Wednesday, March 01, 2017

One Groups View Of Range Of Steps To Improve Usability and Interoperability Of EHRs.

This appeared last week.

White Paper Outlines Recommendations to Improve EHR Usability

DirectTrust Urges Physicians to Provide Feedback

February 21, 2017 02:16 pm Sheri Porter – A brand new draft white paper that addresses issues related to the usability and interoperability of electronic health records (EHRs) has the potential to rock the world of family physicians -- and in a very good way.
The paper's authors are asking the companies that develop EHR systems to make long-overdue improvements to products physicians need to support health record sharing for care coordination and transitions of care.
The white paper( from DirectTrust lays out 50-plus feature and function recommendations aimed at jump-starting action among the more than 350 vendors who provide information exchange through Direct Interoperability, a protocol for secure electronic sharing of health care information.
Some of the top-priority Direct Interoperability recommendations outlined in the paper include assurances that a system is able to provide
Story Highlights
  • A recently released white paper lays out more than 50 recommendations for how health IT vendors can improve their products with secure electronic sharing of health care information.
  • Some of the top-priority recommendations are delivery of messages in real time; inclusion of patient-specific attachments; and reconciliation of active patient medications, problems, allergies and immunizations.
  • The paper was authored by a clinician steering workgroup within DirectTrust, a nonprofit association that is urging family physicians and other clinicians to read the paper and provide feedback to strengthen the recommendations.
  • delivery of messages and attachments in real time rather than in prescheduled batches;
  • triggering of messages automatically, initiated by specific events such as a patient's hospital discharge;
  • inclusion of patient-specific attachments;
  • reconciliation of active patient medications, problems, allergies and immunizations;
  • automatic matching of incoming messages to patients for whom a record already exists in the recipient EHR; and
  • support for a variety of attachment types, including Word files and PDFs, as well as image files such as JPGs and GIFs.
In a Feb. 13 press release( introducing the paper, Steven Lane, M.D., M.P.H., co-chair of the clinician steering workgroup responsible for its drafting, explained the importance of the project.
"Sharing patients' clinical information across commonly encountered boundaries of health IT systems is critically important to clinicians and their teams who are coordinating their patients' care across different providers and organizations," said Lane, clinical informatics director at Sutter Health Palo Alto Medical Foundation in Palo Alto, Calif.
"Right now, in the typical medical community, there is great diversity in the brands of EHRs and other health IT systems used by clinicians for Direct messaging. We're calling for all these vendors to make available more consistent and standardized software features to manage Direct clinical messages and their attachments," said Lane.
He called the current "variability in usability" unacceptably high and said it posed a barrier to interoperability, secure messaging and care-coordination workflows.
There is a great deal more found here:
This view would be music to the ears of the ADHA as it really pushes the need for improved communications of a wide range of clinical data between clinicians.
It is going to be fascinating to see what the ADHA SMD workforce comes up with. They would probably enjoy a quick browse of this whitepaper.


Anonymous said...

Documents, attachments and messages ARE NOT DATA and these do do comprise an EHR

Peter said...

As an IT professional - this looks like a list of motherhood statements. Of course you use real-time interfaces, it is only legacy systems (or something like banking) that would use anything else these days. Of course you look for an match before inserting a new record, the industry term is "upserting" - update or insert depending on whether it exists or not.
It is like reading the architectural advice in the NEHTA standards, they looked like they were cut and pasted from a guide in basic design principles.
Is there no-one in eHealth that has any experience in the IT industry?

[That last tag should be understandable to anyone with ANY knowledge of IT]

Bernard Robertson-Dunn said...

Whoever wrote the document "High-Level System Architecture, PCEHR System, Version 1.35 — 11 November 2011" was no architect. They haven't even done a decent cut-and-paste.

The way the terms Conceptual, Logical and Implementable Architecture have been used bear no relationship to any accepted architectural practice I've ever seen.
And for the record, I was a certified IT architect at IBM, a certification accepted by The Open Group as equivalent to their highest international standard.

When one of the most fundamental architectural/design documents in a project is so badly flawed, it's no surprise that the whole system has some pretty serious problems.

I don't know if anyone else has noticed, but the Concept of Operations document is no longer available on the website. Both the Con-OP and the
High-Level System Architecture were supposed to be updated. The Con-Op has disappeared and the High Level Architecture is still dated April 2011.

Anonymous said...

Conceptual ... Logical ... Physical(implantable). Anyone in manufacturing or construction (be it highways or software) would recognise the Owner's requirements, the Engineer's design and the Manufacturing Engineer's design ... conceptually what you are trying to produce ... logically how it would be designed ... and physically how you intend to build it.
Implementable is probably used to extract away from any intention to build an implementation, by rights NEHTA/ ADHA end products as they call them are simply intermediate products, complete as a product but intended to be used to create addition products. I would not be too quick to blame the architects, what were the constraints they worked under, how disciplined was the organisation? People find it hard to separate themselves from defining the solution when they should be defining the problem, and designers are developers are no better.

Anyway as you would understand it is all about the viewpoints, personally the biggest problem was a lack of adoption of RM-ODP

But I have little faith there are all but a few in ADHA who could wield it and even less who give a dam.

One other clarification – they are NEHTA/ADHA specifications not Standards, neither NEHTA nor ADHA are standards developing organisations, Standards Australia is the only one still operating, the Agency has a role but that is more in the governments obligations to the creation, maintenance and use of standards. The latter somewhat of a skill in fast decline in eHealth.

Also concept of operations, it is in operation so probably do not see a need for a concept of operations

Bernard Robertson-Dunn said...

"Conceptual ... Logical ... Physical(implantable). Anyone in manufacturing or construction (be it highways or software) would recognise the Owner's requirements, the Engineer's design and the Manufacturing Engineer's design ... conceptually what you are trying to produce ... logically how it would be designed ... and physically how you intend to build it."

Why would you use an approach from manufacturing/construction engineering in the development of an Information System[*]?

Information System architecture has: business architecture, application architecture, information architecture and technology architecture, each of which has a conceptual a logical and a physical architecture. Design comes much later.

If you are building a health records management system, would it not be better to use an approach from the information systems world rather than manufacturing/construction?

If ADHA is still using the same inappropriate approach, then there is no hope until they drain the swamp, to use a current metaphor.

But that's only my opinion, having spent thirty years working in both camps. Rule #1, pick the right approach, otherwise you'll regret it.

[*] Answer: Because to someone with a hammer, every problem looks like a nail. In today's world you need to be a fox, not a hedgehog. Look it up. Archilochusis not Aesop.