Interoperability takes Center Stage at Health IT Committee Meeting

Connected computers to represent interoperability in healthIT

The Office of the National Coordinator for Health IT shared "early strategic elements" of a draft 10-year roadmap for achieving an interoperable health IT infrastructure, Health Data Management reports (Slabodkin, Health Data Management, 10/16).

In June, ONC released a paper outlining health IT interoperability goals the agency hopes to achieve over a three-, six- and 10-year time period (iHealthBeat, 6/5).

The agency plans to release a final version of its 10-year national interoperability plan by the spring (Conn, Modern Healthcare, 10/15).

The updated draft roadmap was presented at a joint meeting of the Health IT Policy and Standards committees by ONC's Interoperability and Exchange Portfolio Manager Erica Galvez.

During the meeting, Galvez said ONC has adopted the Institute for Electrical and Electronic Engineers definition of interoperability, which calls for a system or product to work with other systems or products without special effort on the consumer's end.

She said that the draft report, which will be available for public comment in January 2015, takes an incremental approach to achieving interoperability (Health Data Management, 10/16). The draft report states:

  • By 2017, providers and patients should be able to send, receive, find and use basic electronic health information;
  • By 2020, providers and patients should be able to contribute to and access their health information at a granular level and seamlessly use remote monitoring devices;
  • By 2024, patients should be able to regularly track and share data from mobile and medical devices electronically, and providers should have increased longitudinal information to contribute to a learning health system (ONC draft report, 10/15).

According to the draft report, ONC will create and launch a program that monitors who complies with the voluntary national framework (Bowman, FierceHealthIT, 10/14).

During her presentation, Galvez also touted the nation's existing interoperable system, noting, "There is a base from which we can build. We're not starting from zero."

For example, she noted that health care organizations have increased the number of directed exchange transactions through health information exchanges by 225% to more than 226.6 million transactions between the second quarter of 2012 and the fourth quarter of 2014 (Modern Healthcare, 10/16).

Overall, committee members generally agreed with the draft roadmap (Gold, PoliticoPro, 10/15).

In addition, the Health IT Now Coalition in a statement applauded ONC for a plan that "immediately challenges the status quo to think beyond pecuniary interests to transforming health care."  Health IT Now Coalition Executive Director Joel White said the Policy and Standards committees must "step up," take charge and demand better outcomes for consumers (Health Data Management, 10/16).

Committees Approve Several JASON Task Force Recommendations

Also on Wednesday, the Policy and Standards committees formally approved a set of six recommendations from the JASON task force that calls on CMS to focus efforts on public application programming interfaces, Clinical Innovation & Technology reports (Pedulli, Clinical Innovation & Technology, 10/16).

The JASON task force was created as a short-term joint workgroup under the Policy and Standards committees to analyze and synthesize feedback on a previously released JASON report, which was prepared by an independent group of scientists that advises the federal government on issues pertaining to science and technology (iHealthBeat, 9/4).

In a final report, the JASON task force recommended using Stage 3 of the meaningful use program as a "pivot point" to begin the transition to public APIs (Durben Hirsch, FierceEMR, 10/14).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of EHR systems can qualify for Medicaid and Medicare incentive payments.

Specifically, the committees approved recommendations to:

  1. Focus on interoperability by realigning the meaningful use program and initiate adoption of public APIs;
  2. Create a coordinated industry-based exchange architecture to support API-based interoperability;
  3. Create nationwide data sharing networks;
  4. Enable the public API to allow data- and document-level access to clinical and financial systems;
  5. Develop priority API Services; and
  6. Have ONC monitor the progress of adopting APIs and implement non-regulatory steps to assist with the adoption (Sullivan, Government Health IT, 10/15).

According to Healthcare Informatics, the committee members did not approve language that would encourage CMS and ONC to delay or stagger Stage 3 of the meaningful use program (Raths, Healthcare Informatics, 10/15).

The Policy and Standards committees will draft a letter to ONC and CMS formally endorsing the task force's recommendations (Clinical Innovation & Technology, 10/16).

Source: iHealthBeat, Thursday, October 16, 2014

The myth of too many clicks

We have seen a number of recent blog posts and tweets complaining about EHRs having ‘too many clicks.’ (and a great video on youtube by ZDoggMD '30 clicks for an Ambien?')

A number of people have proclaimed that reducing the number of clicks in an EHR as a method to improve EHR Usability. Multiple clicks are not a deterrent to usability and user satisfaction, in fact there are many occasions where having more clicks may actually improve usability.

Apple Touts Health Initiatives in Newly Unveiled Apple Watch, iPhone


Apple announced the release of its new iPhone and its Apple Watch, which CEO Tim Cook called a comprehensive fitness and health device, Healthcare IT News reports (Monegain, Healthcare IT News, 9/9).

Apple Watch Details

The Apple Watch is expected to launch in early 2015 at a starting price of $349 (Comstock, MobiHealthNews, 9/9). It will require users to use iPhone as its wireless foundation (Brino, Government Health IT, 9/9).

At its launch, the device will use a built-in application suite consisting of two apps:

  • An Activity app that tracks day-to-day exercise activity, movement and minutes standing per day; and
  • A Workout app that allows users to set a goal based on calories, distance, heart rate or time.

In addition, a companion Fitness app on users' iPhones will aggregate data from both the Activity and Workout apps and share that data with Apple's cloud-based health information platform HealthKit, which was announced earlier this year.

In addition, the Apple Watch will have the ability to:

  • Use a built-in accelerometer to track people's movements;
  • Monitor heart rates through optical sensors located in the back of the watch; and
  • Use data from GPS and WiFi on users' iPhones to collect additional information.

Jay Blahnik, Apple's director of Health, Fitness Technologies, said, "Over time, Apple Watch actually gets to know you the way a good personal trainer would. It is designed to deliver intelligent reminders to keep you motivated and on track. It can suggest goals that are personal, realistic and most important, achievable, which gives you a far better chance of succeeding" (MobiHealthNews, 9/9).

Meanwhile, Michael Mytych, a principal at Health Information Consulting, said the Apple Watch has the potential to significantly improve medication adherence by tracking when medications are supposed to be taken and sending reminders to users.

However, he raised concerns about the device's battery life being able to support health care tasks (Goedert, Health Data Management, 9/10).

iPhone 6's Health Features

Apple also announced some new health-related features that will be included with its iPhone 6.

Specifically, Apple said that the phone will come with an M8 chip that will use a built-in barometer to estimate altitude changes to deduce the number of steps a user climbs.

In addition, the phone could have some effects on telemedicine efforts, according to MobiHealthNews. For example, the new iPhone will have:

  • An updated camera that could make photographing wounds and blemishes easier; and
  • An updated FaceTime app that supports a front-facing HD camera, which could improve video visits with providers (MobiHealthNews, 9/9).

Possible Mayo Clinic Partnership

According to reports, the Mayo Clinic might endorse Apple Watch as a tool to help patients improve and maintain their health, Healthcare IT News reports.

Reports noted that Mayor Clinic representatives were scheduled to be present at the announcement, but they did not make an appearance during the meeting (Healthcare IT News, 9/9).

According to Modern Healthcare, the Mayo Clinic already has a patient app available through the iTunes app store.

John Wald, the clinic's medical director for public affairs, said, "We will see what the [Apple Watch] brings from the remote-monitoring perspective. I think the [Apple Watch] is one tool to begin to remotely monitor these patients" (Tahir, Modern Healthcare, 9/8).

Privacy Concerns

Meanwhile, some privacy experts have expressed concerns over how Apple will keep user data safe as it moves toward collected health data.

For example, experts have asked:

  • If users will be able to see how their data are being used;
  • Whether Apple with comply with HIPAA;
  • How Apple will handle and report data breaches; and
  • How Apple will address apps from developers that sell data to third parties.

While Apples has not specifically addressed privacy and security concerns, it has taken some steps to ensure users' privacy (Dwoskin/Beck, "Digits," Wall Street Journal, 9/9). For example, Apple has changed its iOS developer license agreement to prohibit developers from selling health information collected through HealthKit "to advertising platforms, data brokers or information resellers." In addition, the agreement states that developers are not permitted to use the HealthKit app or data collected from it "for any purpose other than providing health and/or fitness services" (iHealthBeat, 9/3).

Source: iHealthBeat, Wednesday, September 10, 2014

Evolve Digital Labs report finds U.S. Hospitals Lack Patient-Centered Websites

Some of the nation's top hospitals struggle to create a strong online presence and offer patient-centered websites, according to a new report from Evolve Digital Labs, Becker's Hospital Review reports.

Report Details

For the report, titled "The Digital Health of Today's Best Hospitals," researchers between January 2013 and January 2014 analyzed the digital presence of 57 of the top hospitals in the U.S., as identified by U.S. News & World Report.

The researchers used various search analysis and social media tracking tools to determine the patient "reach" of each hospital's website through:

  • Domain and page authority;
  • Inbound links;
  • Linking domains; and
  • Traffic.

The study also examined various website functions, such as those that allow patients to:

  • Complete medical forms before appointments;
  • Make appointments;
  • Pay medical bills;
  • Request refills;
  • View discharge and rehabilitation information; and
  • View medical records and/or test results.

To determine the hospitals' rankings, the researchers' search terms included all of the 16 health specializations in which the top hospitals are ranked nationally.

Report Findings

Overall, the report found that:

  • 67% of the hospitals did not offer online rehabilitation and aftercare information;
  • Nearly 50% of hospitals did not support post-prescription refill requests;
  • 49% of hospitals did not have a mobile website;
  • 33% did not allow online bill pay;
  • 20% allowed patients to pre-register online; and
  • 18% had website errors that affected the patient experience.

According to the report, the top 10 patient-centric hospital websites belong to:

  • Mayo Clinic;
  • Cleveland Clinic;
  • University of Texas MD Anderson Cancer Center;
  • Massachusetts General Hospital;
  • University of Pittsburgh Medical Center;
  • Duke Medicine;
  • Thomas Jefferson University Hospital in Philadelphia;
  • Massachusetts Eye and Ear Infirmary;
  • Mount Sinai Medical Center; and
  • Florida Hospital.


Derek Mabie, president of Evolve, said the findings highlight the need for digital governance throughout hospitals and health care systems to reduce the communication gap between health care professionals and patients.

He said, "If there were digital governance, these top hospitals would all have mobile-friendly sites" (Gamble, Becker's Hospital Review, 4/17).

Source: iHealthBeat, Tuesday, April 22, 2014