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
© 2019 iShare Medical®2
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
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iShare Medical Disclosure
• Accredited Trust Anchor• Accredited Partnership for Patient Trust Anchor• Accredited Governmental Trust Anchor
Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 2
© 2019 iShare Medical®4
Medical Records Stored in Silos Organized Around the Provider
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Historical Methods for Exchanging Medical Information
FTP
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Develop Custom Interfaces
Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 3
© 2019 iShare Medical®7
Transport Standards
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National Exchange Networks
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Content Standards Examples
Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 4
© 2019 iShare Medical®10
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
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Interoperability: Innovating the Future
Interoperability is the ability to get, organize, use, and share health information
regardless of care setting, provider, or EHR system.
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2015 Edition EHR Requires Direct Edge Protocol
Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 5
© 2019 iShare Medical®13
Two Ways to Deliver Data to EHR: Direct Edge Protocol or API (Direct or FHIR)
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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
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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
Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 6
© 2019 iShare Medical®16
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
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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
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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
Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 7
© 2019 iShare Medical®19
HiMSS19 FHIR and Patient Access
Patient Access to Get and Share
Medical Records
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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
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Why Direct?Level of Adoption of Direct Standard
95% of Hospitals 87% of Doctors
Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 8
© 2019 iShare Medical®22
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Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 9
© 2019 iShare Medical®25
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.
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Types of Identities That Are ID Proofed and Issued A Trust Credential
Individual Patients & Providers
Provider & Payer Organizations
FDA and Non-FDA Devices & Servers
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How Does a Trust Framework Work?
Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 10
© 2019 iShare Medical®28
Authentication
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Authorization
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Sharing
Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 11
© 2019 iShare Medical®31
What Types Medical Information Is Being Shared?
Radiology Reports and
Images
Prescription Records
Lab Test Results
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What Types of Medical Information Is Being Shared?
Unstructured Office Visit Notes Structured Office Visit Notes
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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
Data Sharing Back to the Point of Care 3/27/2019
Linda Van Horn, MBA 12
© 2019 iShare Medical®34
Interoperability Use Cases
BetterManage Referrals
Improve Care Coordination
Increase Patient Engagement
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What Does the Future Hold?
AI Clinical Decision Support
Personalized Medicine
Convenient Care
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Linda Van Horn, MBAPresident / CEO
3150 Mercier, Suite 608AKansas City, MO 64111
816.249.2555 ext. 101