Wednesday, May 20, 2015

Interoperability in Action Post #2: A Tale of Two Connectathons

HL7 International held Connectathon 9 in Paris on May 10 and followed up with a FHIR Clinician
Connect-a-thon on May 15. Both events came at the challenge of interoperability from different angles.
Credit: Yann Caradec
Connectathon 9 had 4 separate themes:
·         Basic patient management
·         Version 2 mapping to FHIR messages
·         Financial Resources
·         Terminology Services
Clinician Connect-a-thon, meanwhile, featured two streams:
·         A “Clinician challenge stream” that tackled the “clinical adequacy, validity, accuracy and reliability of the FHIR clinical resources,” using different test scenarios
·         Testing of FHIR clinical resources through the following environment:
There were plenty of threads to pick up in the discussion around these events. One of the most interesting was a comment from Grahame Grieve (the ‘man of FHIR’), as captured on the FHIRplace blog:
The FHIR registry is on top of my most-important, damn-if-I-don’t task list.
Users of FHIR need to know if profiles and extensions exist already for the standard to be truly interoperable. It will be fascinating to see how this unfolds – including where this registry (or registries) ultimately lives and who will be its overseer.

Real-world scenarios
A registry is vitally important to the standardization of FHIR, but so is the real-world clinical perspective.

In an effort to ground FHIR testing in real-world clinical scenarios, Clinical Connectathon participants worked from clinical storyboards and scripts. These scenarios were provided in plain-language prose and rooted in common occurrences – through a range of clinical settings – that would make demands on FHIR resources or databases.

These storyboards are highly instructive, serving as a window into how interoperability might play out practically through the use of FHIR and also a more generally instructive testing tool. As we test interoperability in our development work, DHIT strives to simulate common use cases that affect patients and physicians. Particularly relevant to our recent work is the immunization storyboard.

The more we can return to the question of “What do physicians and patients need from this technology?” the closer we get to meaningful interoperability. As the Connectathon demonstrates, we should bake this right into our design and testing.

Extensibility in action
FHIR’s extensibility, at least in theory, allows it to accommodate a wide variety of real-world clinical situations. David Hay, part of the Connectaton planning team, writes over at the ‘Hay on FHIR’ blog: “FHIR has a built-in extension mechanism that allows specific implementations to add the properties they need that are missing from the resources.”

The Registry is the killer app to make these connections. When FHIR knows what to look for, it can rapidly address the demands the clinical world can make on data at rest.

Monday, May 4, 2015

Interoperability in Action Post #1: Immunization Records

Interoperability is a mammoth, catchall topic on the minds of healthcare IT stakeholders everywhere. For most providers, however, the term remains an abstraction. For patients, it likely has little meaning. What matters for both is not some lofty ideal of “interoperability,” but rather improved health and health care experience.

What does interoperability look like when it works to assist providers to better serve their patients? In this series of posts, Dynamic Health IT will look at a few concrete examples of breaking down barriers to health information exchange. Like any physical engineering project, many parts of it are far-from-glamorous. But doing the grunt work is essential to inching closer to fully portable, patient-centered health data.

Making immunization records accessible
Immunization records are historically one of those essential pieces of health information that patients and caregivers have had difficulty tracking down and toting around to each new provider. Providers, meanwhile, often lack assurances that they are seeing a reliable immunization history. The idea behind connecting providers to state immunization registries is to make sure patients receive needed immunizations in a timely manner, removing the headaches of scattered records.

Credit: NIH
In practice, each state has different data exchange needs and policies. Providers – often small private practices – must work with EHRs or practice management companies to navigate the requirements. For the last year, Dynamic Health IT has been increasingly involved in applying our knowledge of HL7 data, information exchange methods and development to bridge this gap.

In Texas, we worked to establish an HL7 interface and secure FTP connection to the state. Through iterative testing, we then adjusted EHR output from the client system to fit state HL7 requirements.

This test case then came to serve as the template for future implementations. Drawing on experience with HL7 interface design and knowledge of other state specifications, we have worked to create a “master message” generated by the EHR. Fields that are optional in some states will be ignored, while in other cases our HL7 interfaces will make tweaks so that these messages will pass testing and be submitted efficiently through any transport method.

In Georgia – whose immunization registry bears the clever acronym “GRITS” – we wrote a web service to pick up immunization messages dropped from an HL7 interface into folders. The web service knows the client credentials and expectations from the Web Service Definition Language (WSDL) on the GRITs site. The two sides talk to each other broker the exchange of information, with our web service pulling down acknowledgments of received messages.

We’re working to ensure that any physician or patient can reach immunization data where and when they need it. More patients have access to an easily-accessible clearinghouse of data reachable from anywhere on the internet. Similarly, physicians are gaining access to more complete patient immunization histories (where appropriate and in keeping with norms of patient consent). It’s an ambitious goal, but we look forward to staying in the trenches.