• Interoperability
  • Is lots of IOp that important?

    Health informaticians and eHealth’s technical enthusiasts continuously extol the virtues and need for extensive interoperability (IOp) standards, especially semantic IOp. A post in HIE Watch says we needn’t worry too much if eHealth doesn’t go that far. By Sid Nair from Dell Services says vendors don't have big incentive to make their products IOp compliant because keeping proprietary silos makes switching difficult, so helps to sustain customer loyalty.  So, expecting the industry to take the lead on interoperability isn't realistic.

    Governments setting standards is one way ahead, but Nair sees limits. If, and usually when, there’s no agreement with the industry as a whole, and it requires more clarity and precision, governments can face a dilemma. If they’re too directive or pacey, they may promote imperfect IOp. If they’re too slow, IOp constraints build up. The result is often incremental IOp development.

    What can Africa’s healthcare do instead? Nair sees  a way forward in the increasing use of population health and predictive analytics. They’re progress towards better healthcare systems. They need reliable data from numerous sources, such as EHRs, claims systems, social media, census data, and the data range doesn’t have a common IOp standards base. An alternative to IOp’s needed.

    Instead of seeking disparate systems to talk to each other, a bridge between them can integrate them and enable several uses. The first requirement is a unified patient record.  Next, is sharing data through a vendor-neutral platform that lets authorised people, such as patients, families, health workers and analysts access the data. This may offer faster progress than waiting for total IOp.

    African countries could adopt this approach as they step up their eHealth investment. It needs a balance between eHealth at the point of care, such as EHRs, reporting systems that can collect information, and tools to collect information from sources beyond healthcare. Both IOp and integration need extra investment. 

  • HIE has five criteria to adopt

    With data sharing being core to eHealth, especially EHRs, adopting good practices are important. Health Information Exchange (HIE) is part of the solutions, and HIE Watch offers five themes to look out for.

    Advanced health models are making progress by making existing data actionable in new ways, but stakeholders need seamless access to analytics capabilities to make this data useful Community organisations are integral partners to advanced health models and are motivated to share data, but sharing across clinical settings and social services isn’t standardised, with weak incentives Some advanced health models are responding to interoperability challenges by granting community organisations access to a single platform instead of achieving interoperability (IOp) across different systems Mapping patient identities across data sets is challenging without consistent patient identifiers Health organisations need to think beyond EHRs when they’re developing data infrastructure.

    These are important themes for African eHealth projects to incorporate. Projects also need to ensure that their vendors help with these directly.

  • Has HL7 set IOp on FHIR?

    Significant semantic Interoperability’s (IOp) not easy to achieve. The USA has a ten year programme. European countries have long term plans too. To ease the path, HL7 now provides Fast Healthcare Interoperability Resources, thankfully referred to as FHIR, and pronounced fire.

    FHIR’s a new IOp standard for secure and simplified way to exchange healthcare data between systems. Its main components are a set of resources and networks. They’re  self-describing, discrete blocks of data that make sense  in a healthcare environment, such as patient, condition, procedure, medication, allergy, observation, appointment and rehabilitation. Each one has a small set of properties, such as name, date of birth, gender, and can be extended and profiled to meet specified use cases. Resources link together to create a network.

    Orion, a health IT supplier has release a White Paper about FHIR.  It says it’s:

    Lightweight, matching similar RESTful online real-time exchange used by vendors like Google, Twitter and Facebook Documents like discharge summaries, progress notes and referrals are represented in FHIR Messaging for notifications Better customised services where complex exchanges are needed Removes common barriers to IOp Provides information to people who need it Maximises the value of time with patients Reduces duplication Frees technical time to focus on more complex IOp issues.

    Stackoverflow describes RESTful as the web’s underlying architectural principle. It’s proven and offers healthcare an IOp step up, but it’s not a panacea. Orion points out that there many other requirements meet. They include the way that information content’s modelled in detail for security, privacy, terminology, workflows and behaviours needed for better quality healthcare. While FHIR helps with these, and offers hooks for other standards, such as Logical Observation Identifiers Names and Codes (LOINC) used in laboratories and SNOMED-CT, but development’s needed in how FHIR works with them.

    FHIR offers a good IOp step forward for African countries’ eHealth. As FHIR grows and matures, Africa’s eHealth can find an easier route into IOp than the one that’s now before them.

  • IOp potential isn't achieved

    In its economic evaluations of proposed eHealth projects, the African Centre for eHealth Excellence (Acfee) always distinguishes between potential and probable benefits. eHealth has enormous potential. Evaluations of actual eHealth invariably show that these are seldom realised, so identifying probable benefits is much more important.

    A report on interoperability (IOp) for medical devices, from Frost & Sullivan, a research organisation, says:

    Connected healthcare infrastructure isn’t uniform across the globe It’s due to a lack of a holistic digital healthcare strategy that focuses on integrated care models and a failure to adopt established standards in connectivity and interoperability Standards such as HL7, Digital Imaging and Communications in Medicine (DICOM) and Direct Project, and clinical terminologies such as ICD and SNOMED CT that enable recording and exchange of healthcare information Alliances, gateways and devices from several market participants that can share information between devices and healthcare ICT solutions from different vendors are enhancing connectivity Technological advances in Wi-Fi, Bluetooth, and Radio Frequency Identification (RFID) add momentum towards healthcare connectivity and iOp Hospitals can connect devices and healthcare ICT solutions for centralized monitoring and real-time data analysis, but have to deal with cost constraints and managing reviews for updating workflows Several medical device manufacturers offer connectivity, but with proprietary and closed gateways Manufacturers with open medical connectivity are in demand There’s an increasing emphasis on diagnosis, monitoring, and prevention.

    An accompanying press release says that "More than 50 percent of healthcare providers do not have a healthcare IT roadmap, although they acknowledge the role of digital health in enhancing healthcare efficiency…Consequently, even the existing interoperability standards such as HL7, DICOM and Direct Project are not being utilized optimally by many providers."

    Maybe the most important step for Africa’s healthcare is preparing, or updating their roadmaps for health ICT infrastructure. As technology moves on, they’re good at providing clarity and the actions healthcare needs to catch up and keep up.

  • Are interoperability and security obstructing your eHealth's growth?

    Most of us are getting used to the idea of a more connected and technologically-based healthcare system. Dr David Blumenthal, president of the Commonwealth Fund, a national healthcare philanthropy based in New York, says this is a future that won’t materialise unless challenges such as security and interoperability are solved along the way.

    In an article in Wall Street Journal, Blumenthal describes three possible technology-enabled scenarios that could become routine by 2030, including a home-based remote monitoring that detects deterioration in an elderly relative, and a smartphone app to forecast the risk of a heart attack.

    "These stories illustrate how new health information technologies could revolutionize the quality and convenience of health-care services. With the rapid spread of electronic health records, much critical health data is already digitized. Pretty soon, all that information will be stored in the cloud in personal health records that are accessible 24/7."

    “Computerized algorithms will empower individuals to make rapid, sound decisions about their own health and health care. Tele-medicine will enable round-the-clock consults with health professionals standing by to take your call."

    It’s a rosy picture, but might not get far enough if people can’t trust the privacy and security of cloud-based health records and don’t feel comfortable using them.

    Interoperability (IOp) is another problem. Assuring that all these electronic devices talk to each other and share data is a mammoth task. Currently most can’t and don’t exchange information. One constraint is that healthcare organisations are fearful of sharing patients’ data in case it  liberates their customers to go elsewhere for their care. EHR vendors are also charging prohibitive fees and creating other barriers to information sharing.

    Most of these problems are man-made and can be fixed. The USA already has a ten-year plan for IOp. African countries developing and implementing EHRs and introducing electronic devices should start to address these issues so they don’t become obstacles down the line. A robust regulatory framework may help to start dealing with privacy and security issues. A standards and interoperability framework will be essential too.

  • USA's ONC published 250 comments on its IOp roadmap

    The USA’s Office of the National Co-ordinator (ONC) has published the comments from its consultation on its interoperability (IOp) roadmap. There are 250.

    Several people object to the initiative on the grounds of privacy invasion and constitutional rights. One of the most telling is a comment on the ten-year timescale. The Electronic Health Record Association (EHRA) of the Health Information and Management Systems Society (HIMSS) suggests it’s too ambitious. It also says that:

    IOp should include workflow and administrative data Security protections should extend beyond EHRs to all aspect of IOp IOp should leverage current HIE projects that have already achieved some of the roadmap's goals.

    These are valuable reminders for African countries that IOp is a long-term development with links to other eHealth initiatives. They point to an approach to IOp as a set of steps, leading to the important question of how much IOp is enough for now?

  • When will Argonaut improve health IOp?

    Large-scale interoperability (IOp) has been an elusive goal for eHealth. It may now be a bit closer. A report in Health Data Management says that Health Level 7’s (HL7) Argonaut Project for Interoperability has almost completed its first phase. The project is seen as the foundation for HL7’s Fast Healthcare Interoperability Resources (FHIR) standard. It aims to construct an Application Programming Interface (API) and core data services specification to expand data sharing between EHRs and other health IT systems.

    The goal is to accelerate the provision of practical and focused FHIR profiles and implementation guides to healthcare. It’s looking ahead to the next generation of a standards framework to advance health ICT interoperability.

    Massachusetts eHealth Collaborative’s managing the project that started in December 2014. It’ll enhance the adoption of RESTful FHIR APIs. RESTful APIs are a type of architecture that often use standards already used by the Internet, such as Hypertext Transfer Protocol (HTTP), Uniform Resource Identifier (URI), JavaScript Object Notation (JSON), and Extensible Markup Language (XML). It also uses Open Authorization (OAuth) security. OAuth is an open standard for token-based authentication and authorisation on the Internet. An aim is to provide healthcare with the standards and practices used by business. Completion’s on track.

    Currently, over 40 providers and vendors, including rival EHR vendors Cerner and Epic, are collaborating with HL7 to accelerate FHIR’s development and adoption to leverage the latest web standards. Accenture and Surescripts have recently joined the joined Argonaut.

    The Argonauts were also a crew of at least 85 sailors in Ancient Greece, named after their ship, the Argo, and led by Jason to find the Golden Fleece. They did. It’s also the name of a Toronto football team, the US version, not soccer. It’s up for sale. As Africa’s large-scale EHRs are mostly downstream, most countries may find their EHR’s IOp’s more easily attained by the Argonaut.

  • Interoperability: Lessons Learned 6

    Elusive goals spawn many strategies. There seem to be two main types for eHealth interoperability (IOp): total IOp and incremental  IOp. Technical and syntactic IOp are less of a challenge than semantic IOp. There are three main types:

    Unidirectional Bidirectional Full IOp.

    Two directional types are sometimes called orthogonal, so at right angles to each other. Full is a seamless co-operability. The computing and network capacity needed for IOp increases with each step up towards full IOp. With current technology, it may be a high-cost solution with negative returns, so IOp may be a journey, not an absolute sate.

    In the USA, it’s ONC, the government agency responsible for eHealth, has a ten year plan to achieve expanded IOp. An eHNA post has a summary. It includes:

    Build on the existing health ICT infrastructure One size doesn’t fit all Empower individuals Leverage the market Maintain modularity Consider the current environment and support multiple levels of advancement Focus on value Protect privacy and security in all aspects of IOp.

    These are good principles for African countries to adopt. Over ten years, it should enable users to:

    Contribute information to their care team integrate data to set and meet health goals Help health professionals and researchers health and healthcare performance Connect clinical settings and public health departments through bi-directional interfaces Manage information from their own devices and Share information seamlessly across numerous platforms Select effective medications for patients based on their genetic profiles and research results.

    SNOMED-CT is a tool that’s needed for semantic IOP. eHNA summarised its role as “Data that makes sense.” Computers, like people, can process and act on information better when it’s presented in a familiar format using familiar language. SNOMED CT, is a standard that does this for healthcare data. African countries need to identify the points in their eHealth development when SNOMED-CT begins to offer the loner-term benefits of better IOp.

    What’s the outcome of pursuing better semantic IOP? Two eHNA posts identified these. One reported on the challenges identified by the Brookings Institution. The other on HIE challenges identified by a survey. The first says the gains are:

    Access to accurate, timely and actionable cost and coverage data for treatments and tests in certifications Insurers, employers and other payers won’t need several hard copies Switch from a "Prescriptive and process-driven" certification to "User-centered design" EHRs responsive to each providers’ needs Flexible health ICT structures so that ICT can evolve to meet specialties and practice needs Information that supports high-value care Use quality and cost metrics to promote and capture timely data beyond regulatory standards and requirements.

    The HIE survey reveals the challenges facing eHealth IOp. They include:

    Cost Producing consistent and timely reports Technical issues Identifying and implementing standards Unrealistic end user expectations Normalising data feeds Patient matching Trouble shooting errors.

    Taken together, the themes show that semantic IOp is a long-term initiative that offers many benefits and needs sustained resources. Success needs each country to have an adequate, stable dedicated team of specialists in health in health informatics who can take and implement sustainable, successful decisions on standards. It puts their recruitment, training and retention at the eHealth’s core. It’s an essential human capacity needed for successful eHealth.

  • Is mHealth IOp a step closer?

    With mHealth an important part of eHealth for Africa, it’s good news that Microsoft’s providing tools for software developers to move apps from Google’s Android and Apple iOS devices onto Windows phones, tablets, and other machines. Wired, an online news site, says the project’s part of a larger initiative to significantly expand the number of apps that run on Windows phones and tablets. Windows mobiles only have about 3% of the market.

    The tool takes Java or C++ code that drives Android apps, then reshapes them into a Windows app that ties into Microsoft OS services. Apple apps should run on Windows 10 phones. It should run on desktops, laptops and tablets too.

    It may offer a bigger market for mHealth app developers, but with a market share of about 3%, it may not be too valuable. The extra mHealth users may benefit, so African’s who use Windows phones may be the main beneficiaries. It remains to be seen if the improved interoperability (IOp) will make a big difference to African’s health.

  • Jembi releases OpenHIM

    Interoperability’s (IOp) eHealth’s Holy Grail. A step towards it is South Africa’s Jembi Health Systems‘s Open Health Information Mediator (OpenHIM) version 1.1. It’s middleware software that eases IOp between disparate information systems. There are features for security communications, data governance and support for routing, orchestrating and translating messages as they flow between systems. Jembi says “The HIM can be thought (sic) of as the "lock" within a health information exchange.”

    OpenHIM was initially developed as part of the Rwandan Health Enterprise Architecture project. It was part of the OpenHIE initiative, where it serves as an IOp layer. It has two parts, the OpenHIM core and the OpenHIM console, and provides:

    A single entry point for a HIE Security management through authentication, authorisation and message encryption and decryption Routes for messages to the appropriate infrastructure service A central logging mechanism for the messages sent through the exchange A mediator plugin architecture to orchestrate or adapt messages if needed Metrics for monitoring the flow of messages.

    The OpenHIM is developed and maintained by Jembi Health Systems NPC. It was developed in collaboration with the Health Architecture Laboratory (HeAL) lab at the University of KwaZulu-Natal. There were several open source collaborators too.

    It’s financed from the President's Emergency Plan For AIDS Relief (PEPFAR) initiative for Health Informatics Private-Public Partnership (HI-PPP). It shouldn’t be too long before it's in place across most of Africa’s healthcare.