The Standard

Working Together: Our best option to improve C-CDA® Content

Most people have heard of HL7 Fast Healthcare Interoperability Resources (FHIR®) Connectathon events, as well as IHE North America and European Connectathon events, which focus on testing the interoperability of solutions. But did you know that one of the most important content efforts – improving C-CDA® (Consolidated Clinical Document Architecture) documents – is also underway? At each HL7 C-CDA® Implementation-A-Thon, health IT activists have met to improve C-CDA quality and resolve industry differences that result from varying interpretations of standards and implementation guides.

Efforts to Improve the Content of the C-CDA

Many efforts are underway across the industry to help all of us improve the content of C-CDA documents. For example, the Relevant and Pertinent project and the ONC Site C-CDA Scorecard. For anyone who wants to improve C-CDA content quality, you will make the best use of your time at an HL7 C-CDA Implementation-a-Thon.

These two-day events provide an opportunity for multiple participants (20 – 30) from a diverse cross-section of companies and government agencies (16 – 20) to tackle specific use cases for both content creation and content consumption.

What We’ve Accomplished So Far at the C-CDA Implementation-A-Thons

Through the past three C-CDA Implementation-A-Thons, we have accomplished the following:

• Identified many inconsistencies in how document content has been created and consumed
• Clarified language in implementation guides
• Suggested and actually written material for the upcoming C-CDA R2.1 Companion Guide (see C-CDA R1 Companion Guide here)
• Made best-practice statements on a variety of topics
• Exchanged ideas with ONC about certification, validation and document scoring

At Allscripts, we have products that cross the continuum of care, with the ability to both produce and consume CDA-based documents. I am fortunate to work with the very talented Community Solutions group, which is responsible for the creation and consumption of all CDA-based documents for Allscripts products.

Yet, even with this single, focused approach at Allscripts, we are still faced with a number of interesting choices about data, and the construction and consumption of CDA documents. Participation in the C-CDA Implementation-a-Thon events resulted in us making some useful changes, and feeling confident that these were changes made with an industrial consensus for producing an improved quality of C-CDA.

HL7 on FHIR at HIMSS17 

With its world-class education, ever-expanding exhibition and exceptional networking opportunities, no other event brings the brightest minds in health and IT together like HIMSS17. More than 40,000 health and IT professionals are expected to attend to explore creative solutions to real-world challenges in Orlando, Florida at the Orange County Convention Center. 

HL7 is proud to support this annual event that helps health IT professionals find the right products and solutions for their organizations so that they can continue to transform health and lives through IT.

The Spectrum of Interoperability

In a world of polychromatic nuance, it’s interesting to see how often some individuals try to see things in black and white.  This tendency also seems to apply to healthcare data interoperability, as if any given product, organization or service can be classified as either “interoperable” or not. To me it’s absolutely clear that interoperability is a spectrum, which can only be aspired to as a matter of degree. 

Any given player may be viewed as more or less interoperable, but not wholly interoperable, because we live in such a heterogeneous world, with science and medicine continuously evolving. But no matter how you might personally think of interoperability, we can probably all agree that we still have a long, long way to go before we get there.

This is why we need events like Partners in Interoperability.  To achieve real progress, we must engage major stakeholders to stop and listen for awhile, and roll up their sleeves to make small incremental steps to move along that spectrum from the cold blue reality of the recent past to a warm, FHIR-y future based on improved interoperability. 

Partners in Interoperability October Meeting

The second Partners in Interoperability meeting was held at the Johns Hopkins Mt. Washington Conference Center in Baltimore on Oct. 18-19, an arcadian space conducive to deep thought.  As before, the meeting included a set of opening talks each day followed by breakouts focusing on the particular challenges of using FHIR among three distinct business communities:  Clinicians, Payers and Biopharma. 

Day 1

The meeting opened with a welcome from Dr. Christopher Chute, a long-time thought leader in the world of health data standards.  Dr. Chute evoked the history of the Great Baltimore Fire of 1904, which even predates the last Chicago Cubs championship, and led to the establishment of national standards for fire hose fittings.  The metaphor of a great fire being a pivotal event that burned down the old to create a new and improved place did not go unnoticed by the 60+ attendees at the event.

Next was a fast-paced set of five short insights on what FHIR means to the three represented communities, the health IT industry, and, above all, to the future of interoperability which we all aspire toward. 

The morning concluded with three lively presentations on FHIR’s promise and reality:

• Micky Tripathi gave an update on the Argonaut Project, which is close to completing its implementation guides for using the FHIR API and is already thinking about what to tackle next
• Ricky Bloomfield, MD gave an exciting visual talk on how FHIR is enabling several mobile apps to enhance patient care and interaction at Duke University’s Health System
• Sean Khozin, MD, presented on how the FDA is reinventing itself to capitalize on real world evidence from EHRs as well as multiomics big data sources – portraying several opportunity areas where FHIR can help advance the FDA’s mission.

Day 2

The second morning included recaps  from each of the breakouts, followed by one more set of plenary presentations:

• Avinash Shanbhag of ONC discussed the importance of FHIR to realize the goals of the next phase of Meaningful Use
• Titus Schleyer, PhD, of the Regenstrief Institute painted the vision that health information should flow like water, and demoed a FHIR app that allows patients to collect all their medication data from disparate health IT systems into one unified list
• The legendary Dr. Clem McDonald discussed and demonstrated an intriguing JSON-based forms generation toolset used by the National Library of Medicine that can be used, for example, with the Surgeon General’s Family Health History form.

Vote for the 2017 Top 50 in Digital Health 

Each year 50 of the leading entrepreneurs, investors, technologists, reporters, and providers dedicated to bringing technological advancements to healthcare are recognized at the Top 50 in Digital Health dinner hosted by Rock Health, Fenwick & West, Goldman Sachs, and Square 1 Bank. 

 
Climbing the Summit

When surveying the current landscape, I see a host of reasons to be excited about where our little collective of clinicians, researchers, academics, standards geeks, and industry partners sit at the close of 2016. Those who dabble in health informatics and health IT can look back over the last five to eight years and see a real transformation in how care is delivered, and we are on the cusp of doing the same to the clinical research enterprise.

Advances in the coming years

Public policy, with the aid of congressional support and impressive scientific advancement, has laid the groundwork for what promises to be an exciting next few years:

• EHRs are no longer the play toys of academic medical centers, with more than 98% of hospitals and 51% of office-based physicians using EHRs to deliver care;
• Congressional support for efforts like the Precision Medicine and Cancer Moonshot initiatives has reached a fever pitch, which fundamentally shifts conversations from “what is ideal,” to “what can be operationalized”;
• Data storage prices have fallen through the floor and computational speeds have gone through the clouds, with more organizations are leveraging SaaS-based platforms;
• Advances in genetic sequencing and gene-editing technology have changed how we understand and treat disease for generations to come; and
• A cultural shift that integrates patients, families and participants into care and research decision-making.

Reaching summits only to discover more

Now, the experience of wiring our healthcare system has taught us that once we reach the summit of one challenge, we are likely to see the summits of other, more daunting challenges.  This is a natural consequence of progress, which I measure by the complexity of our problems, not a list of our accomplishments. These complex challenges include:

• Continuing the march towards interoperability among different and disparate health IT;
• Identifying clinical utility of ‘omics’ data;
• Integrating useful omics data with routine clinical data; and
• Developing sustainable funding models, supported by data sharing and privacy-related public policies.