interoperability, fhir, & blockchain: where do we go from ... · resources (fhir)...
TRANSCRIPT
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
Interoperability,FHIR,&Blockchain:WhereDoWeGo
FromHere?
TimKosty,RPh,MBA
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
Agenda• Review21stCenturyCuresActandONCFramework• WillnewtechnologiesmakeFrameworkobsolete
beforeitsimplemented?• Apple’sPersonalHealthRecord• Whoownsandcontrolsdataflow?• QuestionsandAnswers
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
AdvancingInteroperabilityofPatientHealthcareData
The21stCenturyCuresAct(CuresAct)&Section4003
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
TheOfficeoftheNationalCoordinatorforHealthInformationTechnology(ONC)
• TaskedbytheCuresActtocreateapathwayforestablishinganinteroperableexchangeofElectronicHealthInformation
• CongresstaskedONCwithaddressingthecoreprincipleofinteroperability→buildingandmaintainingtrust
• Section4003ofthebilldirectstheONCto“developorsupportatrustedexchangeframework,includingacommonagreementamonghealthinformationnetworksnationally”
• StandardsandInteroperability(S&I)Frameworkworkingtobuildoutcomponentsneededtoachievetheseamlesselectronicinterchangeofhealthinformationbetweenorganizationsandinformationsystems
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
• Usecasesandhealthinformationstandards• Toolstosupporttheadoptionanduseofthestandards• Processtoevaluate,test,andrefinethestandardsexchange• Certifiedproductsthatmeetsecurityandinteroperability
standards• PoliciesandgovernancestructuresfortheNationwideHealth
InformationNetwork• Technicalinfrastructure(directoriesandcertificateauthority)
S&IFrameworkComponents
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
ONC’sVisionforInteroperability• Patientcenteredcarebymeansofasystemwherehealthcare
providershavethecapabilitytoaccesspatienthealthinformationfromallavailablesourcesinaconvenient,secureandjudiciousmanner
• Asystemthatdeliversalongitudinalpictureofapatientshealth• Mechanismforresearcherstoharnesshealthinformationdatato
advanceresearchanddevelopment• Patientshaveconvenientfullaccesstotheircompletepersonal
healthrecords
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
TrustedExchangeFramework:5Goals• Buildonandextendexistingworkdonebytheindustry • Provideasingle“on-ramp”tointeroperabilityforall
• Bescalabletosupporttheentirenation
• Buildacompetitivemarket,allowingalltocompeteoninformationservices
• Achievelong-termsustainability
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
TrustedExchangeFramework(TEF)• TEFtoselectasingleRecognizedCoordinatingEntity(RCE)thathas
extensiveexperienceregardingexistinghealthinformationnetworkcapabilities
• RCEselectionwillbecompetitiveandtransparentwithsupportfromtheONC
• RCEwilldevelopacommonagreementbyworkingwithintheTEFframeworkthatQualifiedHealthInformationNetworks(QualifiedHINs)andtheirparticipantscanvoluntarilyadopt
• OnceRCEdevelopstheTrustedExchangeFrameworkandCommonAgreement(TEFCA),itwillbepublishedintheFederalRegister
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
TEF:TwoParts
Part A
Principles to provide guardrails and promote trust between HIE’s
based on the existing trusted exchange frameworks
• Policies, procedures, and technical standards
Part B
• Minimum required terms and conditions to help ensure that common practices are in place and required for all participants
• Common Agreement that QHIN’s and their participants can voluntarily adopt
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
QualifiedHealthInformationNetwork• Hospitalsystemsandotherparticipantswillbeaffiliatedwitha
QualifiedHealthInformationNetwork(QHIN)• EachQHINwillberesponsibleforappropriatelysharingdatato
otherQHINs• AllQHIN’swillbeconnectedtoeachothertofacilitate
interoperabilityinaNationwideHealthInformationNetwork• ParticipantsconnectthroughthesameQHINortheycanhave
accesstootherparticipantsnotintheirQHINbymeansofQHIN-to-QHINtransfer
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
ProjectedTimeline• EarlyJanuaryandFebruary2018:45daypubliccommentperiod
onthereleaseddraftTrustExchangeFramework
• Middleof2018:SelectionofaRecognizedCoordinatingCommittee
• Endof2018:FinaldraftofthecombinedTrustedExchangeFrameworkandCommonAgreement(TEFCA)
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
CurrentChallenges• Participationisvoluntary,andthereisaneedtoappealand
incentivizeinvolvementintheTrustedExchangeFramework• Allstakeholdersneedtoachieveafinalconsensusforthe
agreement.Verycomplexnetworkthatrequiresallparticipantstoagreetoacentraltrustedauthority
• ROInotclearforhealthsystemsandHCP’s• Longimplementationtime
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
Apple’sPersonalHealthRecordReview
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
ApplePersonalHealthRecord• UsesFHIRandBlockchaintechnologies• Patientcentricmodelwherethepatientagreeswithenduser
agreement→Offloadsliability,aspatientshavebeenwarned• Privatesectordrivenwithoutacentraltrustedauthority• Leveragespatients’existingskillsetwithanalreadyestablished
technology• AllowsforthedownloadofpatienthealthrecordstoiPhones
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
FastHealthcareInteroperabilityResources(FHIR)Characteristics
• HL7FHIRV3–latestversionwithmodularcomponentscalledResources
• Suitableformobileapps,EHRbaseddatasharing,cloudcommunications,etc.
• Multipleimplementationlibrariestoassistdevelopers• Specificationisfreetouse• Strongfocusonimplementation
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
• Mathematicalstructureforstoringdatathatisnearlyimpossibletofake
• Someblockchainsrequirepermissiontoaccess,whileothersareopenaccess
• Nosingleentityownsorcontrolsapublicblockchain;distributedledgerwithnocentraltrustedauthority
• Anetworkofcomputersmaintainsandsecuresthedatabase,whileeachparticipant(node)storesacopy
BlockchainCharacteristics
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
• PilotprogramannouncedJanuary24,2018–12healthsystemsparticipated
• Twomonthslater,39healthsystemsparticipatingora325%increase→anextraordinaryadoptionrate!
• Healthsystemsdonotneedcomplexdatasharingandcybersecurityagreements
• Nocentraltrustedauthorityrequired
Image source: ejinsights
AppleEHRPatientDataView
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
• Whatisthenameoftheapp?MyChartfromEpicEMR,whichistiedtoPiedmontHealth(networkofphysiciansandhospitals)
• Whatwerethestepsintheprocesstogetitsetupandlinkedtoyourrecordsatyourhealthsystem?IwenttotheappandloggedinwithanIDandpassword.Thatprocessloadedallmypriorandfutureappts,medicationhistory,fluvaccinereminder,bloodtests,futuretestsscheduled,etc.
• Howdifficultwasittosetuponascaleof1-10(easiesttohardest)?1
• Howlongdidtheprocesstake?Lessthan5minutes
• Whatcategoriesofinformationareavailable?Upcomingappts,priorappts,andabilitytoscheduleapptwithanyphysicianinthePiedmontHealthnetwork,testresults,allergies,medications,messagesfromdocs,facilitylookupofotherhospitals,practicesinthePiedmontnetwork,andquestionnaires/surveys
AppleEHR–PatientExperience
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
PatientDataViewerLimitations• CurrentlylimitedtoiPhoneusers• Protectedhealthinformation(PHI)limitedtoparticipating
healthsystemsandEHRsystems• Marketing-HealthsystemstryingtofindaplaceforAppleApp
insidetheirportals,andsomepatientsareconfusedaboutoptions
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
Patients Healthcare Providers
Health Systems
Insurers PBMs Lab Vendors
WhoOwnsYourHealthcareData?
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
Predictions• TEFwilltakemuchlongertoimplementthanexpected–too
complexandnumerousstakeholders• UnclearROIwilldelayITinvestments• BlockchaintechnologyuseinhealthcarewillmakeTEF
obsoletebeforeitsimplemented• Intensecompetitionforaccesstopatienthealthcare
information• Patientswilltakecontrolovertheprocess
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AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear
Questions&AnswersTimKosty,RPh,MBA
PharmacyHealthcareSolutions,Inc.(PHSI)
[email protected](412)635-4650