Congratulations to the HL7 Leaders Named to Health Data Management's "20 People to Watch in Healthcare IT in 2017"
The health IT industry publication Health Data Management released its list of the health leaders they expect to make large contributions to the discussion on HIT and provide guidance on where the industry needs to go in "20 People to Watch in Healthcare IT in 2017."
Happy Holidays!
From our family to yours, Health Level Seven International wishes you a happy holiday season.
We would like to take this opportunity to thank our members, business partners and colleagues who have donated their time and expertise to help HL7 achieve its mission to empower global health data interoperability. We cannot continue this important work without the support of the health IT community.
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:
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:
Day 2
The second morning included recaps from each of the breakouts, followed by one more set of plenary presentations:
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:
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:
Many have asked the question: When are we going to realize the promises of sequencing the human genome?
Some argue the benefits are here. Others say not much has changed for healthcare consumers and patients. Some have invested in pharmcogenomic programs in the clinic, while there remain pharmacists who say the evidence still isn’t there. Patients see advertisements for cancer services that utilize genetic testing for targeted therapy, while others still claim most cancer patients don’t see any benefit.
We are in a period of both confidence and uncertainty, enough evidence and not enough evidence; let’s move forward with expanded testing and let’s only adopt a few tests, promises and warnings, a cost benefit or just increased cost.
Investments in Genomics Advances
In spite of the controversy, billions of dollars in investments are developing more products and services directed at healthcare consumers. This already includes direct-to-consumer genetic and genomic testing.
The precision medicine initiative is emerging as a high profile effort in genomic research and encourages patient-directed data ownership and sharing. It will be a major driver in building awareness and demand for genetic-based clinical services.
Tools from vendors—that range from biomarker and drug discovery to the clinical knowledge of diagnosis, risk assessment, and clinical meaning—are working toward advancing genetic-based care and realizing greatly improved outcomes.
Amidst this debate, many are committed to moving ahead to find clarity and the right path forward. In increasing numbers, people with day jobs are participating in mostly volunteer organizations to define and complete demonstration projects that prove both clinical utility to healthcare providers and significant value to patients.
Progress in Genomics
Internationally-focused organizations—like the Global Alliance for Genomics and Health (GA4GH), the Global Genomic Medicine Collaborative (G2MC), and US-based activities like the Genetic Alliance, the National Academies DIGITizE action collaborative, NIH grants like IGNITE and eMerge, and HL7 clinical genomics and Fast Healthcare Interoperability Resources (FHIR®)—are all making substantial progress. And there are many more related and critical activities I haven’t listed. Not only do we need to coordinate these activities, but we also need to bring together the diverse stakeholders in academics, research, technology, and national and global policy to see the vision move forward as well as how we’ll get there together.
Why FHIR for LATAM?
Latin America (LATAM) arrived on the scene late in terms of the use of earlier HL7 standards. HL7 Version 2 was created in 1985 but we (LATAM) did not begin using it until after 2000). HL7's Clinical Document Architecture (CDA®) was published in 2000 but we began using it after 2005. HL7's Fast Healthcare Interoperability Resources (FHIR®) is being created now and we are starting to use it in LATAM. Two implementation guides have been developed in Argentina and Colombia; Chile is working on one. We can discuss the ‘we’ (as in ‘Who in LATAM’?), but the trend cannot be discussed. Some countries in our region have yet to use any standard—there is NO installed base— why get stuck with stuff that’s 10 or 20 years old?
However, work is still in progress. While CDA Release 2 is good for document repositories, when it comes to mobile, what you can/should exchange is more discrete and granular. The choices will come down to how to use FHIR for examples such as:
A little history
Studying HL7 history, our standards went from a plain text, replication/messaging-based paradigm in the 1980s to the current, Internet 2.0, resource-based paradigm. We also created document-based standards such as the Clinical Document Architecture (CDA®) Release 2 and SOA based standards like Common Terminology Services (CTS).
These 30 years of history gave us a good insight on what we need as standards users and developers.
What do we need as standards users?
People who implement and use standards want open access to standards and implementation guides. They need understandable and short specifications, off-the-shelf tools, reference implementations, friendly representation of information (instances), easy access to vocabularies, automated validation of instances, affordable education, a formal extension mechanism.
Finally, they need examples, examples, and more examples. They need lots of examples!
What do we need as standards developers?
Standards developers have different needs. They want easy profiling with graphical user interfaces (GUI) and the ability to reuse templates. They also want one-click, automated publishing, validation and QA profiles, validation of instances, global profile registry, and ease of vocabulary binding.
A litte about me
My name is Tim Hricik and I am a consultant with Accenture. I have been with the firm since late 2011 and have been a member of the HL7 community since 2013.
In May, I had the opportunity to attend my first HL7 working group meeting (WGM) in Montreal. As I attempted to navigate the WGM, I was introduced to a fellow Accenture colleague and longtime HL7 leader, Ken McCaslin. Ken is the head of HL7’s Technical Steering Committee and kindly helped shepherd me through the agenda and activities of the WGM. He provided introductions, shared his past experiences, and gave general words of wisdom to help me get the most out of my own experience.
Subsequently, Ken asked if I would write an article that might serve as a guide for future first-time attendees. Wishing that I had had a little more information about the WGM before my first visit, I jumped at the opportunity to share my observations with others. So, for all those attending a WGM for the first time in the near future, here is a little bit about my experience and what you might expect.
What did I anticipate for the working group meeting?
I really had no idea what to expect for my first visit to an HL7 WGM, but I knew that this would likely be different from other types of conferences I had previously attended. My initial intention was to simply attend the Fast Healthcare Interoperability Resources (FHIR®) sessions and connect-a-thon in hopes of learning as much as I could about the emerging standard.
I knew the HL7 organization was actually more than just one standard, but I will admit I let myself get a bit pessimistic about what I would encounter: