare benefits, sooner, for our patients, our families and ourselves. 

  • Limited IOp’s a drag on benefits

    For several years, health informaticians and other eHealth’s ICT experts have recognised the link for effective Interoperability (IOp) and eHealth benefits. Now, US finance executives have added to the case for more IOp.

    A US Healthcare Financial Management Association (HFMA) survey of 117 financial executives identified their views. It found an increasing need for an increased IOp priority, slightly up to from 68% in 2015 to over 70%. Almost a quarter, 24%, said their organisations can’t share data effectively with other providers and payers.

    Their views extended to external and internal IOp. Both are seen as a combined, upcoming primary focus of healthcare providers. Three drivers are:

    Current shortcomingsAnticipated future needIncreasing demand for access to numerous data sources.

    While the survey may not have revealed much that’s new about IOp, it’s a valuable reminder that progress is slow. For Africa’s health systems, it confirms the long timescales needed to reach high IOp levels. If it’s taking the rich US health systems so long, Africa’s can’t expect rapid results. Slow, steady and sustained seem to be their IOp plan.

  • Healthcare enters the blockchain ecosystem

    Over the last few years, healthcare has seen a record number of security breaches involving healthcare data.  This has prompted several start-ups to realise the work that needs to be done on the cyber-security front to make healthcare data secure.  Blockchain offers one potential solution to this challenge. Other solutions offered by blockchain include interoperability and the ability to connect data silos for more seamless systems and improved patient safety.

    SimplyVital Health is one of those start-ups experimenting with blockchain technology to give the healthcare industry a facelift. The company has developed a decentralised open-source protocol that will enable frictional-less sharing of healthcare data.  Their Health Nexus is a public-permissioned blockchain. It provides a platform to build advanced healthcare applications while maintaining the privacy and security required in the healthcare industry. 

    The developer tools on the Health Nexus are open source and available for free.  Members are able to build and deploy distributed apps utilising the blockchain protocol for transactions, identity and smart contracts, and a distributed hash table (DHT) for data storage, managed by a governance system. This will allow developers to create valuable solutions for pharmacies, healthcare providers, insurers, clinical researchers or patients.  

    Blockchain is certainly paving opportunities for new business models in healthcare.  The trajectory it will follow in the coming years, however, is an unmapped terrain waiting to be explored.  The road ahead for blockchain and healthcare will also require substantial intra-industry cooperation as well as dialogues between the public and private sectors regarding standards and regulatory frameworks.

     

  • US ONC mission: to IOp and beyond!

    Buzz Lightyear, a Toy Story celebrity and star, saw his environment extending “To infinity, and beyond.” The US Office of the National Coordinator (ONC) sees interoperability (IOp) having an equivalent horizon. In an interview with EHRIntelligence, Genevieve Morris, ONC’s Principal Deputy National Coordinator, says the emergence of new technology and data sets means that IOP extends beyond a conventional EHR-to-EHR connectivity, which is becoming  an IOp  foundation.

    Extending IOp into genomic data and all other data needed for precision medicine’s ONC;s goal. They’re different data sets to mainstream healthcare data in EHRs. Learning health systems comprise totally integrated healthcare environments where IOp takes on a new and expanded meaning. This is a concept embedded in the ONCs’ updated healthcare IOp roadmap reported by eHNA. 

    While IOp and beyond may seem like a leap into the unknown, ONC’s approach’s pragmatic and incremental. It includes underlying standards and technical components needed for medical device integration and patient-generated health data. 

    Provenance’s an example. It identifies people and devices that create data elements and specifies when and where. This meets healthcare providers’ needs to know who and where data comes from as part of clinical data exchanged between EHRs.

    Africa’s IOp strategies and initiatives need to stretch out into these extra territories. It’s a continuous commitment to skills, resources and finance. EHRs are a start, not an end.

  • Oracle has a supply chain system for healthcare

    Effective logistics are essential for efficient and effective healthcare. Oracle aims to provide this by transforming healthcare’s supply chains. Its white paper from Fierce Markets set out the steps: 

    Better automation and analyticsTighter integration between all stakeholders, including end users, supply chain, distributors, suppliers and Group Purchasing Organisations(GPO)Increased emphasis on sound inventory management and demand planning. 

    Care and Cost Drive Healthcare Supply Chain Revolution says these can overcome four core challenges:

    Master data management, such as item pricing and trackingManual processes and multiple hand-offs between stakeholdersLegacy technologyA reactive instead of proactive approach.

    A general savings estimate, claimed as conservative is 3% to 5% of supply costs. These are achieved by enhanced strategic sourcing that can weed out supply chain redundancies. Actual savings depend on the levels of efficiency that healthcare providers have already achieved. Further gains may be from better re-order quantities and minimum and maximum ordering and stockholding levels. IoT solutions can help too.

    Oracle’s solution relies on a cloud service. For Africa’s health systems, it could be a big step forward. Better spending on drugs and medicines and avoiding counterfeits are high-value objectives. Improving their costs and availability has a direct impact on healthcare quality and efficiency. The Supply Chain Management System from Management Sciences for Health ( MSH) and operating across much of sub-Saharan Africa has insights in the impact.

  • What were the top ICT stories in 2017?

    Now 2017’s history, the significant ICT themes can be seen. A retrospective by Health IT Analytics found the top ten from its posts. They’re Big Data, Fast Healthcare Interoperability Resources ( FHIR) and machine learning are included. They’re:

    Top 10 Challenges of Big Data Analytics in HealthcareTop 4 Machine Learning Use Cases for Healthcare ProvidersWhat is the Role of Natural Language Processing in Healthcare?Judy Faulkner: Epic is Changing the Big Data, Interoperability GameHow Healthcare can Prep for Artificial Intelligence, Machine LearningExploring the Use of Blockchain for EHRs, Healthcare Big DataHow Big Data Analytics Companies Support Value-Based HealthcareBasics to Know About the Role of FHIR in InteroperabilityData Mining, Big Data Analytics in Healthcare: what’s the Difference?Turning Healthcare Big Data into Actionable Clinical Intelligence. 

    It’s a valuable checklist for Africa’s health informatics and ICT professionals for there personal development plans. eHealth leaders can use it too to ensure their eHealth strategies either include initiatives for the top ten, or lay down the investigative and business case processes for future plans. 

  • Patient ID architecture needs an overhaul

    As eHealth expands its reach across more health and healthcare activities, each health system needs a more reliable Master Patient Index (MPI). Three activities are limited without it: 

    Co-ordination across the healthcare continuum and locatonsAccessing patient informationResolving patient identities across disparate systems and enterprises. 

    These need patient ID architecture needs to switch away from episodic modes. A whitepaper from        

    Verato, a cloud-based platform that matches identities, sets out how. It’s based on three components:

    Agreed business rules and policies for sharing patient dataStandardised EMR access protocols andPatient identity matching. 

    Significant progress on Interoperability (IOp) for data sharing rules and Health Level Seven (HL7) provide a foundation. What’s needed now's a set of Unique Patient Identifiers (UPI) so data sharing unambiguously refers to each patient. Easy to say, and Verato acknowledges the logistical and politically constraints. 

    Using demographic identifiers, such as names, addresses, birthdates, genders, phone numbers, email addresses and social security numbers, to identify individuals and their EMRs are error-prone when captured at receptions. They change over time too. Between 8 and 12% of people have more than one identity across healthcare organisations. Their medical histories are spread randomly across these different IDs. These duplicates are one of healthcare’s most intractable challenges.

    Current MPIs were created in the late 1990s and broadly deployed over the last ten years. They use probabilistic matching algorithms that compare all demographic attributes to decide if there are enough similarities to make a match. Common changes, such as maiden names, old addresses, second home addresses, misspellings, default entries twins, junior and senior ambiguities, and hyphenated names aren’t detected. 

    Verato’s approach uses pre-populated, pre-mastered and continuously-updated demographic data

    spanning countries’ populations. It referential matching that leverages the pre-mastered database as an answer key to match and link identities. This isn’t enough in eHealth’s changing and expanding world.

    Verato also aims to deal with:

    Adding new ICT by using standard Application Programming Interfaces (API)Automating existing MPI technologies stewardship, discovering missed duplicates and validating identities at registrationSupporting EHR consolidation where connections MPIs can’t reconcile patients’ data in other EHRsSupport HIE. 

    For Africa’s eHealth, these are valuable steps forward. It emphasises the need for better civil registration too, a long-standing challenge.

  • KLASified IOp needs to progress

    A bit like an horizon, as eHealth Interoperability (IOp) takes a step forward, its horizon seems like two steps further away. KLAS, the eHealth analyst outfit, has published its Interoperability 2017 report of its Cornerstone Summit. First Look at Trending – Some Progress toward a Distant Horizon,” summarises the findings. It’s the third interoperability summit. The KLAS 2017 research provides the first year-on-year comparison measuring progress. There’s plenty left to do.

    KLAS research shows that shared patient data often fails to benefit patient care much. It’s an important insight for EHR business cases, and reveals the ubiquitous gap between eHealth’s potential and its probability in realising its benefits. An essential question to ask before driving ahead investing scarce resources is asking eHealth sponsors to estimate the percentage of patient encounters in which:

    Outside data informs healthcare delivery betterUsers have access to needed data from outside their organisations. 

    Most of the report deals with methodologies and questions about measuring IOp. They provide a wide range of detailed and precise themes that Africa’s eHealth programmes can use to specify and test their IOp components.

    Other issues are: 

    Should behavioural health and home medical equipment be incorporated in post–acute care interoperability?Pharmacies are key partners in post–acute care IOp, so need includingWhich IOp capabilities and synergies should or should not exist between post–acute care and hospital systems?Should hospitals’ Emergency Department (ED) systems query HIEs to identify if patients receive home health services, and can the home health records and their patient information be added to ED systems?

    Healthcare’s concerns and insights include:

    Securing national IOp inter-organisational trust of incoming data and its accuracyClarity on liability of outgoing data not being used securely or guarded How to co-ordinate between organisations sharing data, especially when different users  need different data?How can patients help bridge IOp?IOp gaps in healthcare transitions are a significant market oversight and need fixingHow should information blocking be defined and implemented?

    Africa’s eHealth programmes can extract invaluable insights from the KLAS report. I can help them extend the stride of the next step. Whether it takes them closer to the IOp horizon’s another matter.

     

  • How can Africa innovate with Unique Patient Identifiers?

    Unique Patient Identifiers (UPI) are both essential and demanding to achieve. They’re harder to use when data’s transferred and shared between organisations. An article from the American Health Information Management Association (AHIMA) proposes innovation with UPIs propriety to vendors and customers as part of the solution. For African health systems, it may improve the current position until national UPIs are in place.

    US provider organisations and payers are innovating with propriety UPIs. A common theme’s dealing with real time or batch queries held by third parties, such as credit agencies. These already have UPIs for their commercial activities. It suggests they offer value to health organisations because commercial entities frequently update and constantly maintain their data, providing current demographics for data warehouses, population health management and illness prevention.

    UPI innovation must be integrated with eHealth governance, which need developing in African health systems. Through eHealth governance, UPI innovation can engage with stakeholders such as:

    Governance teamsProfessional bodiesPatient access and registration staffHealth information management teamsICT teamsData users, such as care coordinators and health analytics teams.

    Their roles can extend to strategic information governance and how innovation and success will be applied. Mitigating risks is another role they can participate in.

    A set of generic questions can help to define UPI innovation:

    Who’s responsible for identifiers’ integrity, especially new identifier created by innovation?When existing data’s augmented with new external data, how is the new data integrated, and what is its lifecycle of managed?What are acceptable uses for the identifiers set by legal and regulatory requirements for UPIs, privacy and compliance?How can organisations incorporate UPI technology with human data stewardship to ensure a compliance and governance?How are discussions and findings from UPI innovation relayed to eHealth governance?How can discussions be for ICT, and people and process supporting eHealth governance?Should innovation deal with data creation for patient access or registration, data governance through procedures, processes and data fields standardisation, or both?How can a sample database be built to support proof of concept and technology?How can enough data be included in UPI innovation projects for rigorous, reliable testing, such as 100,000 records?How can UPI data goals be integrated into data governance programmes?

    AHIMA’s article says organisations and healthcare professionals are cautious in applying innovation to the long-standing UPI challenge. Mismatching records can have profound, adverse effects, so reluctance is reasonable. Despite these anxieties, innovation can still proceed, provided it’s based on a rigorous risk assessment, impact probability, costs and benefits.

    UPI innovation creates two activities for Africa’s health systems. One’s setting up their UPIs. The other is constant, managed innovation with UPIs.

  • IHE updates cardiology, IT infrastructure and radiology frameworks

    It is important that Africa’s health systems and informatics teams contribute to Integrating the Health Enterprise (IHE) updates. They are opportunities to help to shape eHealth’s essential building blocks and how they change.

    IHE has put out three framework updates:

    Cardiology Procedure Note (CPN) Rev. 1.1IT Infrastructure Technical Framework SupplementsRadiology volumes 1 to 4.

    The IHE Cardiology Technical Committee says trials began on 4 August 2017. They may be available for testing at IHE Connectathons. Comments on the changes can be submitted at any time.

    The IHE IT Infrastructure Technical Committee has published supplements for trial implementation, also from 4 August 2017. These profiles may be tested at IHE Connectathons and comments are invited at any time. They deal with:

    Mobile Care Services Discovery (mCSD) Rev. 1.1Mobile Cross-Enterprise Document Data Element Extraction (mXDE) Rev. 1.1Non-patient File Sharing (NPFSm) Rev. 1.1.

    Four updated Radiology Technical Framework (RADTF) volumes deal with:

    Volume 1 (RAD TF-1) Integration ProfilesVolume 2 (RAD TF-2) TransactionsVolume 3 (RAD TF-3) Transactions (continued)Volume 4 (RAD TF-4) National Extensions.

    Like the cardiology and IT infrastructure updates, comments can be submitted at any time and profiles may be tested at subsequent IHE Connectathons.