• Interoperability
  • IOp needs to do more to fulfil its promise

    WiFi’s a good example of comprehensive Interoperability (IOp). All WiFi-enabled devices are compatible with WiFi without having to worry about different specifications. It’s because the Institute of Electrical and Electronics Engineers (IEEE) standard 802.11 has been adapted as the universal standard. Prof Howard Po Hao Chen uses Wifi to show the limitation of healthcare’s IOp in his article in the American Journal of Managed Care (AJMC). It’s reassuring for Africa’s health systems that may be well behind the IOp curve.

    IOp healthcare’s much more complex. The links needed to long medical histories of patients create a challenge, especially at the semantic level that aims to integrate healthcare information systems using a common structure and a shared lexicon. IOp with the same proprietary solutions is one method of achieving this goal. Microsoft achieved IOp in the 1990s when Word.doc format became the de facto standard for document exchange simply because Microsoft Office had a huge percentage of users, creating a network effect. However, there are still limitations.

    Open standards offer another approach where vendors and developers agree specific ways of implementing services so that their data are compatible. The best open standards are unobtrusive and seamless, understating the monumental efforts needed to create them. Examples include IEEE 802.11 wireless standard, Hypertext Transfer Protocol (HTTP) and Hypertext Markup Language 5 (HTML5). These open standards for the Internet benefit all users. Prof Chen sees this as a goal for eHealth IOp.

    He says that “While proprietary solutions align powerful market forces with patient interest, the reality of healthcare's complexity will require all the major players to work together and agree on an open format.” Until they do, IOp will not fulfil its promise. Africa’s health systems seem to have time to catch up.

  • IOp gets a boost in South Africa

    Interoperability (IOp) discussions continued in Pretoria Friday, hosted by South Africa’s CSIR and National Department of Health. Integrating the Healthcare Enterprise (IHE) European Chairman, Lapo Bertini was joined by Charles Parisot from GE, IHE Services Chair, who spoke on Health Information Exchange Policies. Both were supportive of South Africa’s National Health Normative Standards Framework for Interoperability in eHealth and optimistic about how African countries’ could use IHE for improved interoperability and better healthcare.

    “We need ‘rules of the road’ to establish trust,” said Parisot “and stakeholder engagement is critical”. It’s a welcome theme and timely as South Africa rolls out its National eHealth Strategy.

    Friday’s CSIR workshop, and SAHIA’s meeting the day before, signals the beginning of a new phase of eHealth development in South Africa. Stakeholders are beginning to see the implications of the IOp framework and the work that needs to be done to move forward. Important questions now include:

    What are the key choices South Africa still needs to make? What impact will IOp choices have on health benefits? What are the costs of adoption and sustainability and how will affordability be managed? What are the policy implications for procurement? 

    Many other African countries are exploring and building their interoperability frameworks too. South Africa’s experience will certainly be watched for lessons.

    You can Watch Charles Parisot speak about IOp and IHE’s contribution at Med-e-Tel 2015. They offers lessons for African countries too.

  • South Africa's big plans for interoperability

    Prof Paula Kotze is a researcher at the CSIR’s Meraka Institute in South Africa (SA). She’s helped to lead the development of the National Health Normative Standards Framework for Interoperability in eHealth in South Africa. Version 2 was published in March 2014. Kotze’s a prominent speaker at two days of interoperability (IOp) discussions in Pretoria this week.

    Integrating the Healthcare Enterprise (IHE) is an important part of the SA’s IOp approach. Yesterday, the South African Health Informatics Association (SAHIA) hosted a meeting of its IHE Working Group and IHE’s European Chairman, Lapo Bertini was in town to explain. He noted that there are no IHE member countries in Africa yet and he’d like to see this change. Today discussions continue with the Department of Health’s eHealth Interoperability Workshop, led by DoH, CSIR and IHE. 

    SA’s framework is an important step forward for eHealth in Africa. There’s no doubt that eHealth needs interoperability (IOp) to succeed and countries need to start getting familiar with the topic and its benefits. IOp has challenges too. They include struggling with what approach is best, how much is enough to drive better care and how to make sophisticated IOp affordable.

    The next steps SA takes will be equally important. Quantifying the ICT infrastructure investments needed for each option, how these costs match benefits to patients and doctors and the business models that will support adoption and sustainability are all complex decisions.

    Paula Kotze and her team are certainly aware of these questions and likely to continue to have their hands full as they figure out the options and help SA make choices that will support better healthcare and healthier South Africans.

  • L'interoperabilite semble difficile a faire

    En Afrique, la cybersanté évolue depuis le début et experts de l’informatique conseillent toujours sur la nécessité de l'interopérabilité (IOP), les résultats des Etats-Unis montrent qu'il n’est pas facile à réaliser. C’est une leçon importante pour les systèmes de santé en Afrique.

    Un rapport de la réunion du Comité politique de la cybersanté des Etats-Unis, résumé dans HIE Watch, dit que l'échange électronique d'informations entre les hôpitaux ne cesse d'augmenter. En 2014, près de 97% des hôpitaux dotés de la technologie EHR certifiée utilisée par rapport à près de 72% en 2011. Jusqu'ici, tout va bien, mais American Hospital Association (AHA) et le Bureau du Coordonnateur national pour la cybersanté (ONC) disent qu'il n'y a pas également d’obstacles tenaces à arrêter les hôpitaux de partager patients et les données cliniques. L'échange de données ne suffit pas. Il doit être utilisé.

    Le rapport indique que les résultats de l'enquête montrent des problèmes de la PIO de l'AHA et ONC sont le plus grand obstacle à l'échange de données, et il est bien en avance sur d'autres défis. Près de 60% des hôpitaux ont déclaré que leurs partenaires d'échange ne sont pas dans les systèmes de DSE ou ont des systèmes de DSE utilisés avec aucune capacité à recevoir des données. La deuxième raison sur la liste était à 45% la difficulté à trouver des adresses de fournisseurs. Environ 30% ont trouvé que le flux de travail à faire, était trop lourde.

    En désaccord avec 97 % des hôpitaux avec les DSE approuvés, 23 % ont réussi avec quatre fonctions PIO : trouver, envoyer, recevoir et utiliser. Voilà un écart de 74 % des hôpitaux qui ne pouvaient pas le faire, même si l'infrastructure est en place. Environ 25% ont trouvé que le coût du changement est une barrière. Quelles sont les leçons pour la cybersanté de l'Afrique ? Elles sont nombreuses. Tout d'abord, la PIO prend plus de temps qu’initialement prévu. Deuxièmement, l'aide, n’est pas toujours facile. Troisièmement, il existe des obstacles financiers qui doivent être résolu. Il peut y avoir deux critères pour les projets de la PIO. Tout d'abord, combien d’Iop seront suffisants ? Deuxièmement, comment les systèmes de santé de l'Afrique peuvent développer la PIO d'une manière durable stable?


    See article in English. 

  • IOp's now measured in a better way

    Twelve EHR providers have agreed to a new way to measure InterOperability (IOp). KLAS Research has announced the agreement by twelve EHR providers at the KLAS Keystone Summit in Utah, USA, to help solve essential IOp challenges. Now, it’ll be measured objectively. The KLAS announcement doesn’t say what the measures are. FierceHealthIT reports that they’re a combination of:

    Transaction counting The experience of clinicians.

    The twelve vendors are:

    Allscripts athenahealth Cerner eClinicalWorks Epic GE Healthcare Greenway Healthland McKesson MEDITECH MEDHOST NextGen Healthcare.

    The next step’s to put a cohesive plan in place to launch and monitor the measurement. After that, the task is to implement it. From these activities, Africa’s health systems can ask to see the performance of the vendors who bid for their EHR service. It’s reasonable for Africa’s health systems to include the availability of the measurement information as part of their vendor accreditations.

  • Philips partners with Amazon to expand digital health solutions

    Philips and Amazon have joined forces to connect millions of devices to the Internet of Things (IoT) using Amazon Web Services (AWS). An article in Med Device Online says the deal extends the health data management connectivity and capability of Philips own HealthSuite digital platform. 

    “Our HealthSuite digital platform and its device cloud are already managing more than seven million connected, medical-grade and consumer devices, sensors, and mobile apps. With the addition of AWS IoT, we will greatly accelerate the pursuit of our vision. It will be easier to acquire, process, and act upon data from heterogeneous devices in real-time. Our products, and the care they support, are enabled to grow smarter and more personalized over time,” says Jeroen Tas, CEO Healthcare Informatics, Solutions and Services, Philips.

    For data from unrelated devices to interact securely with each other, device manufacturers have to create expensive new systems. AWS IoT is a cost effective alternative that provides a "pay-as-you-go service that handles the heavy lifting." The system makes these devices interoperable and allows for better managing of the continuous stream of data they create. 

    "The digital health revolution and the power of the Internet of Things offer tremendous opportunities to positively transform how care is delivered," said Tas in a separate release. "By unleashing data from connected devices and health records, combined with analytics, valuable insights into how we can live and age well can be uncovered.”

    Philips introduced its initial series of personal health programmes where consumers can use health devices, related apps, and a cloud-based data analysis performed by HealthSuite in Germany last month. The devices include a health watch, blood pressure monitor, body analysis scale, and ear thermometer.

    Philips claims that, every year, over 275 million hospital patients are monitored by Philips equipment, and it sells the same number of consumer appliances into homes across the world. This new partnership should have global implications for eHealth, so Africa.

  • Finally, the USA's final IOp roadmap

    After considerable consultation, the USA’s Office of the National Co-ordinator’s (ONC) released the final version of Connecting Health and Care for the Nation A Shared Nationwide Interoperability Roadmap. It sets out the policy and technical actions needed to realise the vision of a seamless data system. It comes after representation that the proposals may be over-ambitious, as reported by eHNA. 

    The plan was informed by a wide range of stakeholders across the country that has helped to coordinate collective efforts for interoperability (IOp). eHNA has a link to 250 comments that the ONC received. Now that the consultation’s over, it doesn’t mean that the Roadmap’s fixed in stone. It’s seen as a living document that’ll evolve it in partnership with the public and private sectors.

    The ten-year phasing is:

    2015-2017: send, receive, find and use priority data domains to improve health care quality and outcomes 2018-2020: expand data sources and users in the IOp health IT ecosystem to improve health and lower costs 2021-2024: learning health system, with individuals at the centre of a system that can continuously improve care, public health, and science through real-time data access.

    There’s less than three months left in 2015 to start. It’s a safe assumption that work has been underway before the Roadmap was finalised. It doesn’t represent the start of the race.  

    It offers African countries both a methodology and a template to use for advancing IOp in their eHealth initiatives. Both the process of building the Roadmap and the content, have lessons for African countries in completing their equivalent roadmaps. Parts of the lesson are:

    It needs a considerable time-scale to build an IOp roadmap Achieving IOp and its benefits is a long-term endeavour.

    For Africa’s eHealth, and unending question is how much IOps needed? The answer will change over time.

  • There are five main IOp barriers

    If interoperability (IOp) is critical to successful eHealth, why hasn’t it been fixed after all this time? The Government Accountability Office (GAO) in the USA’s report ELECTRONIC HEALTH RECORDS Nonfederal Efforts to Help Achieve Health Information Interoperability says there are five big barriers to EHR IOp. They seem to fit most countries eHealth endeavours The five are:

    Insufficiencies in standards for EHR interoperability Variation in state privacy rules Accurately matching patients’ health records Costs Need for governance and trust among entities.

    The GAO’s view of IOp for EHRs has five components: 

    View results from diagnostic procedures conducted by other providers to avoid duplication Evaluate test results and treatment outcomes over time regardless of where the care was provided to better understand patients’ medical histories Share a basic set of patient information with specialists during referrals and receive updated information after the patient’s visit with the specialist to improve care coordination View complete medication lists to reduce the chance of duplicate therapy, drug interactions, medication abuse, and other adverse drug events Identify important information, such as allergies or pre-existing conditions, for unfamiliar patients during emergency treatment to reduce the risk of adverse events.

    The review was need for many reasons:

    EHR IOp’s seen by many healthcare stakeholders as a requirement for improving healthcare It’s remained limited, despite the federal government’s role in guiding IOP ahead Many initiatives needed for IOp are pursued by non-federal stakeholders who have to develop and implement infrastructure needed for national IOp.

    The overall finding is that IOp is still a Work-In-Progress (WIP). Removing the barriers, sometimes called inhibitors or challenges, is always a priority for eHealth. Acfee‘s report Advancing eHealth in Africa found loads of challenges for Africa’s health systems, fat outweighing other eHealth themes. IOp’s only one of them. That it’s a WIP isn’t too surprising. eHealth, like life, "Is a journey, not a destination," as the poet Ralph Waldo Emerson said. It’s much more elegant than saying it’s a WIP.

  • Interoperability seems hard to do

    As Africa’s eHealth moves along and informatics experts consistently advise on the need for interoperability (IOp), findings from the USA show it’s not easy to achieve. It’s an important lesson for Africa’s health systems.

    A report from the USA’s Health IT Policy Committee Meeting, and summarised in HIE Watch, says electronic information exchange between hospitals keeps increasing. In 2014, nearly 97% of hospitals with certified EHR technology used it compared to nearly 72% in 2011. So far, so good, but American Hospital Association (AHA) and the Office of the National Coordinator for Health IT (ONC) say there’s also stubborn barriers stopping hospitals from sharing patient and clinical data. Exchanging data isn’t enough. It has to be used.

    The report says that findings from the AHA’s and ONC’s survey show IOp issues are the biggest roadblock to data sharing, and it’s well ahead of other challenges. Nearly 60% of hospitals said their exchange partners either had no EHR systems or used EHR systems with no capability to receive data. Second on the list at 45% was difficulty in finding provider addresses. About 30% found the workflow to do it was too cumbersome.

    At odds with 97% of hospitals with approved EHRs, 23% succeeded with four IOp functions; find, send, receive and use. That’s a gap of 74% of hospitals who couldn’t do it, even though the infrastructure’s in place. About 25% found that the cost of exchange is a barrier.

    What are the lessons for Africa’s eHealth? They’re numerous. First, IOp takes longer to achieve than originally envisaged. Second, using it isn’t always easy. Third, there are financial barriers that need removing. There may be two criteria for IOp projects. First, how much IOp’s enough. Second , how can Africa’s health systems develop IOp in a steady, sustainable way?

  • USA's ten-year IOp plan not realistic?

    eHNA’s reported on the USA’s Office of the National Coordinator for Health Information Technology’s (ONC) ten year interoperability (IOp) plan several times. Some views have been expressed that ten years may be optimistic. A survey by Scrypt, a document management and delivery company, found that only 17% of healthcare professionals are confident that vendors will meet the ten year goal.

    The survey also found that human error is the biggest concern for healthcare’s cyber-security, despite the 98% of organisations with policies in place to keep staff informed. It may reflect the value of stolen patient information, estimated as worth ten times more than financial data.

    African countries have an IOp opportunity to set in train their IOp and standards before embarking on large-scale eHealth. It’ll help to ease the implementation burden. It’s clear from the USA that it’s a very long, arduous and hazardous road to travel, but more attainable with an early start. It’s a vital eHealth challenge, and needs a firm, long-term place in Africa’s eHealth strategies and plans. What’s clear from the USA’s that achieving high levels of IOp extends well beyond the time frame of a five-year eHealth strategy. Clarity and realism’s needed on how much IOp’s enough in five years, and what’s needed beyond. IOp investment needs it’s place alongside eHealth applications.