DHIT Goes to Washington: Behind the Scenes at the ONC #InteropForum

Credit: Max Pixel.

The Office of the National Coordinator for Health IT (ONC) hosted the the 2nd Interoperability Forum from August 6th to 8th, 2018 in Washington, DC.

The event was an interdisciplinary meeting-of-minds on interoperability, with plenary sessions and break-out, topic-based panel discussions. Dynamic Health IT staff participated in all three days, with our VP of Development, Raychelle Fernandez, giving a panel talk on the second day of the event and our team taking a deep dive into the collaborative atmosphere throughout.

The event featured a variety of “tracks” to facilitate focused discussion and information sharing. These centered around application programming interfaces (APIs), clinician experience, patient matching, security and others.  The tracks are overseen by ONC and other industry experts, allowing for a direct line to those shaping policy in this sphere.

The final day of the Forum consisted of recap and presentation from each track lead.

Hot Topics
One big-picture issue discussed at the Forum was the future ONC role in advancing interoperability. With the recent pivot of the Advancing Care Information (ACI) program to “Promoting Interoperability,” it’s clear how central this is to both CMS and ONC’s missions, but what will be levers for real change? Everyone has their thoughts, but much of the discussion will come down to picking winners among the available standards and championing their success.

In any contemporary discussion of interoperability, you’re likely to hear about FHIR, Blockchain, Patient Engagement, data blocking and the roadblocks perceived in the leading standards the inhibit broader implementation. The Forum was no different, but what was eminently useful about the event is the breadth of perspectives – the attendees really attacked the issues from all sides.

The discussion of Patient Engagement went well beyond Portals, into newer methods or delivery and patient involvement.  There was a discussion of current EMR/bolt-on software development punctuated by remarks from the panel on how patients will (or will not) benefit from there trends. As Mark Scrimshire (@ekivemark) mentioned on Twitter, in order to start better joining data together “we have got to start involving patients in our efforts to resolve patient matching challenges.” Blue Button 2.0, a patient-facing, FHIR-based API and a treasure trove of CMS data, is another major channel for engagement.

In the halls of application development, it can be difficult to get a direct perspective on the burden on the patient and feasibility of tasks such as patient matching without costly studies with uncertain value. And patient users are often at least degree removed from developers, who are not on the ground as service providers.

Clinician perspectives

As Dr. Steve Lane put it, "If you're not satisfying the needs of the clinician you are missing the mark."

For one specific example of where data requirements and providers, there was much discussion about how clinicians document when something is NOT done. While it’s true you can’t prove a negative, it’s important to understand why another clinician did not perform a task and to get that info in a clinical note. This concept of 'Reason not done' data is required for eCQMs, but currently isn't represented in CCDA.

Where there’s Interop, there’s FHIR

FHIR is always near the top of the marquee for any interoperability event. But like many ballyhooed technologies, it is still largely opaque to its end users – both patients and clinicians.

There were a number of other discussions that entered into practical applications of interoperability, including an implementation of the Bulk FHIR API. Our team previewed items for discussion at the upcoming FHIR Connectathon and Roundtable, including CCDA on FHIR, our Dynamic FHIR API and Health Lock-It Mobile App. Having certified and refine our FHIR API, we are afforded time to participate in the ongoing CCDA-FHIR mapping discussion and pivot to new challenges in the FHIR orbit. At the Connectathon, our focus will be we on CQMs and FHIR, with special attention paid to the Clinical Reasoning track.

Apple has made its presence known at recent interoperability and FHIR events and wherever they go, they have a tendency to move markets. One way in which this directly affects DHIT and other development shops is the need to support FHIR DTSU 2 to be in the HealthKit ecosystem.

DHIT: Our Implementer Story

Raychelle Fernandez speaking at the Implementer's Story panel.

Raychelle Fernandez, DHIT’s VP of Development, participated in the Implementer's Story panel and shared insights related to our development of FHIR resources, ‘FHIR on the Fly’, API, Mobile application development and relevant tools.

Raychelle also discussed integration with a wide range of EMRs and the need for U.S. Core Data for Interoperability Task Force (USCDI) to expand data elements and ensure proper use cases exist to minimize the burden on implementers. For example, we should not require specialties like Optometrists, Orthopedics, Podiatrists, or Chiropractors to capture Immunizations if it has no clinical relevance.

These are exciting and fast-moving times in our field. Stay tuned for more.