Data Sharing Back to the Point of Care

Data Sharing Back to the Point of Care 3/27/2019

Linda Van Horn, MBA 1

© 2019 iShare Medical®1

Data Sharing Back to the Point of Care

Linda Van Horn, BS, MBA


Data Sharing Back to the Point of Care

Agenda

iShare Medical Faculty Disclosure Medical Records Organization HITECT Act Information Exchange Methods Content FHIR DirectTrust Trust Frame Work


iShare Medical Disclosure

• Accredited Trust Anchor• Accredited Partnership for Patient Trust Anchor• Accredited Governmental Trust Anchor




Medical Records Stored in Silos Organized Around the Provider


Historical Methods for Exchanging Medical Information

FTP


$$$$$$$$$$$$$

Develop Custom Interfaces




Transport Standards


National Exchange Networks


Content Standards Examples




HITECH ActAmerican Reinvestment and Recovery Act of 2019

HITECH Act Spent $30 Billion on EHR Incentive program that automated the past and despite large scale adoption of EHR systems did not materially address:

- Usability or - Interoperability


Interoperability: Innovating the Future

Interoperability is the ability to get, organize, use, and share health information

regardless of care setting, provider, or EHR system.


2015 Edition EHR Requires Direct Edge Protocol




Two Ways to Deliver Data to EHR: Direct Edge Protocol or API (Direct or FHIR)


Problems with Adoption of FHIR

FHIR not widely adopted

FHIR is not scalable because FHIR requires a relationship be defined in advance

FHIR does not have Security and Trust Framework


EHR API Standard % Hospitals % of Clinicians

Allscripts FHIR Release 2 5% 9%

athenahealth FHIR Release 2 < 1% 5%

Cerner FHIR Release 2 21% 5%

CPSI FHIR Release 2 10% -

eClinicalWorks FHIR Release 3 - 7%

Epic FHIR Release 2 21% 27%

GE FHIR Release 2 < 1% 5%

MEDHOST FHIR Release 2 5% -

MEDITECH FHIR Release 2 20% < 1%

NextGen FHIR Release 2 < 1% 6%

source: HealthIT.gov 10/1/2018

Top 10 EHR's Adoption of FHIR




21st Century Cures Act

Signed into Law December 2016 Outlaws Information Blocking Mandates the creation of:

• “Trusted Exchange Framework” • “Common Agreement” and• “Permitted Purposes”

Certified EHR’s must publish an Open API or use a HISP for a Direct Edge

• Foster a plug and play for apps• Encourages secure data sharing


Notice of Proposed Rulemaking

Two coordinated NPRM’s published 2/11/2019 by CMS and ONC, comments due 5/3/2019

Emphasis on patient access and ability to share EHI (electronic health information)

CMS (references ONC’s rule): - Interoperability- Patient access - RFI’s for interoperability and patient identity


Notice of Proposed Rulemaking

ONC: 21st Century Cures Act- Interoperability- Information Blocking - ONC Health IT Certification Program Rule - RFI’s: for TEFCA, Information Blocking,

API’s, and FHIR




HiMSS19 FHIR and Patient Access

Patient Access to Get and Share

Medical Records


501(c)3 Non-profit Created in 2013 by a Grant from the ONC to create

the Trust Framework Member Organization for interoperability ANSI Standards Board for Direct Protocol Has no software Highest Level of Adoption Largest Exchange Network


Why Direct?Level of Adoption of Direct Standard

95% of Hospitals 87% of Doctors









3 Components of DirectTrust Trust Framework

Identity of the sender and receiver is always known

You will know where the data came from and have an audit trail of all transactions

Sharing is HIPAA compliant, safe, and secure.


Types of Identities That Are ID Proofed and Issued A Trust Credential

Individual Patients & Providers

Provider & Payer Organizations

FDA and Non-FDA Devices & Servers


How Does a Trust Framework Work?




Authentication


Authorization


Sharing




What Types Medical Information Is Being Shared?

Radiology Reports and

Images

Prescription Records

Lab Test Results


What Types of Medical Information Is Being Shared?

Unstructured Office Visit Notes Structured Office Visit Notes


Can sent any electronic content in a Direct Message (structured or unstructured) such as: - HL7 V2 ADT,- C-CDA, - Word, - Excel, - .pdf, - FHIR

Direct Protocol




Interoperability Use Cases

BetterManage Referrals

Improve Care Coordination

Increase Patient Engagement


What Does the Future Hold?

AI Clinical Decision Support

Personalized Medicine

Convenient Care


Linda Van Horn, MBAPresident / CEO

3150 Mercier, Suite 608AKansas City, MO 64111

816.249.2555 ext. 101

[email protected]

Data Sharing Back to the Point of Care

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