Friday, August 23, 2019

The 3rd Annual ONC Interoperability Forum

A dozen years ago, there were 200 people deeply involved in Interoperability programs in the US.  Over this last week I attended the third annual Interoperability Forum hosted by ONC, and I can safely say that there are at least 1000 people deeply involved in Interoperability programs.  It was hard enough then to keep track of it all back then, and I can honestly say that I don't envy Steve Posnack his new role (nor his past one), as well served as we are in this country by having him in it.

I would have to say that 21st Century Cures represents the second reboot of our Interoperability program in the US.  The "first" program was under the ONC created by Bush's Executive Order 13555.  The first reboot of the US program via ARRA/HITECH when ONC was enshrined in law by congress.  Having followed national programs in Canada, Europe, Asia and the Middle East, I can safely say that programs at this level reboot about every 5-7 years.

Big themes this year:

  • Not just payer engagement, but strong payer leadership in interoperability initiatives.
  • Learning from the international community ... International keynotes book-ended this conference, the Dr. Simon Eccles from the UK and NHS program kicked things off, and a team from the Netherlands including long time IHE participant Vincent van Pelt wrapped it up.
  • APIs was watchword 1, quickly followed by TEFCA and then Privacy.
    • Ready, FHIR, Aim... that's the state of FHIR right now.  In Garner hype cycle terms, we are so at the peak of inflated expectations.  This isn't a bad thing, or even a ding, it's just me acknowledging where we are at.  We have to be there at some point.  I expect that FHIR will cross the chasm swiftly though, with the brain power that is working on uses of it to solve so many challenges.
    • TEFCA and the framework are still on the ramp up from what I can figure, there's so much that people have yet to work out (but are working madly to do so).  The big challenges: How to get to an endpoint given a patient, provider or payer identity.
    • The biggest concern of many around APIs is about how to protect consumers (b/c this data isn't protected by HIPAA).  I'll say this again: 20 years ago you never would enter your credit card number on the web, we will figure this out, and mistakes will be made, just as before.  Yes, we can learn from mistakes of the past, but the reality is, you won't discover the real problems until they crop up.
      As to the assertion that consumers aren't ready for APIs, that's like saying that consumers weren't ready for the internal combustion engine.  It's also the wrong concern. Consumers are ready for what the APIs (internal combustion engine) will be used for: Apps (cars, tractors and lawnmowers).
  • The thing that everyone wanted to know and nobody could figure out was "When's the (Cures|CMS|HIPAA) Regulation|Next version of TEFCA going to show up?" 
    • Cures had 2000 comments, it was planned for in Q3 this year, but then there was a shutdown before it ever got published (that was planned for Q4 last year).  The pressure is still on, but my bet: Q1 2020, and I'm sure that ONC wants it out sooner, but I don't see how it could happen in Q3 at this stage (it would already need to be in OMB at this stage), and in my opinion, Q4 is still dicey based on what we heard about the review that's still going on from Elise Anthony on day 1 (recall that last year, it was in OMB in October, and we still didn't see it before Christmas).
    • I heard that the CMS regulatory agenda (the RegInfo site is down this morning so I cannot verify) is suggesting November for it's final rule (Learn how to use these tools if you need to track this stuff).
    • In case you missed it, the 42 CFR Part 2 Update just came out, which is why it isn't listed above.

Thursday, August 15, 2019

Getting FHIR Data from mHealth devices and applications

I've been spending a good bit of my time working on understanding health data in mobile apps and devices.  Most of my research tells me we need to look at what the problems really are, rather than to assert that ___ will solve the problem.

There's not really a good collection of FHIR data coming from mobile apps and devices that could be used for any sort of analysis.  To address this problem, the Mobile Health Workgroup in HL7 is sponsoring a track at the HL7 September FHIR Connectathon to explore what kind of FHIR resources come out of these devices, and produce that collection for analysis.

The workgroup is hosting a meeting on August 23rd at 11am Eastern to discuss this track if you would like to learn more.  Coordinates are below:

 Web Meeting :
Dial-in Number (US): (515) 604-9930
Access Code: 836039
International Dial-in Numbers:
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