NeoTool — Singular Focus, Healthcare Integrated

In February 2009, we changed our name from NeoTool to Corepoint Health. Corepoint Health provides a brand in which we will continue our accelerated growth and more accurately reflects the central role of our solutions in the healthcare market. More information on our refreshed brand can be found in the press release announcing our change.

With the new brand, our blog is now the Corepoint Health IT Blog. Within this blog, there are two channels:

• Healthcare IT Perspectives - Offers opinions and insights on healthcare IT practices, initiatives, and projects.
• Integrated Healthcare Insights - Highlights best practices and approaches to working with HL7 and other healthcare standards, healthcare integration initiatives, healthcare information exchanges, and streamlining patient data flow and radiology workflow.

Please adjust your RSS feed and your bookmarks. We appreciate the active participation in our blog and look forward to building on it in our new location.

Thank you!

Radiology practices are navigating through many changes and, in the process, are making investments in information technology to enhance their productivity, efficiency, and presence in the marketplace. In a recent ImagingBiz.com article, Summit Radiology CEO, Mark Schaefer, was interviewed. The article is entitled “The Role of IT in Building the Practice.”

It is an interesting article that highlights the radiology workflow reasons for making IT investments as well as the operational perspective on the expected and realized benefits.

Each new year always brings a fresh round of predictions for the next 12 months, and healthcare is no different. Below are a few predictions from various sources.

Hospital Impact - Predictions for Healthcare in 2009

 Patient Empowerment - Happy New Year! And Some Healthcare and Patient Empowerment Predictions for 2009

 iHealthBeat - Industry Predictions: What Are the Drivers Shaping Health Care IT in 2009?

My prediction for healthcare 2009:  Some of these predictions will come true! What are your healthcare predictions?

In a recent ImagingBiz.com article, the CIO of Shields MRI was interviewed. The article is entitled “Patricia Whelan, MHA, CIO: Leading Shield’s E-strategy Charge.”

It is always good to learn from other experiences, and this interview provides several good insights on IT’s role in supporting different radiology workflows and strategic objectives.

The concluding paragraph is worth highlighting:

“Boards are turning to CIOs and saying, ‘How do we leverage technology to drive the business? How do we market ourselves and demonstrate value? How do we differentiate ourselves to achieve a competitive advantage?’ These types of conversations really didn’t occur in the past with the frequency they do today. It’s this whole concept of moving from a support role (keeping the machines running) to actually driving and setting the direction of the business through technology solutions. It’s a whole different way of thinking. I, for one, am very glad to see that many companies are starting to realize that if you leverage technology, you can grow the business. Technology as a growth strategy is something that must be embraced in health care.”

There is a great article in Physicians Practice entitled “Technology: The Road to EMR Interoperability.” Key points of the article include:

• The article highlights key reasons why there are so many standards in existence today, and it makes several good analogies to explain the state that we are currently in.
• Not only is there a lack of interoperability standards, there is little agreement on basic terminology such as EMR, EHR, etc.
• Why bother with EMR interoperability? Key reasons:  patient safety, accessibility, and efficiency.
• How can you get involved? Collaborate, get on board, be open to sharing…

In the presidential debates, each candidate mentions the need for online patient records, but it is done in such a casual manner that it seems so simple. ”Why hasn’t it been done already?” This must be the thought going through the audience’s minds (if they are really listening). However, reality is different — multiple, differing standards along with confusion over basic definitions and many other barriers get in the way.  It takes effort to dig deeper and strong will to move interoperability forward.

For additional information on EMRs and interoperability, please explore our various blogs on these topics, and read the Physicians Practice article to get a good practical overview.

Kai Heitmann, who is the HL7 International Representative to the Board of Directors, reported this morning on the attendance mix at the September 2008 HL7 Working Group Meeting (WGM). Given that this meeting is the “international meeting” for the year and also Annual Plenary session, it is no surprise that the mix of US and international attendance is different than a typical WGM.

However, the numbers were pretty stunning in terms of the international attendance amongst the approximately 530 attendees: 44% of attendees are non-US. The break down (in attendee count)

• 100 from Canada
• 29 from UK
• 17 from Japan
• 15 from Australia
• 12 from Germany
• 11 from Korea
• 7 from France
• 5 from Switzerland

There are many issues associated with connecting physician offices running EMRs into a hospital or reference lab. In prior postings we’ve covered:

• The use of standard vocabularies or terminologies such as LOINC.
• The challenges of using HL7 Orders and HL7 Results in a standard way — typically via profiling such as ELINCS profile (also described here).
• Communications infrastructure — using a VPN with a real-time, always-on connection or using an asynchronous method such as web services.

Why do I mention this topic? Because it is “readers write” day over at HIS-Talk and there is some excellent discussion about many of these topics.

Selected quotes:

I think the labs agree [more standard integration] needs to happen, but just don’t want to invest in it. It is very painful to get a lab interface up and running. Each lab has multiple regions that act differently, have their own compendiums, etc. Because there is no standard test code, all the codes are proprietary. Testing is required for each and every one.

…

One of the barriers right now is a normal one for our industry: the existence of entrenched systems which would be very costly to change. Since there are many regions with just one or two dominant lab players who control their local markets, there isn’t a great deal of momentum to make the changes happen very fast. However, the ELINCS standard definitely has traction with major players such as the Markle Foundation, CMS, HL-7, etc. and it is also the standard for results for CCHIT certification which is obviously a major force.

…

By their very design, the use of a standard will require the implementer to jump though at least a few hoops (some of which may be on fire). Also, the device-to-EMR interface you complete today will probably not work for the same device and EMR in a year from now.

…

Nobody dislikes standards. Interoperability is usually good for business. There are two primary reasons why a company might not embrace communications standards:

1. The compromise may be too costly, either from a performance or resources point of view, so a company will just do it their own way.
2. You build a propriety system in order to explicitly lock out other players. This is a tactic used by large companies that provide end-to-end systems.

…
I’ve been to many conferences (TEPR, HIMSS, World Health Congress, etc.), and nobody seems to be able to tackle the thorny problem of semantic interoperability. Everyone can speak HL7, but that’s only half the problem. There are so many different entities that need to agree on what each of those data elements MUST ACTUALLY MEAN that I’m not sure we’ll ever see a solution.

There used to be a saying that “all politics is local,” meaning that how to get elected or get things done was at the local level. This was the idea behind a post several months ago entitled All Healthcare Integration is Local. While there are many grand initiatives happening (from IHE to HIEs to RHIOs, etc.), the actual integration work is happening with several leading health care entities. The local approach is taking hold with hospitals and their efforts to connect to the referring physician community without a RHIO-type effort.

In a recent Health Data Management article entitled The Hospital as the Network Hub, the telling statement is:  “The hotbed of networking activity in health care today involves hospitals linking with their referring physicians, not broader RHIOs or health information exchanges…”

The motivation for hospitals to implement their own networks is described as:

• Competitive pressures:  Make it easy for community physicians to refer patients and access data.
• Enhance reputation:  Focus on specialty physicians - cardiology or oncology - to dominate local market niches.
• Timing:  Now is better than later… can’t afford to wait for community-wide HIE initiatives.

Hospitals are taking advantage of the Stark Law changesand are hosting applications (such as EMRs) for their referring physician community. In a hosted environment, providing the connectivity and electronic exchanges for patient data becomes a more manageable approach than larger scale HIE initiatives.

RHIOs and HIEs will still play a role in the longer term, larger picture approach.  However, the local approach to healthcare integration is happening now (as it should), and it is working.

Massachusetts recently passed a law requiring hospitals and certain other organizations to use interoperable electronic health applications. One key part of the story is that, by law, the systems must be CCHIT Certified. There is good, broad coverage at FCW.com. As is typical with such programs, the hope is to contain health care costs while boosting quality, transparency, and access to healthcare.

What does this have to do with interoperability? One of the sections (#37) of this law states that by the year 2015 hospitals and community health centers will be required to use interoperable electronic health records (EHR) in order to renew or obtain a license to operate in Massachusetts. Another section (#36) says that by 2012 these entities will be required to use computerized physician order entry (CPOE) systems.

The other very interesting twist is that these CPOE and EHR systems must be certified by CCHIT.

In order to meet the state’s goal of “full implementation of electronic health records systems and the statewide interoperable electronic health records network by January 1, 2015″, the law allows for the creation of the Massachusetts eHealth Initiative which will set up a mechanism for creating a statewide health information exchange. The institute will have a council of high-ranking state officials that will advise and act as board of directors.

Patients will have the ability to join or remove themselves from the system at any time and, as expected, there will be encryption and other measures to keep personal health information private.

The EHR plan will be laid out by e-Health Institute and, more importantly, will be funded by an e-Health Institute fund that could have a variety of sources for its money, including state bonds, appropriations, federal grants or loans or private donations.

The important parts of the new law (emphasis added):

Section 4, Section 6D:

(d) The institute director shall prepare and annually update a statewide electronic health records plan, and an annual update thereto. Each plan shall contain a budget for the application of funds from the E-Health Institute Fund for use in implementing each such plan. The institute director shall submit such plans and updates, and associated budgets, to the council for its approval. Each such plan and the associated budget shall be subject to approval of the board following action on it by the council.
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Each plan as updated shall: (i) allow seamless, secure electronic exchange of health information among health care providers, health plans and other authorized users; (ii) provide consumers with secure, electronic access to their own health information; (iii) meet all applicable federal and state privacy and security requirements, including requirements imposed by 45 C.F.R. §§160, 162 and 164; (iv) meet standards for interoperability adopted by the institute with the approval of the council; (v) give patients the option of allowing only designated health care providers to disseminate their individually identifiable information; (vi) provide public health reporting capability as required under state law; and (vii) allow reporting of health information other than identifiable patient health information for purposes of such activities as the secretary of health and human services may from time to time consider necessary.
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(e) The corporation may contract with implementing organizations to:
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(v) ensure that electronic health records systems are fully interoperable and secure and that sensitive patient information is kept confidential by exclusively utilizing electronic health records products that are certified by the Certification Commission for Healthcare Information Technology;
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(f) Funding for the institute and council’s activities shall be through the E-Health Institute Fund, established in section 6E. The institute, in consultation with the council, shall develop mechanisms for funding health information technology, including a grant program to assist health care providers with costs associated with health information technologies, including electronic health records systems, and coordinated with other electronic health records projects seeking federal reimbursement.
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SECTION 36. Notwithstanding any general or special law to the contrary, on or before October 1, 2012, the department of public health shall adopt regulations requiring hospitals and community health centers, as a standard of eligibility for original licensure and renewal of licensure, to implement computerized physician order entry systems as defined by the department. The systems shall be certified by the Certification Commission for Healthcare Information Technology or a successor agency or organization established for the purpose of certifying that health information technology meets national interoperability standards.
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SECTION 37. Notwithstanding any general or special law to the contrary, on or before October 1, 2015, the department of public health shall adopt regulations requiring hospitals and community health centers, as a standard of eligibility for original licensure and renewal of licensure, to implement interoperable electronic health records systems, as defined by the department. The system shall be certified by the Certification Commission for Healthcare Information Technology or a successor agency or organization established for the purpose of certifying that health information technology meets national interoperability standards.

Prior to the approval of the Continuity of Care Document (CCD) as an ANSI Standard in 2007, electronic clinical document exchange could utilize one of two formats: HL7 Clinical Document Architecture (CDA) or ASTM Continuity of Care Record (CCR). In an effort to combine the two closely related formats, the Continuity of Care Document was created.

CCD harmonizes the two separate standards by using CCR within the broader context of CDA. It shares summary information about the patient in an easy-to-read format, using CCD templates to constrain the data. The information can be read by the human eye or processed by a machine (such as an EMR system), and can be sent electronically or manually carried by the patient.

CCD is widely compatible with new and existing technology/standards because it is based on HL7 CDA - a RIM-based specification. It can work with existing applications, browsers, EMRs and even legacy systems. Because of its small fixed XML tag set, CCD can be rendered as HTML or PDF, and requires no specialized communication efforts or changes to existing processes.

For patients, this means less loss of meaning and misinterpretation of data by providers. For physicians, this means easier access to vital health information and better patient care.

Moving into the future

New CCHIT certification criteria require all ambulatory and inpatient EHRs to be CCD compatible, making CCD the preferred standard for clinical document exchange as we move forward into the future. The new criteria is also instrumental in encouraging the use of an electronic health record within the healthcare community.

Those implementing CCD will be readily compatible with new technology, while simultaneously opening the doors to greater compatibility and better care for patients.