How Data is Failing Healthcare Today & When Data Can Become Actually Useful

The purpose of this post is to help you understand the status of current available data specifically in medicine and how to track where it’s heading. I was inspired to write this post based on feedback from one of my favorite health plan CIO’s who agreed to the sentiment that failure of tech in healthcare stems from when a team “doesn’t have perspective, comprehension, or experience for the market or its changes.”

This post is for the person who basically understands how electronic medical records work and who knows that there is a problem today in movement of clinical data between settings (hospital, between two hospitals, clinic) and computer systems to optimally treat patients. You know some evolution is happening, but you’re confused about its status and how to track it. We focus at Medigram on empowering the physician within a team context and we believe that doing so will have the biggest impact on improving quality and reducing cost. We explain exactly where clinical data flow is today and how to track its progress below though first, briefly we describe what this post is not about.

1) This post is not about consumer generated data.

2) This post is not about financial data found in claims which does not include any clinical data.

3) This post is not about desktop-oriented interoperability efforts. There are many seemingly worthwhile interoperability efforts underway that for a variety of reasons, primarily only work well on a good connection in a desktop context. Because physicians are on the go, we do not focus on this context.

4) This post does not describe how to do EMR integration today. Here is an explanation of that. https://qr.ae/TUNNsM. The current way is difficult, labor intense, custom, and not scalable but possible when necessary.

If you want to know what’s happening in healthcare data for medicine, you need to track the standard, FHIR (Fast Health Interoperability Resources). It’s similar to if you really need to understand computing for example, how you would have to understand the TCP/IP protocol, the Transmission Control Protocol/Internet Protocol, which is a suite of communication protocols used to connect network devices on the internet. In plain terms, TCP/IP is what allows data to move. Remember, data is oxygen to apps, they don’t open without them. When I described FHIR to our VP of Operations, she said. “that sounds like the TCP/IP for healthcare,” and I said, BINGO you’re right. The problem is that FHIR is not fully built out and that’s why it’s confusing. In order to make a difference in cost and quality in healthcare, you have to be able to help Grandma in her 80’s. She will commonly have co-morbid conditions (two or more such as heart disease AND diabetes).

When comparing medical use cases to consumer ones, we like to compare airplanes. For example, fighter jets are on a dangerous, time sensitive mission and Boeing 747 passenger planes have a lot more space and time. To discern using FHIR for example, on iOS for medicine vs. CONSUMERS, you need to really dig down into what kind of data you need, how often you need it, and whether you need to write it back. Some EHRs don’t capture all of the data you might need in a medical context. Some EHRs have bad data, where they don’t use standard codes like SNOMED or ICD-10. And some EHR’s may not support bi-directional data exchange. Apple, for example is doing a good job on and is very motivated by the CONSUMER use case though what we care about at Medigram is enabling truly reliable physician communication for faster, better medicine. Apple is bringing some basic FHIR resources into their app. Patients as consumers are able to see things like allergies, medications, conditions, and immunizations, as well as the sort of things they would check an EHR patient portal for, such as lab results.

25 year old Cassie checks her allergy meds even though Cassie does not require much in the way of medical resources.

By contrast, moving the needle on medicine means better treatment of Grandma. Helping Grandma requires having flow of data related to concepts that are relevant to specialties and genetics and things like that are yet to be fully built out in FHIR. What needs to happen is that the entire FHIR community and clinicians need to work together on one data element at a time, and agree on a model, or how to represent that piece of data. The only mechanism that can push progress on this are provisions from the CURES Act which are described below. You have to have that to really have interoperability across organizations for complex patients with co-morbidities in order to really help health systems improve care.

FHIR is not tee’d up to help doctors treat Grandma yet.

Some EMR’s are providing API’s and a sandbox environment. FHIR [Fast Healthcare Interoperability Resources] is technically two things:

1) There is the FHIR standard which enables you to package discrete bundles of data.

2) Then there is a thing called the FHIR transport standard which enables one application to be able to connect in a physical way with the data repository underneath it, like the EHR.

Healthcare going back decades has been to silo information and care. Treatment has tended to focus on independent specialists treating separate aspects of the patient condition without fully addressing how they impact one another. This makes as much sense as changing the oil on a car with four flat tires. To fully bust these silos, we need interoperability. The Medigram team has built the only system designed to really work on mobile for physicians to collaborate in the context of the conditions in which they practice. Data doesn’t matter if it doesn’t get reliably to the doctor in a mobile context.

How to track FHIR?

The Draft US Core Data for Interoperability (USCDI) and its proposed expansion process aim to achieve the goals set forth in the Cures Act by specifying a common set of data classes that are required for interoperable exchange (first proposed classes below). Rule making for the act is : “Trusted Exchange Framework” USCDI is part of that and scheduled to be finalized by the end of 2018. I would watch that to pace the implementation of clinical elements into practice of FHIR exchange. (When data will become actually available and useful).

Image credit: HealthIT.Gov

The full, original post first appeared here on Medium https://medium.com/@SherriDouville/how-data-is-failing-healthcare-today-when-data-become-actually-useful-e8e91325e431

By: Sherri Douville, CEO at Medigram

Sherri Douville is CEO and board member for Medigram, the modern, mobile communication platform and system for physicians. At Medigram, Sherri leads a world-class team of technology, healthcare, physician, and business executives in Medigram’s mission to eradicate the leading cause of preventable death, a delay in information. Sherri has 15 years of healthcare experience in product development, sales and marketing including with Johnson & Johnson, and as a health care product development and business consultant. She has a BioPhysics degree and has completed three certificates in electrical engineering and computer science through MIT. Ms. Douville has held a variety of industry and other leadership positions. She serves on the board of the NorCal HIMSS (Health Information Management and Systems Society) as membership committee chair. Sherri has previously been both co-chair of the NorCal HIMSS Annual Innovation conference and a member of the board nominating committee. Sherri also advises Health IT, Medical Informatics, and genetics startup companies; Sherri and her husband, Dr. Art Douville have volunteered together with a variety of NonProfits including as a member of the Board of Fellows for Santa Clara University.