Signs of Spring: Collaboration and Growth in Healthcare IT

February 26, 2015 Written By Frank Speidel, MD

Spring feels distant with the relentless snow here in the Northeast.

And yet, in healthcare IT circles there are seedlings popping up through the frozen ground. New growth and new ideas taking root all around.

In the chill of December, the Argonaut Project arrived on the scene. Echoing the mythological allusion of the JASON report, the project brings together some of the biggest players in healthcare information technology (names like Epic, Cerner and the Mayo Clinic, among others) working together to acquire the Golden Fleece of interoperability.

Their stated purpose “is to rapidly develop a first-generation FHIR-based API and Core Data Services specifications to enable expanded information sharing for electronic health records and other health information technology based on Internet standards and architectural patterns and styles.” They will be combining their powerful resources and abilities to accelerate meaningful interoperability through an open architecture that is Internet-based.

To achieve meaningful interoperability, the Argonaut Project will leverage the nonprofit HL7’s FHIR product.  FHIR, Fast Healthcare Interoperability Resources, is HL7’s next-generation standards framework. Using RESTful web APIs, FHIR is focused on fast and easy implementation.

Successful development and rapid adoption of FHIR will, in the words of the Argonaut Project charter, “preclude the need for further federal government intervention in interoperability standards.”  The intent is to provide the following three elements by May 2015:

1. FHIR data query capabilities for data elements contained in the Common Meaningful Use Data Set,
2. FHIR document query capabilities of IHE X*metadata resources, specifically transition of care and patient summary CCDAs, and
3. Security implementation guide based on SMART OAuth 2.0 and Open ID Connect.

The participants in the Argonaut Project deserve our recognition and respect. By their cooperation and sharing they are foregoing well earned market advantages.

In January, following on the Argonaut project announcement, Pat Conway, MD, Chief Medical Officer for CMS, blogged on CMS rule changes involving meaningful use.  The intended changes such as realigning hospital EHR chart reporting periods to the calendar year and shortening the EHR reporting periods to 90 days may seem to some prosaic and overdue. Such a view shows increased sensitivities to the burdens on providers and an openness to collegially work with all the stakeholders in the HIT arena.

Also in January, the ONC published Connecting Health and Care For The Nation: A Shared Nationwide Interoperability Roadmap and invited comments. The Roadmap is clearly identified as “DRAFT Version 1.0.”

The Roadmap defines 10 principles of interoperability, none of which are controversial, all of which have some value, and some of which (“maintain modularity,” “scalability and universal access” and “simplify”) have thoughtful impact.

In identifying barriers to interoperability, the Roadmap again shows the ONC’s sensitivity to stakeholder inputs. In identifying the lack of structure and standardization of health information and the sea of misinformation regarding HIPAA standards, the ONC shines a light on long needed corrections. The report also revisits and tightens the definition of interoperability.

Defining interoperability as “the ability of the system to exchange (emphasis added) electronic health information and use electronic health information from other systems without special efforts on the part of the user,” the Roadmap nicely mirrors the interoperability definition of the Institute of Electrical and Electronics Engineers.  Additionally the report strongly reaffirms the essential role of core technical standards in achieving interoperability.

Another small sprout is found in this month’s (February 2015) Annals Of Emergency Medicine. The lead article for this issue is “Efficiency Achievements From A User-Developed Real-Time Modifiable Clinical Information System” by R.O. Bishop, et al. The article compares efficiency of a proprietary ED IT system with a locally designed and built ED IT system (NEDIMS) as measured by time spent and click count. NEDIMS showed a 40% time-saving and 30% click saving. The study leaves many more questions than it answers. But for me, the results are not the comment worthy aspect of the study.

I find it remarkable that this was the lead article in a journal one usually with articles such as “Nontraumatic Subarachnoid Hemorrhage In The Setting Of Negative Cranial Computed Tomography Results: External Validation Of Clinical And Imaging Prediction Rule.” Discussion of both the challenges and opportunities of healthcare IT is now consistently a prime focus of clinical journals.

Healthcare IT has arrived and is seen as a mission critical component for the effective provision of care. Furthermore, the article reports a moderately sized (60,000 annual visits) emergency department in Sydney, Australia, created a dynamic, agile, end-user fixated emergency department information system. That is commitment from the frontlines of care to making information technology work.

As the year starts, it’s easy to see health information technology energy, sharing, cooperation, and openness in both ideas and architecture, everywhere you look. Industry competitors are working together to accelerate interoperability by backing a nonprofit standard. The CMS/ONC is avoiding a top-down approach and opting for universal stakeholder involvement. And down under, a moderate-sized emergency department rolls up its sleeves and wades into the fight for a user-friendly ED IT.

Spring will come, and I’m hopeful. Under the snow, there are interesting and powerful ideas germinating.