FHIR

See the following -

AEGIS

AEGIS.net, Inc. (AEGIS) is a CMMI Maturity Level 3 rated, ISO 9001:2008 certified small business and premier provider of Information Technology consulting services to Federal Civilian, Defense and Commercial sector clients. Their domains of expertise include health IT and interoperability, regulatory compliance, finance, human resources, and logistics. Read More »

API Infrastructure Importance When Providing a Health Service

Andy Oram | EMR & EHR | May 2, 2016

In my ongoing review of application programming interfaces (APIs) as a technical solution for offering rich and flexible services in health care, I recently ran into two companies who showed as much enthusiasm for their internal technologies behind the APIs as for the APIs themselves. APIs are no longer a novelty in health services, as they were just five years ago. As the field gets crowded, maintenance and performance take on more critical roles in offering a successful business–so let’s see how Orion Health and Mana Health back up their very different offerings...

Read More »

CMS To Invest $5+ Billion a Year in Open Source and Cloud-based IT Infrastructure for Medicaid

After more than 40 years of relying on monolithic mainframe platforms to administer its services, the Centers for Medicare & Medicaid Services (CMS) has embraced a new modular, open and agile approach to Medicaid health information technology for the Federal government and States. In many ways, this is the best of what open source advocates and technology innovators could have hoped for when it comes to open source policy from a government agency. According to Andrew Slavitt, Acting Administrator of CMS, the agency will spend more than $5 billion a year to fund this transformation.

Read More »

Consumer Access to Health Care Data: Still a Challenge

Consumers continue to be frustrated with lack of access to their healthcare data, even as wearables and other consumer-targeted devices and services continue to sprout. Recently, ONC launched a Consumer Health Data Aggregator Challenge to spur the development of new applications and partnerships to provide aggregated health data to patients. While the financial “prize” for this effort is meager, recognition by ONC might be the real brass ring. This challenge focuses on the use of FHIR exclusively to support interoperability between systems and present data to consumers. I suspect that applicants will have some trouble meeting the requirements of the challenge effectively, and this is indicative of the broader challenge in supporting this type of data access.

Read More »

Google Joins VistA Team Proposing Open Source EHR for the Department of Defense

Google has thrown its hat into the EHR ring by joining the team led by PwC which is proposing that the Department of Defense (DoD) upgrade their current EHR to Defense Operational Readiness Health System (DORHS), a customized application built for the DoD and based on VistA, the open source EHR developed by the U.S. Department of Veterans Affairs (VA)...Google’s participation has enormous implications for both the DoD’s EHR and to the healthcare industry as a whole. By choosing the open source EHR team, Google...has sent a clear message to the world that VistA is the best option for the DoD.

Read More »

Grahame Grieve's FHIR report from Baltimore HL7 Meeting

Last week, HL7 held it’s annual plenary meeting in Baltimore at the Hyatt Regency...For the FHIR project, our main attention was the ballot. Across the core standard, and multiple implementation guides, we received >800 detailed comments as part of the ballot. This represents a slight increase over the last ballot, but there was a clear change in the focus of the comments – there was a significant drop in the number of comments relating to the infrastructure, and much more focus on the domain content, and it’s applicability to real world problems. This is a clear marker of the growing maturity of the standard. We continue to expect that we’ll publish FHIR release 3 at the end of this year.

Halamka Evaluates Blockchain for Health Information Exchange

Yesterday, I read a New York Times article about a possible successor to Bitcoin called Ethereum, which provides a distributed database (no central repository) for the purpose of tracking financial transactions. I immediately thought of the challenge we have turning silos of medical information into a linked, complete, accurate, secure,  lifetime medical record. Might blockchain technology be useful in healthcare?   I posted the question to my colleagues, Arien Malec (VP, Data Platform and Acquisition Tools at RelayHealth and the new Chair of the HIT Standards Committee) and David McCallie (SVP of Medical Informatics at Cerner).

Read More »

Halamka on the ONC Blockchain Challenge

Early this year, I posted a collaborative discussion about the potential applications of Blockchain for healthcare. Ariel Ekblaw from the MIT Media Lab collaborated with Beth Israel Medical Center (BIDMC) to actually implement Blockchain medication reconciliation with deidentified patient data. ONC selected it as a winner of the Blockchain Challenge. The idea is simple. Blockchain was invented to handle financial transactions such as deposits and withdrawls. Medication management is very similar to a bank account. Think of your body as a vault.

Halamka's Notes on the November HIT Standards Committee Meeting

The November HIT Standards Committee focused on “asynchronous bilateral cutover” - the compatibility of different CCDA payloads, healthcare IT that supports long term services and support,  an update on the Standards & Interoperability projects, a discussion of data provenance efforts, and the HITSC workgroup organization. Read More »

Halamka: Advice to the New National Coordinator

Karen DeSalvo started as the new National Coordinator for Healthcare Information Technology on January 13, 2014.  After my brief discussion with her last week, I can already tell she's a good listener, aware of the issues, and is passionate about using healthcare IT as a tool to improve population health...What advice would I give her, given the current state of healthcare IT stakeholders?

Read More »

Health Information Exchange Resist Cures (Part 2)

Andy Oram | EMR & EHR | March 23, 2016

The previous section of this paper introduced problems found in HIE by two reports: one from the Office of the National Coordinator and another from experts at the Oregon Health & Science University. Tracing the causes of these problems is necessarily somewhat speculative, but the research helps to confirm impressions I have built up over the years. The ONC noted that developing HIE is very resource intensive, and not yet sustainable. (p. 6) I attribute these problems to the persistence of the old-fashioned, heavyweight model of bureaucratic, geographically limited organizations hooking together clinicians. (If you go to another state, better carry your medical records with you.) Evidence of their continued drag on the field appeared in the report...

Read More »

How Can Open Source Projects Support Themselves in Health Care?

High prices and poor usability hasn't driven the health care industry away from megalithic, proprietary applications. What may win the industry over to open source (in addition to the hope of fixing those two problems) is its promises of easy customization, infinite flexibility, extensibility, and seamless data exchange. As we will see, open platforms also permit organizations to collaborate on shared goals, which appeals to many participants. But if open source projects can't charge hundreds of thousands of dollars for installation as their commercial competitors do, how will they pay their developers and hold together as projects? This article compares three major organizations in the open source health care space: the tranSMART Foundation, Open Health Tools (OHT), and Open mHealth. Each has taken a different path to the universal goal of stability.

Read More »

Looking Back At A 2014: Thermidor For Health Care Reform?

Andy Oram | EMR & EHR | December 29, 2014

As money drains out of health care reform, there are indications that the impetus for change is receding as well...

Read More »

National Patient Identifier with FHIR is the answer

Direct Secure messaging has been implemented across the country by many physicians and hospitals due to ONC Meaningful Use requirements. Direct is great for clinician to patient interaction or even consults in some cases. Is this really the way that we should be sharing patient information? Ideally, we want the information in the patient record not just between two clinicians out of band and not stored in the patient history. This way anyone entering later in the patient care scenario has access to the information should it become necessary and the patient has also consented to the release. Read More »

Navigating between Heavy-weight and Light-weight Standardization

Andy Oram | EMR & HIPAA | August 25, 2016

Andy Oram

FHIR is large and far-reaching but deliberately open-ended. Many details are expected tovary from country to country and industry to industry, and thus are left up to extensions that various players will design later. It is precisely in the extensions that the risk lurks of reproducing the Tower of Babel that exists in other health care standards. The reason the industry have good hopes for success this time is the unusual way in which the Argonaut project was limited in both time and scope. It was not supposed to cover the entire health field, as standards such as the International Classification of Diseases (ICD) try to do. It would instead harmonize the 90% of cases seen most often in the US. For instance, instead of specifying a standard of 10,000 codes, it might pick out the 500 that the doctor is most likely to see. 

Read More »