interoperability, fhir, & blockchain: where do we go from ... · resources (fhir)...

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

Interoperability,FHIR,&Blockchain:WhereDoWeGo

FromHere?

TimKosty,RPh,MBA

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

Agenda•  Review21stCenturyCuresActandONCFramework•  WillnewtechnologiesmakeFrameworkobsolete

beforeitsimplemented?•  Apple’sPersonalHealthRecord•  Whoownsandcontrolsdataflow?•  QuestionsandAnswers

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

AdvancingInteroperabilityofPatientHealthcareData

The21stCenturyCuresAct(CuresAct)&Section4003

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

TheOfficeoftheNationalCoordinatorforHealthInformationTechnology(ONC)

•  TaskedbytheCuresActtocreateapathwayforestablishinganinteroperableexchangeofElectronicHealthInformation

•  CongresstaskedONCwithaddressingthecoreprincipleofinteroperability→buildingandmaintainingtrust

•  Section4003ofthebilldirectstheONCto“developorsupportatrustedexchangeframework,includingacommonagreementamonghealthinformationnetworksnationally”

•  StandardsandInteroperability(S&I)Frameworkworkingtobuildoutcomponentsneededtoachievetheseamlesselectronicinterchangeofhealthinformationbetweenorganizationsandinformationsystems

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

•  Usecasesandhealthinformationstandards•  Toolstosupporttheadoptionanduseofthestandards•  Processtoevaluate,test,andrefinethestandardsexchange•  Certifiedproductsthatmeetsecurityandinteroperability

standards•  PoliciesandgovernancestructuresfortheNationwideHealth

InformationNetwork•  Technicalinfrastructure(directoriesandcertificateauthority)

S&IFrameworkComponents

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

ONC’sVisionforInteroperability•  Patientcenteredcarebymeansofasystemwherehealthcare

providershavethecapabilitytoaccesspatienthealthinformationfromallavailablesourcesinaconvenient,secureandjudiciousmanner

•  Asystemthatdeliversalongitudinalpictureofapatientshealth•  Mechanismforresearcherstoharnesshealthinformationdatato

advanceresearchanddevelopment•  Patientshaveconvenientfullaccesstotheircompletepersonal

healthrecords

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

TrustedExchangeFramework:5Goals• Buildonandextendexistingworkdonebytheindustry • Provideasingle“on-ramp”tointeroperabilityforall

• Bescalabletosupporttheentirenation

• Buildacompetitivemarket,allowingalltocompeteoninformationservices

• Achievelong-termsustainability

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

TrustedExchangeFramework(TEF)•  TEFtoselectasingleRecognizedCoordinatingEntity(RCE)thathas

extensiveexperienceregardingexistinghealthinformationnetworkcapabilities

•  RCEselectionwillbecompetitiveandtransparentwithsupportfromtheONC

•  RCEwilldevelopacommonagreementbyworkingwithintheTEFframeworkthatQualifiedHealthInformationNetworks(QualifiedHINs)andtheirparticipantscanvoluntarilyadopt

•  OnceRCEdevelopstheTrustedExchangeFrameworkandCommonAgreement(TEFCA),itwillbepublishedintheFederalRegister

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

TEF:TwoParts

Part A

Principles to provide guardrails and promote trust between HIE’s

based on the existing trusted exchange frameworks

• Policies, procedures, and technical standards

Part B

• Minimum required terms and conditions to help ensure that common practices are in place and required for all participants

• Common Agreement that QHIN’s and their participants can voluntarily adopt

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

QualifiedHealthInformationNetwork•  Hospitalsystemsandotherparticipantswillbeaffiliatedwitha

QualifiedHealthInformationNetwork(QHIN)•  EachQHINwillberesponsibleforappropriatelysharingdatato

otherQHINs•  AllQHIN’swillbeconnectedtoeachothertofacilitate

interoperabilityinaNationwideHealthInformationNetwork•  ParticipantsconnectthroughthesameQHINortheycanhave

accesstootherparticipantsnotintheirQHINbymeansofQHIN-to-QHINtransfer

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

ProjectedTimeline•  EarlyJanuaryandFebruary2018:45daypubliccommentperiod

onthereleaseddraftTrustExchangeFramework

•  Middleof2018:SelectionofaRecognizedCoordinatingCommittee

•  Endof2018:FinaldraftofthecombinedTrustedExchangeFrameworkandCommonAgreement(TEFCA)

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

CurrentChallenges•  Participationisvoluntary,andthereisaneedtoappealand

incentivizeinvolvementintheTrustedExchangeFramework•  Allstakeholdersneedtoachieveafinalconsensusforthe

agreement.Verycomplexnetworkthatrequiresallparticipantstoagreetoacentraltrustedauthority

•  ROInotclearforhealthsystemsandHCP’s•  Longimplementationtime

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

Apple’sPersonalHealthRecordReview

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

ApplePersonalHealthRecord•  UsesFHIRandBlockchaintechnologies•  Patientcentricmodelwherethepatientagreeswithenduser

agreement→Offloadsliability,aspatientshavebeenwarned•  Privatesectordrivenwithoutacentraltrustedauthority•  Leveragespatients’existingskillsetwithanalreadyestablished

technology•  AllowsforthedownloadofpatienthealthrecordstoiPhones

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

FastHealthcareInteroperabilityResources(FHIR)Characteristics

•  HL7FHIRV3–latestversionwithmodularcomponentscalledResources

•  Suitableformobileapps,EHRbaseddatasharing,cloudcommunications,etc.

•  Multipleimplementationlibrariestoassistdevelopers•  Specificationisfreetouse•  Strongfocusonimplementation

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

•  Mathematicalstructureforstoringdatathatisnearlyimpossibletofake

•  Someblockchainsrequirepermissiontoaccess,whileothersareopenaccess

•  Nosingleentityownsorcontrolsapublicblockchain;distributedledgerwithnocentraltrustedauthority

•  Anetworkofcomputersmaintainsandsecuresthedatabase,whileeachparticipant(node)storesacopy

BlockchainCharacteristics

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

•  PilotprogramannouncedJanuary24,2018–12healthsystemsparticipated

•  Twomonthslater,39healthsystemsparticipatingora325%increase→anextraordinaryadoptionrate!

•  Healthsystemsdonotneedcomplexdatasharingandcybersecurityagreements

•  Nocentraltrustedauthorityrequired

Image source: ejinsights

AppleEHRPatientDataView

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

•  Whatisthenameoftheapp?MyChartfromEpicEMR,whichistiedtoPiedmontHealth(networkofphysiciansandhospitals)

•  Whatwerethestepsintheprocesstogetitsetupandlinkedtoyourrecordsatyourhealthsystem?IwenttotheappandloggedinwithanIDandpassword.Thatprocessloadedallmypriorandfutureappts,medicationhistory,fluvaccinereminder,bloodtests,futuretestsscheduled,etc.

•  Howdifficultwasittosetuponascaleof1-10(easiesttohardest)?1

•  Howlongdidtheprocesstake?Lessthan5minutes

•  Whatcategoriesofinformationareavailable?Upcomingappts,priorappts,andabilitytoscheduleapptwithanyphysicianinthePiedmontHealthnetwork,testresults,allergies,medications,messagesfromdocs,facilitylookupofotherhospitals,practicesinthePiedmontnetwork,andquestionnaires/surveys

AppleEHR–PatientExperience

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

PatientDataViewerLimitations•  CurrentlylimitedtoiPhoneusers•  Protectedhealthinformation(PHI)limitedtoparticipating

healthsystemsandEHRsystems•  Marketing-HealthsystemstryingtofindaplaceforAppleApp

insidetheirportals,andsomepatientsareconfusedaboutoptions

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

Patients Healthcare Providers

Health Systems

Insurers PBMs Lab Vendors

WhoOwnsYourHealthcareData?

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

Predictions•  TEFwilltakemuchlongertoimplementthanexpected–too

complexandnumerousstakeholders•  UnclearROIwilldelayITinvestments•  BlockchaintechnologyuseinhealthcarewillmakeTEF

obsoletebeforeitsimplemented•  Intensecompetitionforaccesstopatienthealthcare

information•  Patientswilltakecontrolovertheprocess

AmericanSocietyforAutomationinPharmacy2018MidyearConference June20–22•PalmBeach,Fla.•www.asapnet.org•#ASAPMidyear

Questions&AnswersTimKosty,RPh,MBA

PharmacyHealthcareSolutions,Inc.(PHSI)

tkosty@phsirx.com(412)635-4650