Interoperability Matters: The ONC Interoperability Roadmap and Standards Advisory

Healthcare reform has been a hot topic over the past few days and health information technology (HIT) is at the hub. Last week, the Office of the National Coordinator (ONC) released a Shared Nationwide Interoperability Roadmap¹, setting the goal to exchange and use “a common set of electronic clinical information at the nationwide level by the end of 2017.” Also, President Obama highlighted the Precision Medicine initiative² which included funding for ONC to support the development of interoperability standards, and CMS announced that Medicare payments are moving towards a model based on value and care coordination rather than volume and care duplication (and it is well known that lack of interoperability underlies the latter)³.

AMIA 2014: RxNorm

Guest blog by Michael Totzke, 3M data analyst.

At the AMIA 2014 convention in Washington D.C., we showcased some of our processes for mapping and maintaining RxNorm drugs into the Healthcare Data Dictionary (HDD). Our poster and podium presentations emphasized the fact that with clinical data, accurate and consistent mapping of terminology standards over successive versions is critical. With the selection of RxNorm as the drug terminology standard required to meet Meaningful Use criteria, it has become necessary for the HDD to maintain RxNorm’s drug data from a longitudinal perspective. Our former process for maintaining RxNorm dealt solely with the mapping of the current version, with limited regard to managing changes in RxNorm’s data over time. However, it’s not just the initial mapping that is important; having a long term strategy for maintaining that terminology within a larger terminology server is crucial for ensuring data quality. Medical terminologies change over time, and there is no algorithm yet that can alone guarantee the level of accuracy required for exchange of clinical data.

The IHI Triple Aim and Informatics

Recently I attended the American Medical Informatics Association (AMIA) annual symposium in Washington, D.C. I focused mainly on sessions related to nursing, interoperability, or both. The keynote speaker for the nursing preconference session was Dr. Deborah Troutman, CEO of the American Association of Colleges of Nursing (AACN). Dr. Troutman spoke about the Institute for Healthcare Improvement’s (IHI) Triple Aim. This blog gives an overview of the Triple Aim, discusses how it pertains to informaticians, and ends with a discussion about where we need to focus in the future.

The Triple Aim is a framework for developing new designs to optimize health system performance and to capture social needs in healthcare. The three aims are experience of care, health of populations, and costs of health. Experience of care means that if a person gets sick, the perception of their care, including quality, effectiveness, timeliness, etc., should be high. Population health is focused on causes of illness, such as obesity, substance abuse, and heart disease. The final aim is to lower cost, not by decreasing what people receive in their care, but through process improvement and illness prevention. The desired state is person-centered and is not focusing on illness care but moving towards wellness.

Achieving Semantic Interoperability: Point-to-Point Versus Centralized Mapping

Our philosophy at 3M is to approach terminology mapping and semantic interoperability using a centralized terminology server. With a centralized source of terminology management and maintenance, each data source needs to be mapped only once. Once this single mapping occurs, all the other systems that are mapped to the centralized server can leverage the mappings so data can be translated and exchanged without losing meaning. Therefore, for n systems that need to be mapped, only n mappings need to be performed.

On the other hand, in a point-to-point mapping approach, each system is mapped directly to every other system. While this is a feasible approach when dealing with a few systems, it becomes unwieldy as the number of systems increases. For example, given three systems to map, the total number of mappings that need to be created is three. However, if we increase the number of systems to five, the point-to-point mappings increase to 10. This is illustrated in Figure 1.

Meaningful Use and Laboratory Data Management: Getting to the Next Level

I am known for having a “glass is half full” optimistic view of life, so when I was recently presented with the opportunity to be a panelist at a Meaningful Use discussion, I accepted. The discussion was held at the American Association for Clinical Chemistry (AACC) 2014 annual meeting in Chicago. This year’s Healthcare Forum session was held jointly with American Society for Clinical Laboratory Scientists (ASCLS). I pondered the best way to adequately portray the complexity (a.k.a. frustration and confusion) occurring across the industry as hospitals attempt to keep up with MU (not to mention all of the other federal mandates).

Is Nursing Interoperability Within Reach?

This summer, I attended a nursing informatics conference that inspired me to believe that interoperability of nursing data is achievable. The Nursing Knowledge: Big Data Science for Transforming Healthcare Conference, hosted by the University of Minnesota School of Nursing, brought together nursing thought leaders from nursing practice, education and informatics. The goal of the conference was to “Advance a national plan for capturing nursing information for big data research aimed at identifying effective care interventions and improving patient outcomes.” So the question I asked myself: “How far away are we and is nursing interoperability within reach?” This blog discusses the current state of nursing interoperability and an initiative in progress to support interoperable nursing data.

Keeping up with HIT Regulations

 

Guest blog by Amy Sheide, Clinical Analyst with 3M Health Information Systems’ Healthcare Data Dictionary (HDD) team

The ICD-10 delay announcement is over a month old but there still are a lot of Health Information Technology (HIT) regulatory changes to keep up with. The new 2015 Electronic Health Record (EHR) Technology Certification Criteria Proposed Rule and implementation of the 2014 Meaningful Use requirements remain top priorities across the industry. The unfortunate take away is that the amount of change in the HIT landscape is not going away and the amount of effort required by organizations to keep up with and successfully implement these requirements is becoming more and more difficult to maintain. For example, look at the trends in EHR certification criteria. Vendor readiness was stated as a serious concern in meeting the 2014 stage two certification requirements and many organizations were held captive to the promise from their vendor that the EHR technology would be ready in time to meet the 2014 requirements. The release of the 2015 EHR certification requirements supports the goal of the Office of the National Coordinator (ONC) to provide more frequent releases of certification criteria that were less cumbersome for EHR vendors to meet. Despite the goal of more nimble updates and requiring changes to EHR technology in smaller increments, nearly half of the 2015 certification criteria are new or revised (Figure 1).

ICNP/SNOMED CT Nursing Terminology Collaboration

In January, the International Health Terminology Standards Development Organization (IHTSDO) and the International Council of Nursing (ICN) announced the release of an equivalency table between the International Classification for Nursing Practice (ICNP) concepts and SNOMED CT concepts. What does this mean for nursing? In order to answer this I will describe the collaboration agreement between the ICN and IHTSDO, give an overview of ICNP, and discuss how this agreement impacts standardized nursing terminologies.

The IHTSDO has a formal Harmonization Agreement with ICN to “advance terminology harmonization and foster interoperability in health information systems.” ICN is a federation of more than 130 national nurse associations representing millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality nursing care for all and sound health policies globally.

Healthcare’s Efficiency Challenge

I’ve started reading a book by William Baumol called The Cost Disease, which raises an interesting question. Why in 2014 can I buy a laptop computer that is smaller, more powerful, and most of all, much cheaper than one I could have bought just ten years ago, but healthcare costs have risen from ten years ago? Why are some industries able to become more efficient, and produce more of their goods or services, faster and cheaper, while other industries are stuck in a spiral or are continually raising costs with stagnant efficiency?

I won’t give a full, in-depth review of the book, but in short, the analysis lays out the premise that in some industries, such as with computers or automobiles, manufacturers are able to continually improve on both their manufacturing processes and the quality of the goods they are manufacturing. This enables these manufacturers to produce better goods at lower costs. These lower costs then enable them to pass some of these savings on to their customers, as well as to pay their employees more money.

Delivering on the Promise of an “E-Health” Revolution

As more and more hospitals and healthcare organizations convert more and more of their paper medical records to electronic health records (EHRs), an interesting dynamic has begun to emerge, as well as an interesting challenge.

The dynamic is that while the conversion from paper to electronic records was promised to provide time and cost savings for healthcare, the adoption of EHR systems by physicians has led to a number of perhaps unforeseen consequences. One of the chief consequences, which could also be considered a chief complaint, is that physicians who document on their patients electronically make less eye contact with their patients and have lower patient satisfaction ratings, vs. physicians who document on paper.