Tuesday, November 17, 2015

FHIR Developer Days in Amsterdam

Amsterdam (CREDIT: Massimo Catarinella)

International FHIR Developer Days takes place this week (November 18-20) in Amsterdam. The event is hosted by Furore, a Dutch health IT company that has been active in FHIR development. Furore maintains an open-source FHIR test server called "Spark."

The three FHIR project leads ("FHIR Chiefs," as we like to call them), Lloyd McKenzie, Grahame Grieve and Ewout Kramer will all be in attendance. The event promises to be another great opportunity for cross-industry training and collaboration.

And, as with all FHIR Connectathons, there are tracks. Via the FHIRplace, developers will be encouraged to work in the following lanes this time around:
  • Patient: Create, update and search patients 
  • Terminology Services Track: expand valuesets, validate codes and retrieve human readable labels codes.
  • Profile & Validation: Create a profile and an instance; ask a FHIR server to validate the instance 
  • "SMART on FHIR" track: Extend FHIR servers or build a client to add OAuth2 to the FHIR REST interface
  • Imaging: Imaging results using Digital Imaging and Communications in Medicine (DICOM) standard
  • API Beginners Track: For those just starting out with FHIR client applications
  • Community Track: Presentations of real life experiences with FHIR (schedule for those is found here)
The full program of events for Amsterdam is here.

We are looking forward to following the action and international perspective this week. As always, interoperability benefits greatly from frequent, iterative collaboration and a broad range of players from across the globe.

And stay tuned to this blog for new content on our current FHIR development.

Wednesday, November 4, 2015

The CQMsolution Story

Dynamic Health IT first began assisting EMR clients with HITECH certification in the summer of 2010.

Known originally in the 2011 Edition (Stage 1) as 170.304 (j) – and now 170.314 (c)(1), (2), and (3) - the requirements for supporting Clinical Quality Measures (CQMs) proved to be a sticking point for many vendors looking to certify.

Some of our clients who had certified under 2011 edition had done so successfully with the application popHealth for CQMs, a product targeted to Ambulatory (EP) providers, under Stage 1. But users had grown frustrated with the implementation process, one that included difficulty importing data, delayed updates for known issues and virtual machines for various Windows versions that were cumbersome to use.

This frustration was compounded by the 2013 government shutdown that lasted two and a half weeks and affected support and continuity for a host of Health IT-related programs. This put another layer of pressure on vendors facing certification deadlines.

When the 2014 edition of certification standards rolled around, popHealth was not yet certified and ultimately would transition to open source. While DHIT has been involved in open source projects at various, the time-sensitive nature of certification pressed the limits of using open source to build and maintain a certified software package.

PopHealth was built with Ruby on Rails and our development team felt we could harness technology more familiar to our clients (C#, MSSQL) to tackle CQMs. In CQMs, we saw an opportunity to challenge ourselves and embark on some cutting-edge development. We decided to jump in head first and build an what would come to be named CQMsolution.

Our goal from the outset was to create a browser based C# application to support the 93 CQMs (both Inpatient and Ambulatory). We would have to do it from scratch, but we had the development experience and potential clients looking for a new approach.

CQMs don’t allow for a “set it and forget it” approach, so our work did not end with initial development and launch of CQMsolution.

In contrast to the pitfalls of version stagnation that can sometimes occur in open source projects, CQMsolution is subject to an actively managed development cycle. Our team seeks to stay current on updates to Federal policy and quality measure updates across programs (MU, PQRS, IQR). We attend biweekly Tech Talks with Cypress to ensure our software validates with the very latest version of eCQMs and we engage in frequent testing, assisted by an ONC-sponsored tool called BONNIE (a web-based tool primarily for measure developers that allows users to load in quality measures and create test patients).

Where there have been challenges configuring and deploying homebrew CQM aggregators in multi-entity settings, we have worked to ensure that CQMsolution sits atop a stable back-end that runs with minimal client intervention and can be centrally-configured for multiple practices.

Our latest version of the application, which works with Cypress CQM validation software (v2.6.1), includes enhanced drill-down screens and the fruits of a testing process that has increased our coverage of many "border" cases. With BONNIE, Dynamic Health IT has now generated or shared in over a thousand patients to stress-test our application.

These efforts keep CQMsolution current for our clients and on pace with EHR certification and standards.

All of this is not to say that open source does not have its virtues. It most certainly does and often leads to breakthroughs in our industry. Many of us use or even contribute to open source applications on a daily basis. But there can be important differences, especially when dealing in subject matter that is time sensitive (CQMs, check) and frequently changing (double check).

Quality measure software must be updated regularly to accommodate both Cypress validation and CMS measure releases. Meaningful support also should be responsive to client submission deadlines and other potential needs related to reporting and displaying quality measures.

As always, let form follow function.

Stay tuned for a full breakdown of 2015 Certification Updates.