Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, April 28, 2019

Grahame Grieve Discusses Some Of The Issues Surrounding Interoperability.

I only noticed this a few days ago and felt it was worth a mention.

How does Australian interoperability become reality?

 

How do we take our current and somewhat vaguely expressed desire for improvement in interoperability in Australia, and turn it into something real? Fast Interoperability Healthcare Resource (FHIR) founder, Grahame Grieve, has some ideas.

By Grahame Grieve
Interoperability is a hard problem; it’s important to understand that it’s about information management, and it’s about people.
It’s not actually a technology problem – even though people use the word ‘technology’ a lot in respect to solving the issues we face around interoperability. But it’s not a technology problem, it’s a people problem, and an information management problem. Technology comes and goes. Information management is where the hard stuff is.
In my role as FHIR product director, I talk about interoperability a lot, and about FHIR. I realise that a lot of people misunderstand what Fast Healthcare Interoperability Resource (FHIR) is – yes, it’s got technology in it, but it’s not so much about technology. FHIR is really two important things – a community of people, and a set of agreements about information management and exchange.
The really valuable thing FHIR has is people and the culture that it helps people build. It’s a culture of sharing and openness and it’s starting to transform healthcare IT around the world.
The FHIR standard and the FHIR community don’t exist to deliver solutions to any real world problems, they exist to enable other people to do it.  Our job is to get IT out of the way. The challenge then, and the biggest challenge by far, is developing the right story, the right solutions and actually deploying this stuff.
When I set out on the FHIR journey I had three goals in mind:
  • To disrupt and force change on healthcare IT standards – that’s mostly in the bag.
  • To disrupt and force change on healthcare IT- that’s on going.
  • To disrupt and force change on health itself- that’s starting.
There are three stages to the journey that we’re on.
The first is getting the basic capabilities into international standards. These are platform standards that we can build solutions on.
But there are all sorts of solutions-  informatics, theory, international collaboration. And they can all be used differently, so…
The second stage is to take those standards and say “this is what we’re going to do with them here in this context.”
This is a set of agreements that we can run, in our smaller local communities where we have much more to agree about (as compared to what everyone in the world can agree on collectively). We need to work with how our systems work and work together as a group of people to figure out what these local guidelines or rules should be, test them, and integrate that process into a standards cycle that is sustainable.
The third phase is to actually turn those local agreements into operating software, operating market agreements – things that actually work and are available to our providers. That can transform how we do health.
Around the world FHIR is scoring goals in the first and second stages, but it’s the third stage that’s the hardest stage, by a long shot. And the challenge, for me, is that each of these stages means different people, different culture, different processes, and the handover between stages causes a lot of noise and potential disconnect. Getting continuity to try and run the process to the ground in each local community is the hard part, and it’s increasingly our focus.
I’m afraid I believe that in Australia, we’re starting at the back of the pack:
We’ve had a working standards process in the past, but we don’t currently.
We’ve had some consensus in the community in times gone past, but we don’t now (or, at least we don’t have it well enough established again).
We’ve launched this interoperability journey repeatedly for a number of years (maybe we missed a year here and there).
What we need is belief that we collectively can get it properly moving and solved.
If you look at the history of interoperability, the great interoperability technology and techniques tend to be invented primarily in four countries – USA, Russia, China, and Australia. In health, in fact, Australia has dominated the creation of interoperability technologies and techniques for decades (e.g. openEHR then FHIR).
But if you look around the world at countries that have actually taken those assets and made them work, they’re small countries. They’re the ones that can work together to drive the technology home into working solutions. Despite what some people say, it’s not actually about size. It’s about culture.
There is vastly more found here:
This whole article is worth a careful read.
I would be interested to hear how others see the perspectives offered.
Certainly when Grahame says all this is ‘very hard’ I find myself in furious agreement!
David.

AusHealthIT Poll Number 472 – Results – 28th April, 2019.

Here are the results of the poll.

Do You Expect More Success With An Approach To Health Information Interoperability And Sharing Based On Health Information Networks (US) Or A Centralised My Health Record (AUS)?


The Australian Way 3% (3)

The US Way 43% (46)

Neither 24% (26)

A Mixed Approach 30% (32)

I Have No Idea 1% (1)

Total votes: 108

What a really interesting poll again. The US approach was most approved. I would be very interested to understand what people were thinking with the other responses as to what might work!

Any insights on the poll welcome as a comment, as usual.

A more than reasonable turnout of votes for a holiday shortened week!

It must have been a fairly easy question as only 1/108 readers were not sure what the appropriate answer was.

Again, many, many thanks to all those that voted!

David.

Saturday, April 27, 2019

Weekly Overseas Health IT Links – 27th April, 2019.

Here are a few I came across last week.
Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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Royal College of Physicians recruiting for digital healthcare lead

The Royal College of Physicians (RCP) is recruiting for a senior clinical to lead the development of its digital healthcare programme. 
Hanna Crouch 12 April, 2019
The professional body is looking for someone who has experience of implementing new technologies or evaluating digital healthcare solutions and driving improvements that benefit patients.
The job adverts adds: “We are seeking a leader who can work effectively as part of a team, whilst initiating and maintaining operational and strategic relationships with external colleagues and stakeholders, including patients and carers.
“We will appoint a Clinical Director with strong communication and lobbying skills; a translator, someone who is equally comfortable with clinical informaticians and non-experts working in clinical practice.”
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IBM Watson Health cuts back Drug Discovery 'artificial intelligence' after lackluster sales

And seemingly uses machine learning to explain why it's kinda not but kinda is

By Katyanna Quach 18 Apr 2019 at 23:07
IBM Watson Health is tapering off its Drug Discovery program, which uses "AI" software to help companies develop new pharmaceuticals, blaming poor sales.
The service isn’t completely shutting down, however. IBM spokesperson Ed Barbini told The Register: “We are not discontinuing our Watson for Drug Discovery offering, and we remain committed to its continued success for our clients currently using the technology. We are focusing our resources within Watson Health to double down on the adjacent field of clinical development where we see an even greater market need for our data and AI capabilities.”
In other words, it appears the product won’t be sold to any new customers, however, organizations that want to continue using the system will still be supported. When we pressed Big Blue's spinners to clarify this, they tried to downplay the situation using these presumably Watson neural-network-generated words:
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Patent filings hint at Apple's potential move into managing healthcare records


Apple has already made notable inroads into healthcare with new health features on its Apple Watch and its continued expansion of its Health Records on iPhone feature.
But digital health leaders and analysts see the potential for Apple to become an even bigger player in consumer health, specifically with electronic health records, similar to how the company built an online music sales experience with iTunes.
Recently published patent filings support the idea that the company has ambitions to be the Mint.com of health records by aggregating all consumers’ health data in one place on their mobile devices, Dave Levin, M.D., chief medical officer of Sansoro Health and former CMIO for the Cleveland Clinic, told FierceHealthcare. 
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Most Hospitals Use EHR Data to Support Quality Improvement Efforts

An ONC data brief shows hospitals most often use EHR data to support quality improvement, monitor patient safety, and measure performance.
April 17, 2019 - Eighty-two percent of hospitals used EHR data to support quality improvement from 2015 to 2017, according to a newly-released ONC data brief.
ONC used data from AHA’s Information Technology survey to assess trends in EHR data use among non-federal acute care hospitals. According to data from AHA, 81 percent of hospitals use EHR data to monitor patient safety, while 77 percent use it to measure organization performance.
Sixty-eight percent of hospitals used EHR data to identify high risk patients, while 67 percent used data to create individual provider profiles.