Sunday, October 19, 2014

Is It Time To Declare The PCEHR As A Failure That Is Moving In The Wrong Direction?

There was a very interesting meeting that has considerable impact on where e-Health is heading globally held in the last few days.
There are reports here:

Interoperability's 'game-changer'

Posted on Oct 17, 2014
By Bernie Monegain, Editor
Charles Jaffe, MD, CEO of standards organization HL7, came away from the joint meeting of the federal Health IT Policy and Health IT Standards committees earlier this week, thinking that the industry could move faster on interoperability. And HL7 has just the thing to change the game.
"I don't try to denigrate the success; I try to celebrate it," he told Healthcare IT News.
He blames a stuck-in-the-past approach for the slow pace of progress.
"We embrace a lot of technology that is technology for the past and ways of doing things that were important in the past rather than understanding the ideas that fundamentally change the way we achieve interoperability."
Top of mind for effecting that change is HL7's FHIR, he says. The acronym stands for Fast Healthcare Interoperability Resources. Pronounce it "fire."
According to HL7's official description, "FHIR combines the best features of HL7’s Version 2, Version 3 and CDA product lines while leveraging the latest Web standards and applying a tight focus on implementability."
As Jaffe puts it, "FHIR represents a departure from the notion of messaging and document-centric ideas."
"FHIR is such a significant advance in accessing data, delivering data and the enormous, enormous flexibility inherent in the model," he adds. FHIR doesn't specify the content; FHIR specifies what we mean by the content."
He describes FHIR as a platform and a set of rules.
"If you want to use it for consumer or patient-centric information delivery, or you want to use it for a novel idea about wellness, you can. It doesn't limit you the way messaging does. Moreover when you want to query a system, you don't have to have a registry. FHIR allows you to query systems that have FHIR capability independent of registries. Not only is it easy to use and is fast to develop and implement, but it's also inordinately flexible."
Lots more here:
More coverage is here:

'Actionable' steps to interoperability

Posted on Oct 16, 2014
By Tom Sullivan, Editor, Government Health IT
The highly anticipated final recommendations from the JASON task force arrived on Wednesday afternoon.
JASON, a group of independent scientists who advise the federal government, issued a November 2013 report to the Department of Health and Human Services, the Office of the National Coordinator for Health IT and the Agency for Health Research and Quality on the matter of interoperability.
The resulting analysis, not surprisingly, was highly critical of the current state of interoperability and electronic health record systems vendors.
ONC, for its part, has since established a task force to consider the JASON report.
Calling it the capstone of Wednesday’s joint HIT Policy and Standards Committees meeting, John Halamka, MD, CIO of Beth Israel Deaconess Medical Center and vice chair of the HIT Standards committee, explained that the JASON task force essentially "takes a set of general recommendations and turns them into actionable next steps."
More here:
and lastly here:

CHIME, HL7 applaud ONC road map, JASON task force recommendations

October 16, 2014 | By Dan Bowman
Health industry groups expressed optimism following the Oct. 15 meeting of the federal government's Health IT Policy and Standards committees to discuss a draft interoperability road map unveiled by the Office of the National Coordinator for Health IT.
In particular, the College of Healthcare Information Management Executives and Health Level Seven International (HL7) viewed the road map as a step in the right direction. CHIME Director of Federal Relations Jeff Smith (pictured right), who was critical of the interoperability vision paper published in June from which the draft road map stems, told FierceHealthIT that the updated document represents a "marked improvement" from its predecessor.
"The vision paper was very short on details and wasn't at all clear as to what the next version of things would look like," Smith said in a phone conversation. "Based on what we saw yesterday and based on the conversations that were had at the policy committee, things bode well for the next phase and it sounds like ONC is taking diligence in trying to put together something that is both technically robust, as well as considerate of various policies that fall outside the purview of technical standards."
Smith said CHIME will pay close attention to the governance piece of the road map, calling ONC's recommendations neither good nor bad.
Lots more here:
Essentially what has happened here is that the US has concluded the future direction for e-Health interoperability can be summarised thus:
“Top of mind for effecting that change is HL7's FHIR, he says. The acronym stands for Fast Healthcare Interoperability Resources. Pronounce it "fire."
According to HL7's official description, "FHIR combines the best features of HL7’s Version 2, Version 3 and CDA product lines while leveraging the latest Web standards and applying a tight focus on implementability."
As Jaffe puts it, "FHIR represents a departure from the notion of messaging and document-centric ideas."
"FHIR is such a significant advance in accessing data, delivering data and the enormous, enormous flexibility inherent in the model," he adds. FHIR doesn't specify the content; FHIR specifies what we mean by the content."
This essentially says that the US has decided against progressing the complicated parts of CDA and HL7 V3 while building on what is working in the simpler exchangeable clinical documents and focussing on proven Web Standards and actual implementability rather than having NEHTA developing 1000 page specifications which are still struggling to see the light of day.
At the very least DoH and NEHTA must now respond to the direction being adopted in the US and explain to our system developers what is in and what is now out of future plans. The lack of a recently re-confirmed Standards pathway for the Australian E-Health is  deeply problematic given the seismic shifts we are seeing in the US recognising that HL7 V3 has essentially failed and a new path is needed.
As the number of comments to the blog last week makes clear lots of people are interested and we need some clarity about what is going on! It seems to me the Standards base on which the PCEHR has been built may be simply about the become at worst obsolete or at best become an unmaintained technology backwater.
David.

1 comment:

Anonymous said...

"Is It Time To Declare The PCEHR As A Failure That Is Moving In The Wrong Direction?"

You are assuming its moving somewhere. I don't see much movement.