Category Archive News

Season’s Greetings from HL7NZ

At the end of my first full calendar year as HL7NZ Chairman, it’s time to reflect on a productive year for our Affiliate and look forward to the coming months. Hopefully, the fulfilment of our key goal of greatly increased outreach and engagement with the health and disability sector, including more regular updates, means that this final seasonal message can focus on providing some broader perspectives on 2017.

A key component of this strategy has been building membership and new partnerships with NZHIT and HINZ, the later providing our first-ever booth at their highly-successful 2017 Conference in Rotorua. I firmly believe that the combined resources and capabilities of our organisations can provide invaluable support to the designers and developers of digital health solutions.

In particular, we hope to continue to work on removing roadblocks, both technical and tactical, on the path to achieving heath data interoperability. Like another less worthy road, this is ‘paved with good intentions’, but also serious obstacles, notably data silos, that need to be eliminated if the greater objectives of a patient-centric health strategy are to be achieved. For example, in common with other users of patient portal products, it frustrates me that I cannot access this information, via an API, in the health and wellness monitoring application of my choice.

This not to say that the air of optimism that I expressed at the corresponding time last year has dissipated, rather that our progress has been slower than anticipated. In my annual report to the HL7NZ Board, I attributed this to the fractured nature of our health and disability sector, a period of governance changes and the ‘not invented here syndrome’. However, these are the headwinds against which we must sail and one must never underestimate the challenges of change management in our sector.

One increasingly bright light is the number of industry partners now exposing APIs based on HL7® FHIR® in open, ‘sandbox’ environments. One of these platforms will be used as one of the key components of our first 2018 event – the “Developers on FHIR” challenge – in partnership with The University of Auckland. This begins with a Webinar on December 19 and culminates on 17th March 2018 in a full day, hands-on event with submitted solutions judged by health sector leaders.

On the international front, next year will be a seminal one for HL7 as we prepare for Release 4 of FHIR – the first to contain normative content – and it would be wonderful to see as many HL7NZ members as possible contributing to this ground-breaking product. One only has to spend a short time on digital health and networking web sites to realise that FHIR has now been implemented by all of the major digital health software and cloud platform providers. Opportunities to participate in such a significant project are rare indeed!

Although FHIR has taken the world by storm, and is now HL7’s ‘primary standard’, that does not mean that we are withdrawing, or ignoring, our others standards. It is estimated that version 2 messaging will have a long usage tail and we will be engaging with the sector to gain consensus on migrating to what is likely to be the ‘final release’ of this product.

Finally, I’d like to extend sincere thanks to all of our members and benefactors (notably the Technology & Digital Services Team at the Ministry of Health) for their support in the past year and I hope that you and your families all enjoy a well-earned Christmas and New Year break. I look forward to continuing to work together with you all to progress interoperability in 2018.

Peter Jordan, Chairman HL7 New Zealand
admin@hl7.org.nz

AGM Monday 6th November 2017, Auckland

The 2017 Annual General Meeting was held at the offices of Sysmex NZ, 386 Manukau Road, Auckland  on Monday 6th November at 4 pm. All previous Board Members were re-elected along with two new Members – David Moorhouse (Pegasus Health) and John Carter (Healthlink). At the first meeting of the new Board, held directly afterwards, the following officers were unanimously re-elected: Peter Jordan (Chairman), Peter Sergent (Vice Chairman), Edwin Ng (Treasurer), Linda McKay (Secretary). 

Minutes

News and Views from HIMSS 2017

Produced by Martin Entwistle, Board Member HL7 New Zealand

____________

This paper provides a personal view of highlights from the Health Information Management Systems Society Conference (HIMSS) 2017, which took place in Orlando Florida February 19-23, 2017.

Despite the uncertainties over future directions for healthcare in the US, resulting from the new administration, there was significant buzz in several areas of strategic importance with significant potential impact on health systems development in the near to medium term.

The following are the themes that appear to be of particular importance, and with relevance to the New Zealand health sector. The list is not comprehensive, other themes that have importance to those working in more narrow or specialized fields are not included:

  • Consumerization of patient care and customer experience
  • AI and cognitive computing
  • Advancing value-based care
  • Population health, connected health and patient engagement
  • Improving interoperability between the connected health world and EHR systems 
  • Cloud computing and security for the digital healthcare enterprise

Consumerization of Patient Care and Customer Experience

Over the last 5 years there has been an accelerating awareness of a significant social change in the way people seek to engage with and consume traditional healthcare services. The organization Health 2.0 has been leading discussion on this through its conferences and workshops, initially with an emphasis on the disruptive potential of new market entrants with a consumer products and services and more recently increasing interest from mainstream healthcare providers, insurers and vendors. At this Conference the importance of addressing consumerism in healthcare was explicit, with the many and wide-ranging implications being presented and discussed.

Consumerization is about the changing role of consumers (patients) from being a reactive recipient of care to playing a more proactive role in being in control of how they manage their own health, seeking services that focus on wellness rather than just sick-care, being better informed about the choices available and demanding services that better fit their day-to-day lives rather than for the convenience of the health system itself.

This was a common theme throughout the conference. Providers are accepting that this is no longer a future-state concept, but a major dimension of future healthcare delivery that needs to be taken seriously and addressed as a priority. A number of presenters observed that failure to address this deep-seated need by patients represents a major threat if not tackled, with patients moving to alternate providers or accessing services outside mainstream healthcare that do address their needs.

The implications for health systems development are significant, as the systems and services required to meet these needs are very different from those currently available, and the detailed requirements are still not well defined. Relevant solutions include; customer relationship management systems to profile and engage with individuals even when not sick, devices and apps to support behavior change and wellness, big data analytics to help anticipate needs and intervene preemptively, remote managed care including telemedicine and video visits. Of critical importance is not just the functionality these new systems provide, but the experience they generate. Reference models for success are closer to Amazon, Facebook and Salesforce than they are to the health systems currently in place.

AI and Cognitive Computing

Artificial Intelligence (AI) is not new to healthcare. In the 1980s and ‘90s AI was the focus of significant research and development efforts. At that time, AI solutions were built around fuzzy logic, and neural networks used to develop predictive learning systems. There were some interesting results but they did not have sufficient accuracy to become widely adopted. As a result, AI has been on the sidelines for some years.

But no longer! AI is once again a hot topic. Solutions are again focused on predictive analytics, but with methods developed through big-data mining systems that have been evolving over the last 5 – 7 years, and resulting in solutions very different than before. They include the application of machine learning, reasoning, natural language processing, data mining, human-computer interaction to deliver advanced analytics.

There are many companies big and small active in the area offering both broad and narrow solutions. Among the big companies, and while still on the cutting edge, IBM, Google and Microsoft are taking a major role in leading the way forward. However, IBM-Watson was definitely the most prominent of these at HIMSS 2017.

AI systems are undoubtedly complex and historically their use for the development of solutions has been in the hands of experts in the area. Once of the new developments presented at the Conference is the availability of AI analytics tools as cloud-based services. This has the potential to widely expand their use as it puts the tools in the hands of a wider range of developers to build these into their solutions.

Encouragingly, much of the energy is going into practical uses of these solutions to ensure these have wide-scale value in the real world and directly impact patient care and the outcomes achieved. One of the challenges experienced historically was that the underlying fuzzy methods were not easily understandable, so the outputs were viewed with some skepticism, particularly by doctors. With this new wave of solutions ease of use and believability are significant areas of focus. Indeed, a whole new area of technology is being created, “cognitive computing”. 

Cognitive computing systems depend on various aspects of artificial intelligence (AI) to acquire knowledge from the massive amount of data fed into to them. Outputs focus on getting the right information to the right user at the right time and in an impactful format so that rapid decision making without further information processing can be achieved. Uses include matching the patient to specific tailored interventions. For example using genetic data inputs to identify optimal clinical interventions for that patient. Natural Language processing can mine intelligence from unstructured clinical notes and link that information from other clinical inputs to identify patients with specific but hard to identify risks, eg depression.

Some companies are ‘betting the bank” on the future importance of cognitive computing. Ginni Rometty, IBM chief executive, in a key-note presentation said that cognitive computing technologies could usher in a golden era for personalized and precision medicine. “We’re in a moment when we can actually transform pieces of healthcare. It’s within our power”. “This era that will play out in front of us can change the world for the better.”

Advancing Value-based Care

In the US, value-based care is seen as critical to addressing rising health care costs, clinical inefficiency and duplication of services. In value-based models, doctors and hospitals are paid for helping keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way. This contrasts with the traditional fee-for-service approach, where payments are made on the basis of services provided irrespective of the outcomes achieved.

Under “Obamacare” the US government strongly signaled a major shift to value based care by enacting MACRA (Medicare Access & CHIP Reauthorization Act), that would cut physicians base salaries and put more emphasis on incenting quality outcomes. MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or MIPS.

Presentations at the Conference outlined that in the recent past, four models have evolved for the delivery of value-based care:

Accountable care organization (ACO) – Accountable care organizations are alliances of doctors, hospitals and other health care providers that deliver and coordinate care for their patients and are paid based on their success at improving overall quality, cost and patient satisfaction with their health care experience. In an ACO, providers are responsible for improving the quality of patient care and health outcomes, at equal or lower costs, through better coordination and preventive care.

Patient-centered medical home (PCMH) – In a PCMH, a primary care doctor leads a clinical team that oversees the care of each patient in a practice, and is focused on providing enhanced care coordination across the health care system. Financial incentives are based on performance on specific quality measures. When practices do well on quality and efficiency measures, they share in the savings they create. While still fee-for-service, this entry-level value-based model encourages quality and efficiency.

Bundled payments – In a bundled payment model, a single payment is made to doctors or health care facilities (or jointly to both) for all services associated with an episode-of-care, such as a hip or knee replacement. “Bundled payment rates” are determined based on the costs expected for a particular treatment, as well as costs for any preventable complications that may arise. 

President Trump’s promise to repeal and replace the Affordable Care Act (ACA) which underpins “Obamacare” is what is leading to much uncertainty over the future of value-based care. Nonetheless, there was a general consensus at the Conference that the shift to value-based care and that quality payment programs very similar to those developed under MACRA, will continue.

However, the transition from fee-for-service to pay-for-value payment models is one of the greatest challenges the U.S. healthcare system faces. Management of value-based services is data intensive and requires new business processes and workflows. Few provider organizations have the necessary end-to-end clinical, financial and administrative systems in place and there were a significant number of vendors offering such solutions as well as the advisory services for implementation and management.

Population Health, Connected Health and Patient Engagement

Population health management (PHM) is one of the fastest-growing segments in U.S. healthcare systems development. It was reported at the Conference that the majority of $8 billion in US digital health investments during 2016 went to support complex PHM initiatives. At the same time PHM solutions are a major area for development by existing vendors large and small. 

One of the interesting battles being played out, is whether advanced PHM solutions should be delivered as core capabilities of EHR systems or through specialized applications. In addition to EHR vendors Epic, Cerner, Allscripts and AthenaHealth providing solutions to their existing customers, the following vendors were identified among others as being well established in the provision of solutions and services; Optum, Philips Wellcentive, Caradigm, Lightbeam, Deloitte, Health Catalyst, Enli, Premier, i2i, Medicity, Lumeris, Best Doctor, Medecision, ZeOmega, Influence, Humana Transcend Insights, Conduent (Xerox), Cognizant Trizetto, Orion Health.

To give some idea of the challenges for systems development, six diverse functional components were presented as being necessary to deliver the full-scope of required PHM capabilities:

  • Data collection aggregation, storage and patient registries
  • Connectivity and identification of gaps in care
  • Big data stratification and risk segmentation/cost metrics
  • Patient engagement and external data acquisition
  • Care team coordination and management
  • Outcomes measurement, reporting and analytics

As advanced solutions increasingly need to make use of some of the more complex computing capabilities previously identified in this paper, in particular patient engagement, cognitive computing and AI, it is going to be hard for any vendor to provide solutions that meet all these needs and it will be especially hard for EHR vendors to keep up with the pace of development. This suggests that future solutions will be created through seamless integration of systems capabilities from multiple vendors.

Improving Interoperability Between the Connected Health World and EHR Systems 

Digital and personal connected health was the subject of its own 2 day forum at the Conference, accompanied by a booth in the exhibition hall providing a series of case studies and demonstrations by over 50 companies active in the area. 

Connected health embraces a number of technology domains broadly encompassed by the Internet of Things (IoT); medical and consumer devices for remote patient monitoring, mHealth apps for collection and display of data as well as direct interaction with users, advanced data mining, interpretation and presentation capabilities. New devices, wearable sensors and mobile apps now track fitness, behaviours and many important clinical measures, with the promise of even more complex and interesting metrics becoming available in the near future. It is a dynamic and expansive market, exploding with opportunity.

The resulting patient-generated health data (PGHD) is available to be flowed into EHRs to help improve engagement, adherence and clinical outcomes; individuals are connecting with providers through portals and apps to manage chronic conditions, and telemedicine is enabling a growing number of virtual visits. Functionality including gamification adopted from the consumer space is being leveraged to drive both sustained engagement and positive behavior change.

Connected Health already has the potential to improve care delivery across the healthcare continuum, with the promise of adding even greater value in the future. However, as more healthcare providers and plans embrace these technologies, they’re running into interoperability, regulatory, and cultural challenges. Case studies, best practices, and panel discussions, presented at the Conference outlined tools, technologies and strategies designed to address these challenges. A number of presenters called out that Connected Health represents a fundamental change in the way we provide healthcare services that require new systems, delivery models and workflows, and even more importantly a fundamental cultural shift to the total approach to service delivery prevention and remote engagement at large scale with the people for whom health systems are responsible.

A closely related theme is that EHR interoperability continues to be a barrier to progress, and is general and pervasive. Many of the EHR vendors presented work they are doing to overcome these barriers; openAPIs, adoption of interfacing standards (eg FHIR) and use of webapps, but progress is not as fast as many would like. This issue is a particular challenge to the seamless delivery of connected health capabilities into the clinical workflow which are is critical to adoption and use. In parallel, there is significant work underway to simplify EHR integration and facilitate sophisticated data exchange between organizations. FHIR was covered in many presentations and received significant interest for its potential to assist with this particular challenge.

Cloud Computing and Security for the Digital Healthcare Enterprise

Cloud computing and security in the digital healthcare enterprise, which for health systems development are closely linked, were also major themes at the Conference. 

A move to healthcare solutions that have been formally developed and deployed to leverage cloud computing capabilities has significant potential, but to date, healthcare world-wide has been slow to embrace these opportunities. There are a number of reasons; most healthcare providers have significant investment in on-prem deployments of their all-critical clinical systems including EHRs, migration appears potentially costly and to have significant risks even if the end results would have economic and business advantages, but probably the most significant barrier has been the perceived security risks.

The issue is around ensuring complete protection of electronic personal health information (ePHI), and the proven solutions available to healthcare IT teams that still rely on tried and tested, locally deployed security measures, eg network and endpoint security tools.

But the tides of change can no longer be held back and the healthcare industry is increasingly adopting the cloud, with health systems realizing the significant cost savings of contracting their data-center operations. This opens up important questions having to do with data being held in compliance with HIPAA-HITECH; whether ePHI is being encrypted and, if so, where the keys reside and how organizations can port their data from one cloud provider to another if needed.

The other hot topic in this space is medical device security and there were a number of educational sessions dedicated to this topic. Groups like the Medical Device Security Information Sharing Council (MDSISC) and NH-ISAC are focusing much-needed attention on medical device security, and there is growing momentum for security to be incorporated at the point of manufacture as opposed to being an afterthought.

Summary

In summary, this was one of the most interesting and invigorating HIMSS Conferences I’ve attended. While healthcare world-wide face very significant challenges, it seems that the health system development space finally has a range of truly exciting and in many ways disruptive solutions with very real potential to address these challenges. These systems are not only novel in concept, but can facilitate totally new business processes that if well implemented can provide the very different healthcare experience that is it now clear many individuals are seeking. Our ability to address this need  will materially impact the future care of healthcare, leading to a world very different that we know today.

HIMMSS Conference 2017 http://www.himssconference.org/

FHIR front continues to expand with localisation under way

From Pulse+IT:

“HL7 Australia is working on a localised version of the FHIR specification as local implementations start to take off, with early adopter Telstra Health already exploring its potential to link up its disparate business units, implementations in several medications management projects and a mobile gateway for the My Health Record under development.”

The article: https://www.pulseitmagazine.com.au/australian-ehealth/3688-fhir-front-continues-to-expand-with-localisation-under-way

BREAKING NEWS – Release 3 of FHIR

HL7 is pleased to announce that release 3 of FHIR has just been published.

The FHIR community invested a huge amount of work in this release – hundreds of people have contributed to the specification, and there have been thousands of Change Proposals processed (>2400). Most of these change proposals arose from 3 different places:

  • Implementation Experience (Trial use is working)
  • Alignment with other standards
  • Internal Quality Review processesSome of the key changes: 
  • Added support for Clinical Decision Support and Clinical Quality Measures
  • Broadened functionality to cover key clinical workflows
  • Further development of Terminology Services, and support for Financial Management
  • Defined an RDF format, and how FHIR relates to Linked Data
  • Incremental improvements and increased maturity of the RESTful API and conformance framework
  •   READ MORE

FHIR TRADEMARK POLICY

The FHIR trademarks represent the goodwill in the marketplace created by HL7 through its members and collaborators to create a standard for exchanging healthcare information electronically. 

Protection of the FHIR trademarks reinforces the connection between HL7 and FHIR and the projects that they represent; protection of the FHIR trademark protects the quality of the FHIR standard and ensures that the mark is only used for activities that promote our common mission. When HL7 members and collaborators and developers see the FHIR mark on a product, conference, publication, or seminar, they should be confident that those goods or services are of the highest quality and that they reinforce and support our common goals.  Read more in the PDF file below…

“The Standard” (HL7 International’s Official Blog)

HL7 FHIR Foundation Collaborates with Google Cloud Platform to Support FHIR Community

Google Cloud Platform to Work with HL7 FHIR Foundation by Providing the Underlying Cloud Technology for the HL7 FHIR Developer Community Read more » Interview with Grahame Grieve https://blogs.cerner.com/blog/the-cerner-podcast-grahame-grieve/

Festive Seasons Greetings from HL7NZ Chairman – Peter Jordan

    As many end of year summaries will note, 2016 has been a transformational year, both in the Health and Disability Sector as well as the world at large. Within HL7 New Zealand itself, we have followed what appears to have been a broader trend in making a leadership change after an eight year tenure.

Hence it’s my first task, as the incoming Chairman, to thank David Hay for his magnificent leadership of our Affiliate in that period. In particular, David has been at the forefront in the development of the new HL7® FHIR® standard giving New Zealand a seat at the top table of an international project with, to date, over one thousand active participants! However, we’ve not allowed David to retire to his beach hut or the after-dinner speaking circuit: instead he has been awarded the honorary title of Chair Emeritus and will remain on our Board as the strategic lead for FHIR.

Another worldwide trend that’s been mirrored locally has been a shift of emphasis from eHealth and Healthcare IT to Digital Health, with major organisational and personnel changes within the Ministry of Health underpinning the new Digital Health Work Programme 2020. A key component of this strategy will be the adoption of international standards, notably for building APIs to facilitate the interoperability between systems that will provide the right information at the right time to the right people – be they the deliverers or consumers of healthcare services.

FHIR offers a unique platform for building such APIs and has already been implemented, in varying degrees, by nearly all of the 50 odd countries with HL7 membership. Healthcare is increasingly seen as a round-the-clock, global service and only standards that work across jurisdictions will meet this requirement. Another international standard SNOMED CT was a major focus in the NZ sector this year with the highly-successful Expo hosted in Wellington in late October, and I’d like to mention the key role played by our Board Member Alastair Kenworthy in this event.

At the Expo, HL7 New Zealand was privileged to host a booth, jointly with HL7 Australia. This formed part of a strategy to work more closely with our trans-Tasman neighbours, but even more significantly served as an indication of the increasingly close relationship between the FHIR and SNOMED CT standards and their respective governing bodies.

This event, and the following week at the HINZ Conference left many of us with a very positive feeling that our sector is on the verge of a major breakthrough in terms of aligning the requisite elements for the collaborative effort needed to drive the exponential change requirements of Digital Health. One concrete manifestation of this spirit of cooperation will be the publication of NZHiT’s Interoperability Charter, later this month.

Those of us fortunate to have seen the Keynote Presentation by international expert Dr John Halamka in Wellington will have noted his declaration that NZ can be world leaders in digital health. Given that Dr Halamka has also recently described FHIR as the ‘HTML of healthcare’, everything points to 2017 being a pivotal year. Consequently, we at HL7 New Zealand are proposing to increase our engagement with the sector by working closely with those building FHIR-based APIs – so look out for news of upcoming workshops and seminars early in the New Year.

Before then, I hope that you all enjoy a well-earned Christmas and New Year break and return to work re-charged and ready to interoperate.

Best regards,Peter Jordan, Chairman HL7 New Zealand

2016 AGM

This years’ Annual General Meeting was held at Sky City Convention Centre, Monday 31 October at 4.30pm.Officer bearers appointed as of Monday 7th November include:Peter Jordan (Chairman), Peter Sergent (Vice Chairman), Edwin Ng (Treasurer), Linda McKay (Secretary).  A newly created honour goes to outgoing Chairman David Hay (Chairman Emeritus) – David has Chaired the HL7NZ Board for the past eight years.

David Hay, HL7NZ Chairman Awarded this week

The winners of the Excellence in IT Awards 2016 were handed out in front of nearly 700 people at a gala event in Wellington on 12 July 2016. The eight Awards celebrate the individuals and teams that make up the industry and are a collaboration of 11 of New Zealand’s leading tech associations, to create a sector-wide awards programme. Partners include the Institute of IT Professionals, CITRENZ, TUANZ, Health Informatics NZ, itSMF NZ, NZ Software Association, GOVIS, Project Management Institute, InternetNZ, NZRise and the NZ Open Source Society.

The Excellence in Health Informatics was awarded to our own Chairman

Dr David Hay – for demonstrating a breadth of understanding of the Heath sector and has dedicated his entire career to bridging the role of clinician (he is a GP by training) with technology, with stunning results.  Congratulations David.