• Interoperability
  • 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.

  • Kenya’s mHealth standards set out governance and policy rules

    Leadership’s seen as an underpinning component of mHealth governance and policy. Kenya Standards and Guidelines for mHealth Systems sets out the Ministry of Health approach to framework of strategies, plans, budgets, governance and policy.

    Kenya already has a governance framework. It integrates three stakeholder types, policy, suppliers and users. It fits into its institutional governance framework described in Kenya National eHealth Policy 2016 to 2030. Its mHealth governance arrangements fit within its three main policy stakeholder parts of policy, suppliers and users. Each one sets out stakeholders’ roles and responsibilities.

    Its regulation standards extend across:

    A certification frameworkProtection of privacy and confidentialityManaging disclosures of health informationSource code and application ownership.

    Governance has four main parts:

    SecurityValidationAccountabilityOwnership.

    These are huge steps forward for all Africa’s eHealth. A possible trajectory for eHealth governance may be towards the standards released by the American Health Information Management Association (AHIMA). An eHNA post summarised these. COBIT 5 is an international for ICT governance in all economic sectors. Published by ISACA, It’s been adopted by AeHIN. As an extremely sophisticated governance model, it shows a possible destination of Africa’s eHealth governance.

  • Pocket mHealth's patient-centric and advances IOp

    Combining the synergy of patients, their mobiles and healthcare’s a growing ambition. Pocket mHealth likes the idea. It’s an app that brings EHRs to smartphones. The group is part of Atos Research & Innovation based in Atos Spain. It can fit Africa’s programmes for mHealth and EHRs.

    Validated by medical professionals, Pocket mHealth aims drives the paradigm shift needed for person-centric medical care. It provides access to EHRs so users can improve the way they take care of their health. An emphasis on Interoperability (IOp) and eHealth standards enabling integration of clinical data from heterogeneous Hospital Information Systems (HIS), it supports benefits such as better clinical efficiency, fewer medical errors and lower costs.

    Pocket mHealth’s underlying philosophies are:

    Clinical data belongs to appropriate citizensUsers supervised by corresponding, responsible health professionals.

    These are achieved by Pocket mHealth’s validation by medical professionals. Other features include:

    Improved diagnosesSuppressing unneeded paper or DVD reportsAvoiding duplicate and redundant testsEHRs are continuously updated and complete, enabling better health and quality of life decisionsSupporting patient mobility with accessible clinical data that enables better healthcare in rural or holidays locationsCyber-security mechanisms that guarantee the privacy and data security.

    Both the vision and type of solution fit Africa’s needs. Its strategies and programmes for EHRs can incorporate secure IOp links to citizens’ smartphones. 

  • Kenya’s mHealth standards are strong on IOp

    Kenya’s Ministry of Health has set a solid foundation for its next step in eHealth regulation and good practices. The second main section in Kenya Standards and Guidelines for mHealth Systems deals with information exchange and Interoperability (IOp). It has a seven stage model of IOp maturity, including level 0 for no maturity and three conventional IOp classifications of technical, syntactic and semantic. They’re:

    Conceptual, enabling other engineers to understand documentation and evaluationDynamic, to recognise and comprehend data changes in systems over timePragmatic, including modest AISemanticSyntactic and workflow integrationTechnical and integratedNone, so can be ignored.

    They combine into three categories, integration, IOp and composability for maximum interoperation. It’s a requirement that all Kenya’s mHealth complies with its IOp standards. These include Health Level (HL)7 version 3 for clinical messaging and International Classification of Diseases (ICD) 10, Systematized Nomenclature of Medicine (SNOMED) for coding, Logical Observation Identifiers Names and Codes (LOINC) and Rx Norm for pharmacies.

    Developers have to provide Standards for Applications Programming Interfaces (API) to define how their mHealth interacts with other systems. It fits into a Fast Health Interoperability Resources (FHIR) architecture. It complies with Integrating the Healthcare Enterprise (IHE) and HL7 standards

    While these apply to health and healthcare data, Kenya’s standards apply to social health determinants too. It’s an indicator of the breadth of its approach.

  • US eHealth IOp should focus on big impacts

    Interoperability (IOp) in eHealth isn’t an absolute state. Measuring it isn’t either. Sir William Osler, a Canadian doctor and one of four founding professors of Johns Hopkins Hospital, didn’t need to bother with eHealth IOp, but hinted at it in strategy when he said “In seeking absolute truth we aim at the unattainable and must be content with broken portions.”

    Challenges are how much, and which IOp measurement will achieve contentment without breaking it. An article in Fierce Health provide some indication. It sets out responses from five US organisations to the Office of the National Coordinator (ONC) report in the Proposed Interoperability Standards Measurement Framework, reported by eHNA in May.

    It has two main themes.  One’s measuring standards implementation. The other’s how end users can refine and customise standards to meet their needs. Most groups expressed some trepidation that new standards would result in an undue burden for providers. They want the ONC to focus on measurement areas with the biggest impact. Their advice is directly relevant for Africa’s IOp plans.

    The American Medical Informatics Association (AIMIA) supported the ONC’s framework in its response. It also asked the ONC to target “high-value standards” that offer the biggest impact. Specific requirements are functionalities for accessing drug databases and transmitting laboratory data. It wants the measurement framework to be automated too, so easier reporting mechanisms translate to higher participation.

    A combination of support and caution was part of the Health Information Management and Systems Society (HIMSS) contribution. It offers three main themes: 

    Limiting undue burden by leveraging the use of existing reporting frameworksStandards as the means, with the standards measured aligned to use cases critical to advancing IOp and better information exchangeIncluding all relevant stakeholders, including the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC).

    A sub group of HIMSS, the Electronic Health Record Association (EHRA) suggested a combination of standardised approaches with non-standard methods. It’s a focus on use cases with the biggest impact. It emphasised the potential burdens too.

    The College for Health Information Management Executives (CHIME) highlighted patient matching as one of the biggest IOp barriers. It says measurement standards are premature, and wants the ONC to:

    Develop standards for seamless communication between ICT systemsEnsure that data exchange identifies patients with 100% certaintyMake data exchange usable for clinicians before tackling IOp standards.

    CHIME proposed that if the measurement framework’s implemented, the ONC should work with stakeholders to prioritise cases and develop a granular set of standards.

    Health IT Now, a coalition of patient groups, healthcare organisations, employers and payers, recognises that measuring IOP’s necessary, and said a narrow focus on successful data transmissions devalue improvements in using data to improve care and defer the capability of health systems to exchange information. It wants collaboration with patients and patient advocates and private sector organisations that can contribute to identifying, developing, and deploying IOp standards for better information systems.

    These perspectives can inform Africa’s eHealth development. IOp and its choices are seldom off the eHealth agenda.

  • Kenya’s setting up new mHealth legislation

    Africa’s eHealth legislation and regulation needs considerable developed. Kenya’s stepping it up, eHealth experts have welcomed proposed eHealth legislation, including the Health Act 2017 and the Kenya Standard and Guidelines for mHealth Systems. They see the legislation as facilitating Interoperability (IOp) between private and public healthcare, and as guidelines to move wider eHealth on says an article in ITWEB Africa.

    The Health Act 2017 says within three years of its operation, the Ministry of Health (MoH) will implement management information banks. They’ll include an IOp framework for data interchange and security to improve personal health information management.

    Tony Wood, Managing Director at My Dawa, an online service for ordering prescription and wellness products, said he welcomed legislation that builds the eHealth ecosystem. "With everything, as you look at the world, technology is moving faster than regulation, governments and policy. More can now be done on how these are implemented going forward. I hope they are going to be implemented through open consultation where the public and private sector are working together." This seems like the next step.

    The 66-page guidelines are wide ranging. They set out definitions and extend across mHealth implantation, standards, governance and policy. The proposed legislation’s scheduled for debate in the national assembly. It’s a crucial stepping stone implementing successful and sustainable mHealth and wider eHealth.

  • Semantics aren’t good enough on pagers

    Effective communication between people and information systems in eHealth relies on rigorous informatics such as semantic Interoperability (IOp) and data definitions. A US study of pagers’ messages content reported in the Journal of the American Medical Association (JAMA) Internal Medicine found limitations of both quality and safety. These points to initiatives that Africa’s health systems can set up.

    Even with the seemingly ubiquitous mobile communication technology, inpatient healthcare teams often use pagers to communicate using text. The study team say it’s inefficient, disruptive and has communication concerns. The study analysed the content of 575 text messages on pagers in an internal medicine service of an academic tertiary care hospital. The texts included messages sent or received by physicians, nurses, students and ancillary staff. They included texts about the care of 217 patients. 

    Most messages, 78%, were sent to doctors by healthcare workers who were not doctors. The analysis revealed three main deficiencies:

    No standardisation, including information on vital signsUnclear vocabulary on ranges of urgencyCommunication gaps arising from messaging practices.

    While the ranges of content and topics were quite narrow, the team saw wide variations in message clarity and structures. It’s possible that the limitations could reduce patient safety and other aspects of healthcare quality.

    A solution’s to develop guidelines for using text paging effectively, to ensure efficient communication among health care teams. They should extend across standardised, structured communication for high-frequency topics and structured urgency flags for text paging doctors. Africa’s health systems can start their own improvement projects as part of their IOp and data dictionary projects.  While the study dealt with pagers, are the findings likely to be replicated for text messages using mobile phones?

  • USA’s ONC updates its eHealth IOp plans

    eHealth’s Interoperability (IOp) just doesn’t stand still. The USA’s Office of the National Coordinator for Health Information Technology (ONC) has released a new IOp framework. Proposed Interoperability Standards Measurement Framework aims to identify the USA’s progress in implementing IOp standards in healthcare. It builds from the ONC’s IOp roadmap Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap, and deals with:

     The current state of measurementStandards implementation and useAn overview of the Proposed Measurement FrameworkImplementing IOp standards health ICT productsEnd users use of standards to meet specific Imp needsData collection sources and mechanisms.

    The report identifies significant variability across the health ICT ecosystem in capabilities to measure IOp standards vary significantly. It constitutes significant eHealth challenges. Most significantly, health ICT developers and exchange services exhibit variability in tracking the use of standards in Health Information Exchange (HIE). The main causes are attributed to differences in:

     ArchitectureDevelopment decisionsAccess to the dataVariability in standard implementation.

    Two vital proposals to enhance progress towards uniform implementation and use measures set out in the framework are:

    ·       Capturing progress on implementing standards in health ICT products by annual reporting on:

    o    Standards in development plans

    o   Standards implemented in health ICT products and services

    o   Product versions with standard implemented deployed to end users

    ·       End users using standards, including customisation, to meet their specific IOp needs

    o   Standards used by end users

    o   Volumes of transactions by standard

    o   Level of IOp standards conformance and customisation 

    There are three valuable lessons for Africa’s eHealth IOp. An IOp roadmap’s essential. It’s also essential to have a grip on the distance travelled and what’s needed to reach the destination.