Week 6 - Interoperability

Stage 2 MU Interoperability Requirements (8)

1. Capability to submit electronic reportable lab results to public health agencies (HIE) 2. "" "" "" surveillance data to public health agencies (HIE) 3. Record whether a patient is 65+ or had an advanced directive 4. Imaging result and supporting text accessible thru certified EHR 5. Secure messaging 6. Submit electronic data to immunization registries (HIE) 7. Identify and report cancer cases to public health cancer registries (HIE) 8. Identify and report specific cases to a specialized registry other than cancer (HIE)

Definitions of interoperability

2 or more systems to exchange information Use of information exchanged IEEE Definition: the ability of two or more systems or components to exchange information and to use the information that has been exchanged - and - the ability of a system or product to work with other systems or products without special effort on the part of the customer. Interoperability is made possible by the implementation of standards

ONC HIT Roadmap

2015-17 Send receive find and use priority data domains to improve health 2018-20 Expand interoperable health IT and users to improve health and lower cost 2021-24 A learning health system enabled by nationwide interoperability

Current Expectations of Interoperability

Ability to work with other systems Dependent on standards Ease of use

Data at Point of Care Pilot

Announced by Medicare to Shares claims data and reduce duplicate tests and errors and prevent interactions. Currently, only test data is being shared.

HL7

Common syntax to exchange information

C-CDA

Consolidated Clinical Document Architecture CDA's have templates such as the allergy template that can be shared across documents.

DICOM stands for

Digital Imaging and Communications standard intended for the transport of images (header and image)

Name two facilitators of interoperability

FHIR Commonwell

FHIR

Fast Healthcare Interoperability Resources (HL7) Gravity Project is part of HL7s program to accelerate adoption of FHIR was to standardize codes for SDOH data

Impact of interoperability of healthcare

Information available in order to best treat the patient

Levels of interoperability

Level 1: No interoperability - Non-electronic data (paper,mail,phone calls) Level 2: (Structural) Machine-transportable data (scanned docs, images, pdf) Information cannot be manipulated Level 3: (Syntactic) Machine-Organizable Data (structure messages, unstructured content, files in proprietary format) Sender and receiver must understand vocabulary Level 4: (Semantic) Machine-interpretable data with standardized and coded data ( structured messages, standardized content)

What does CMS require under Promoting Interoperability (PI)

Make EHR Data Available to patients upon discharge: *view download and transmit *patient portals *blue button Summary of Care upon transition of care *transmit and consume *renaming to support electronic referral loops by sending health information

Semantics

Meaning of the communication

Stage 3 MU Objectives that require interoperability (4)

Patient electronic access Coordination of care Health information exchange (summary of care record for transitions - CCDa and Direct messages) Public health and clinical data reporting - submit pub health data immunization registry reporting, syndormic

What is the intent of PI

Previously known as MU stage 3, the intent is to advance data sharing in healthcare

Syntax

Structure of of the communication (HL7)

Traditional Definition of Interoperability

Two or more systems to exchange information Use of information exchanged

Blockchain

a distributed action ledger that provides a way for information to be recorded and shared by a community each block has numeric accounting of contents (hash) transaction reference FHIR resources located via URLS

Benefits of interoperability

improved care coordination enhanced patient safety reduced healthcare costs greater accuracy of public health data

Who uses MACRA

medicare clinicians who bill Medicare part B can begin 2017

Commonwell

non-profit vendor organization that uses existing standards and policies to enable interoperability. Service provider is RelayHealth and uses FHIR adn XCA

Who uses Meaningful use under modified stage 2-3

physicians (medicaid) and hospitals

Argonaut Project

private sector initiative that advances FHIR based APIs and interoperability standards

Challenges of interoperability

technology incompatibility vendor limitations patient matching expense