Interoperability, FHIR, & Blockchain: Where Do We Go From ... · Resources (FHIR) Characteristics • HL7 FHIR V3 – latest version with modular components called Resources • Suitable

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

Interoperability,FHIR,&Blockchain:WhereDoWeGo

FromHere?

TimKosty,RPh,MBA


Agenda•  Review21stCenturyCuresActandONCFramework•  WillnewtechnologiesmakeFrameworkobsolete

beforeitsimplemented?•  Apple’sPersonalHealthRecord•  Whoownsandcontrolsdataflow?•  QuestionsandAnswers


AdvancingInteroperabilityofPatientHealthcareData

The21stCenturyCuresAct(CuresAct)&Section4003


TheOfficeoftheNationalCoordinatorforHealthInformationTechnology(ONC)

•  TaskedbytheCuresActtocreateapathwayforestablishinganinteroperableexchangeofElectronicHealthInformation

•  CongresstaskedONCwithaddressingthecoreprincipleofinteroperability→buildingandmaintainingtrust

•  Section4003ofthebilldirectstheONCto“developorsupportatrustedexchangeframework,includingacommonagreementamonghealthinformationnetworksnationally”

•  StandardsandInteroperability(S&I)Frameworkworkingtobuildoutcomponentsneededtoachievetheseamlesselectronicinterchangeofhealthinformationbetweenorganizationsandinformationsystems


•  Usecasesandhealthinformationstandards•  Toolstosupporttheadoptionanduseofthestandards•  Processtoevaluate,test,andrefinethestandardsexchange•  Certifiedproductsthatmeetsecurityandinteroperability

standards•  PoliciesandgovernancestructuresfortheNationwideHealth

InformationNetwork•  Technicalinfrastructure(directoriesandcertificateauthority)

S&IFrameworkComponents


ONC’sVisionforInteroperability•  Patientcenteredcarebymeansofasystemwherehealthcare

providershavethecapabilitytoaccesspatienthealthinformationfromallavailablesourcesinaconvenient,secureandjudiciousmanner

•  Asystemthatdeliversalongitudinalpictureofapatientshealth•  Mechanismforresearcherstoharnesshealthinformationdatato

advanceresearchanddevelopment•  Patientshaveconvenientfullaccesstotheircompletepersonal

healthrecords


TrustedExchangeFramework:5Goals• Buildonandextendexistingworkdonebytheindustry • Provideasingle“on-ramp”tointeroperabilityforall

• Bescalabletosupporttheentirenation

• Buildacompetitivemarket,allowingalltocompeteoninformationservices

• Achievelong-termsustainability


TrustedExchangeFramework(TEF)•  TEFtoselectasingleRecognizedCoordinatingEntity(RCE)thathas

extensiveexperienceregardingexistinghealthinformationnetworkcapabilities

•  RCEselectionwillbecompetitiveandtransparentwithsupportfromtheONC

•  RCEwilldevelopacommonagreementbyworkingwithintheTEFframeworkthatQualifiedHealthInformationNetworks(QualifiedHINs)andtheirparticipantscanvoluntarilyadopt

•  OnceRCEdevelopstheTrustedExchangeFrameworkandCommonAgreement(TEFCA),itwillbepublishedintheFederalRegister


TEF:TwoParts

Part A

Principles to provide guardrails and promote trust between HIE’s

based on the existing trusted exchange frameworks

• Policies, procedures, and technical standards

Part B

• Minimum required terms and conditions to help ensure that common practices are in place and required for all participants

• Common Agreement that QHIN’s and their participants can voluntarily adopt


QualifiedHealthInformationNetwork•  Hospitalsystemsandotherparticipantswillbeaffiliatedwitha

QualifiedHealthInformationNetwork(QHIN)•  EachQHINwillberesponsibleforappropriatelysharingdatato

otherQHINs•  AllQHIN’swillbeconnectedtoeachothertofacilitate

interoperabilityinaNationwideHealthInformationNetwork•  ParticipantsconnectthroughthesameQHINortheycanhave

accesstootherparticipantsnotintheirQHINbymeansofQHIN-to-QHINtransfer


ProjectedTimeline•  EarlyJanuaryandFebruary2018:45daypubliccommentperiod

onthereleaseddraftTrustExchangeFramework

•  Middleof2018:SelectionofaRecognizedCoordinatingCommittee

•  Endof2018:FinaldraftofthecombinedTrustedExchangeFrameworkandCommonAgreement(TEFCA)


CurrentChallenges•  Participationisvoluntary,andthereisaneedtoappealand

incentivizeinvolvementintheTrustedExchangeFramework•  Allstakeholdersneedtoachieveafinalconsensusforthe

agreement.Verycomplexnetworkthatrequiresallparticipantstoagreetoacentraltrustedauthority

•  ROInotclearforhealthsystemsandHCP’s•  Longimplementationtime


Apple’sPersonalHealthRecordReview


ApplePersonalHealthRecord•  UsesFHIRandBlockchaintechnologies•  Patientcentricmodelwherethepatientagreeswithenduser

agreement→Offloadsliability,aspatientshavebeenwarned•  Privatesectordrivenwithoutacentraltrustedauthority•  Leveragespatients’existingskillsetwithanalreadyestablished

technology•  AllowsforthedownloadofpatienthealthrecordstoiPhones


FastHealthcareInteroperabilityResources(FHIR)Characteristics

•  HL7FHIRV3–latestversionwithmodularcomponentscalledResources

•  Suitableformobileapps,EHRbaseddatasharing,cloudcommunications,etc.

•  Multipleimplementationlibrariestoassistdevelopers•  Specificationisfreetouse•  Strongfocusonimplementation


•  Mathematicalstructureforstoringdatathatisnearlyimpossibletofake

•  Someblockchainsrequirepermissiontoaccess,whileothersareopenaccess

•  Nosingleentityownsorcontrolsapublicblockchain;distributedledgerwithnocentraltrustedauthority

•  Anetworkofcomputersmaintainsandsecuresthedatabase,whileeachparticipant(node)storesacopy

BlockchainCharacteristics


•  PilotprogramannouncedJanuary24,2018–12healthsystemsparticipated

•  Twomonthslater,39healthsystemsparticipatingora325%increase→anextraordinaryadoptionrate!

•  Healthsystemsdonotneedcomplexdatasharingandcybersecurityagreements

•  Nocentraltrustedauthorityrequired

Image source: ejinsights

AppleEHRPatientDataView


•  Whatisthenameoftheapp?MyChartfromEpicEMR,whichistiedtoPiedmontHealth(networkofphysiciansandhospitals)

•  Whatwerethestepsintheprocesstogetitsetupandlinkedtoyourrecordsatyourhealthsystem?IwenttotheappandloggedinwithanIDandpassword.Thatprocessloadedallmypriorandfutureappts,medicationhistory,fluvaccinereminder,bloodtests,futuretestsscheduled,etc.

•  Howdifficultwasittosetuponascaleof1-10(easiesttohardest)?1

•  Howlongdidtheprocesstake?Lessthan5minutes

•  Whatcategoriesofinformationareavailable?Upcomingappts,priorappts,andabilitytoscheduleapptwithanyphysicianinthePiedmontHealthnetwork,testresults,allergies,medications,messagesfromdocs,facilitylookupofotherhospitals,practicesinthePiedmontnetwork,andquestionnaires/surveys

AppleEHR–PatientExperience


PatientDataViewerLimitations•  CurrentlylimitedtoiPhoneusers•  Protectedhealthinformation(PHI)limitedtoparticipating

healthsystemsandEHRsystems•  Marketing-HealthsystemstryingtofindaplaceforAppleApp

insidetheirportals,andsomepatientsareconfusedaboutoptions


Patients Healthcare Providers

Health Systems

Insurers PBMs Lab Vendors

WhoOwnsYourHealthcareData?


Predictions•  TEFwilltakemuchlongertoimplementthanexpected–too

complexandnumerousstakeholders•  UnclearROIwilldelayITinvestments•  BlockchaintechnologyuseinhealthcarewillmakeTEF

obsoletebeforeitsimplemented•  Intensecompetitionforaccesstopatienthealthcare

information•  Patientswilltakecontrolovertheprocess


Questions&AnswersTimKosty,RPh,MBA

PharmacyHealthcareSolutions,Inc.(PHSI)

[email protected](412)635-4650

Interoperability, FHIR, & Blockchain: Where Do We Go From ... · Resources (FHIR) Characteristics • HL7 FHIR V3 – latest version with modular components called Resources • Suitable

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