How To Successfully Implement An EHR System: Best Practices

In today’s information age, as our lives are getting increasingly digitized, health data is valuable. Health data is required for maintaining our health records, for helping physicians and health care professionals review patient information and collaborate on providing health care services and for driving health-related decision making, whether for an individual patient or for broader analysis such as determining the efficacy of health procedures or medication or monitoring emergency medical situations.

Hospitals and health care facilities should consider EHR implementation as more of a process engineering project than a technology project — one that adapts their organization and health care staff to modernized health care processes that make use of a technology system. This focus on medical processes allows you to use the EHR system as a tool to make work more efficient, rather than letting the technology dictate the work of your staff. Use the following best practices and tips to make your EHR implementation more successful.

Best Practices

• Assess your needs - Take a process engineering approach and focus on understanding the medical processes at the hospital and how these need to be changed and adapted to use an electronic system. Form a joint team with the EHR system implementation vendor and key hospital staff members and shadow the medical processes at the facility to understand and document them and visualize how they will adapt to the electronic system.
• Choose a flexible platform - The EHR system should provide flexible APIs and bidirectional data integration for supporting interoperability. 
• Check your contract - Your contract should have provisions to give you flexible access to the data along with ownership so you can do reporting and analysis as required and integrate the EHR with other products and devices for future growth and advancement.
• Make sure support is available - Ensure you have enhanced support for the first three to six months of operation. You should expect to find gaps and areas for improvement when you first put the system live. You should have the flexibility to make updates and adjustments accordingly until your system stabilizes for long-term use.

The full Forbes article can be viewed at this link.  

Based on results from eHI’s 2019 Survey on HIE Technology Priorities, this report examines HIE perspectives on:

• Adoption of new technology
• Integrating clinical and claims data
• Types of data being exchanged
• Business drivers and priorities
• Challenges associated with the aforementioned

For almost two decades, eHealth Initiative and Foundation (eHI) has monitored the state of health information exchanges. Healthcare is experiencing rapid evolution with the emergence of new technologies and payment models. In response, both the public and private sectors are seeking ways to improve the quality and safety of care, resulting in a growing momentum to improve interoperability. Organizations like health information exchanges (HIEs) and health information networks (HINs) act as a source of valuable information and services, making the continued evaluation of their challenges, opportunities, and priorities important.

Background on Health Information Exchanges

As the name implies, HIEs provide technology and services to help their stakeholders exchange electronic health information. HIEs do not provide healthcare services. Instead, they impact the quality and cost of care, and ultimately outcomes, by sharing patient health data across organizations within a region, community, or hospital system.

Numerous trends that will drive the adoption of new technologies, the ability to exchange various data types, and the direction of HIE priorities are already evident in 2019. The healthcare industry is in the process of adopting performance-based funding models in place of more traditional reimbursement-based models. Industry is also facing an influx of value-based care initiatives; growing support for application programming interface (API) based interoperability standards, such as HL7®’s Fast Healthcare Interoperability Resources (FHIR®); complex laws for sharing non-traditional types of data; and the push for nationwide exchange of electronic health information across disparate HINs. As new payment models emerge, healthcare stakeholders are increasingly seeking out new types of data that will give a wider perspective of a patient’s health and social experiences.

An HIE’s ability to integrate data enables and supports value-based care. Stakeholders can monitor their quality and cost of care, leading to improvements in care quality and care coordination, and eventually, cost savings. However, not all HIEs have the ability to integrate the many types of data necessary to enable and support value-based care and cost-lowering activities. HIE capabilities may be limited for a variety of reasons, including technical functions, costs, competing priorities, and issues around ownership and control of the data by stakeholder organizations participating in the HIE.

Join us for a May 16, 2019 webinar reviewing the results.

A Qualified Service Organization Agreement (QSOA) is a two-way agreement between a Part 2 program and the entity providing the service, for example a lab. The QSOA authorizes communication only between the Part 2 program and QSO.

This template was provided by Healthix, a NY HIE that presented on best practices of sharing sensitive PHI from 42CFR Part 2 Programs on eHI's April 30, 2019 webinar. 

eHI's Policy Guy Talks TEFCA & 21st Century Cures

Over the past two months, the federal government has issued two major proposals to implement interoperability elements of the 2016 21^st Century Cures legislation (Cures) that are of great importance to the eHealth Initiative and its members.

Late in February 2019, the Office of the National Coordinator for Health IT (ONC) released a proposed rule to implement multiple health IT-related elements of Cures, including provisions on information blocking and certification of health IT using standards-based open application programming interfaces (APIs).  On April 19, ONC released an updated second draft of its Trusted Exchange Framework and Common Agreement (TEFCA), first released in January 2018 and also required by Cures. Taken together, these documents seek to accelerate and reshape the U.S. interoperability landscape.

ONC and CMS Information Blocking and Interoperability Proposed Rules

The ONC proposed rule would implement congressional prohibitions in the Cures legislation on information blocking with associated penalties, while identifying seven exceptions for practices that would otherwise be considered information blocking but will not be subject to penalties if they meet one of these exceptions (e.g., preventing harm to a patient).  In implementing these provisions, ONC seeks to require a broad spectrum of information sharing across organizations and individuals while also limiting the fees, contracts and other potential barriers to data access that can be implemented for various interoperability elements named in the proposed rule (e.g., hardware, software, technical specification, or license used for interoperability). 

ONC also seeks, along with a companion proposed rule from the Centers from Medicare and Medicaid Services (CMS) focused primarily on health plans, to advance the use of open APIs based on the HL7® FHIR® standard. Its goal is to expand data access for patients and other authorized individuals and organizations through apps and applications that would use these APIs to gain secure access to electronic health information (EHI). As with information blocking, ONC proposes significant limitations and requirements for API pricing, contracts and transparency.

While the information blocking provisions apply to a very broad definition of EHI, the API certification provisions apply to a narrower, standards-based U.S. Core Data for Interoperability (USCDI). The USCDI, which will replace the ONC Common Clinical Data Set (CCDS), is intended to expand over time toward the Cures definition of interoperability, which calls for access to all EHI. Although the technical scope of the API certification provisions is narrower than that of information blocking (e.g., read access to the USCDI vs. access, exchange, and use of EHI), its transparency and fee provisions are stricter.

Trusted Exchange Framework and Common Agreement (TEFCA)

The proposed TEFCA seeks to complement the API data access model by creating a framework for trusted exchange that knits together the organizations, health information exchanges, networks, and frameworks that are increasingly exchanging health information. The TEFCA would use a consistent, standards-based trust framework that enables nationwide organizational and individual queries for health information as well as the ability to push health information messages to targeted locations.

This new TEFCA process would be overseen by a private-sector Recognized Coordinating Entity (RCE) to be selected by ONC and operated through a cooperative agreement. The building block of this model would be the Qualified Health Information Network (QHIN). QHINS would have participants (e.g., HIEs), which in turn have members (e.g., medical groups, hospitals, individuals, payers).  This model would be intended to permit nationwide queries for health information consistent with HIPAA privacy and security rules as well as pushed messages.

The TEFCA starts with the Trusted Exchange Framework (TEF)—principles to facilitate trust between QHINs and their members and participants that will be the foundation of the Common Agreement that will govern exchange. The Common Agreement builds on the TEF and will include Minimum Required Terms and Conditions (MRTCs)—mandatory terms and conditions that QHINs agree to follow and additional required terms and conditions developed by the RCE. In addition, the QHIN Technical Framework (QTF), which would include technical requirements and standards, would be incorporated by reference in the Common Agreement.

Implications for eHealth Initiative Members

ONC and CMS goals in putting forth these proposals include:

• Improving the interoperability of electronic health information;
• Enhancing care coordination; and
• Promoting patient access to and control over their health information.

Achieving these milestones can modernize and move healthcare forward. As we think about these proposals, however, it is also important to be alert to potential unintended consequences as we enhance interoperability nationwide, through open, FHIR-based APIs and wider use of trusted exchange models. For example, initial reactions to the ONC proposed rule, in addition to recognizing the value of increased data liquidity, have highlighted the potential complexity and associated compliance costs, broad definitions of such concepts as Health Information Networks and Electronic Health Information, and how concepts in the proposed rule may interact to add to its complexity and reach, including challenges to existing market forces and investments in interoperability.

In the second draft of the TEF, ONC clearly listened to comments received on the first draft and has made changes to simplify and refine its approach. ONC is to be applauded for such efforts and for providing an additional opportunity for public input.

Comments for these proposals remain open. The comment period for the ONC proposed rule has been extended by one month to June 3. Comments on the TEFCA are open until June 17. The eHealth Initiative will be submitting comments developed by its Policy Steering Committee and many other organizations and individuals will be commenting as well. Please let your voice be heard!
 

Mark Segal, PhD, FHIMSS, Principal, Digital Health Policy Advisors, LLC. Member and Past Chair of the eHI Policy Steering Committee. April 25, 2019. Twitter @msegal111

eHI thinks Mark Segal is a super cool guy and is providing his opinions for informational purposes only. The opinions presented, do not represent those of eHealth Initiative, our members or the Foundation.

Recommendations on Digital Interventions for Health System Strengthening

A key challenge is to ensure that all people enjoy the benefits of digital technologies for everyone. We must make sure that innovation and technology helps to reduce the inequities in our world, instead of becoming another reason people are left behind. Countries must be guided by evidence to establish sustainable harmonized digital systems, not seduced by every new gadget.

That’s what this guideline is all about.

At the Seventy-First World Health Assembly, WHO’s Member States asked us to develop a global strategy on digital health. This first WHO guideline establishes recommendations on digital interventions for health system strengthening and synthesizes the evidence for the most important and effective digital technologies.

The nature of digital technologies is that they are evolving rapidly; so will this guideline. As new technologies emerge, new evidence will be used to refine and expand on these recommendations. WHO is significantly enhancing its work in digital health to ensure we provide our Member States with the most up-to-date evidence and advice to enable countries to make the smartest investments and achieve the biggest gains in health. Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.

The full guideline from the World Health Organization can be downloaded below.  

Interoperability: Do we have the value proposition upside down?

Dr. Doug Fridsma, CEO of the American Medical Informatics Association, has been working on the nuts and bolts of interoperability for a very long time. Prior to joining AMIA, he served as chief scientist at the Office of the National Coordinator for Health IT, leading management of the Federal Health Architecture and Standards & Interoperability Framework during the pivotal post-HITECH period.

Since then, Fridsma and his AMIA colleagues have been vocal proponents of a forward-thinking and creative approach to interoperability, with an eye toward the health system of the future – one fed as much by data from medical devices, apps and other consumer-facing technology as by the clinical elements of the electronic health records.

In a future driven by new types of patient-generated information and social determinants data, most of it coming from outside of traditional health systems, Fridsma says it's critical to think of interoperability not as a goal to be strived for, but as an ongoing process, driven by diverse stakeholders, that will continue to evolve and be reshaped by emerging developments.

Fridsma spoke recently with Healthcare IT News about some lessons learned from his tenure at ONC; what AMIA thinks about the proposed interoperability rules from 21st Century Cures; the importance of staying focused on achievable use cases for data exchange, why it might be useful to share first and standardize later, and what lessons can be learned from the APIs undergirding the World Wide Web.

The full Healthcare IT News article can be viewed at this link.  

What you need to know about healthcare APIs and interoperability

Application programming interfaces enable information systems to communicate and transfer data among each other. Depending how it is configured, an API can enable a system to send or retrieve data that can update an individual’s record or provide collective data that can be used to create reports. An API also can send information from one system to another.

A healthcare provider organization, for example, can input a patient’s information into a system that works with insurance companies and nearly automatically determine the patient’s coverage for a specific procedure or medication. That is enabled by an API.

APIs have a big part to play in health IT interoperability in the years ahead, especially as the data exchange rules of the 21st Century Cures Act encourage their standardization and proliferation across the healthcare ecosystem. Here, some API experts point the way forward for APIs and describe where they can be of most help.

The full Healthcare IT News article can be viewed at this link.