Presentation 5: Equipping Your Organization for
Success: What to Expect when Purchasing an Interoperable
System
John T Donnelly President, IntePro Solutions, Inc. IHE Board, PCC Domain; IHE USA rep to CAsC Implementation Task Force, NJ HIMSS Board
• Interoperable Systems Explored • The RFI/RFP Process Considerations • Sales / Contracting Implications • Operationalizing the Selected Solution
Agenda
• Understanding the key components of interoperable systems across different kinds of technologies
• Value of selecting solutions that have achieved milestones through conformance testing and certification programs
• Identify tips that will ensure the organizational success during the acquisition, implementation, and maintenance phases
Learning Objectives
Interoperable Systems
Information Systems in Healthcare
Pharmacy
Pathology
Radiation Oncology
Radiology/PACS
Cardiology
Patient Care Devices
Patient Care Documentation
Eye Care
Quality Research & Public
Health
Laboratory
(Healthcare) IT Infrastructure
Emergency Department
Electronic Health Record System
Billing
Physical/Occupational Therapy
Interoperable Systems Legacy
• Conventional HIT Software Products • Pt Reg, EMR’s, RIS, LIS, EDIS, PharmIS, PHIS, etc • PACS/VNA, Interface Engines, HIE Services
• Medical Devices • Pt Monitoring, Pumps, etc
• Diagnostic & Treatment Devices • Imaging, Lab, Anesthesia
• Implantable Devices • Pacemaker, Defibrillator
Interoperable Systems Works-in-Progress
• Home Medical Devices • Pt Monitoring, Weight Scale, …
• “Smart phone” Apps • Pt wellness, Home Care Regimens, …
• “Smart” Meds • Bio-feedback, Treatment Enablers, …
• Precision Medicine Systems • Bio-markers, Personalized Care Protocols, …
“…the body as the data source”
Interoperable Systems IHE Interoperability Guidance
System A System B IHE Domain(s)
HIT SW HIT SW All
Med Device Med Device PCD
Med & Implantable Device HIT SW ITI, PCD
Imaging Equip Imaging Equip RAD, CARD
Imaging Equip HIT SW RAD, CARD
Lab Equip Lab Equip LAB/AP
Lab Equip HIT SW LAB/AP
HIT SW Pharm Disp Equip PHARM
Interoperable Systems IHE Interoperability Guidance (projections)
System A System B IHE Domain(s)
Home Care Device Home Care Hub ITI, PCD
Home Care Device/Hub HIT SW PCD
Smart Phone App HIT SW ITI, PCC, RAD, QRPH, more tbd
“Smart” Meds Smart Phone App ITI, PCC, PHARM, RAD, CARD
Precision Med Syst HIT SW ITI, PCC, LAB/AP
The RFI / RFP Process Considerations
Transport Standards
• Address the format of messages that are exchanged
Content Standards
• Represent health concepts in an encoded, structured way
Vocabulary Standards
• Define the structure and content organization of the electronic message or document
Security Standards
• Define safeguards that protect the privacy and security of health information
Standards Categories
Informing RFI/RFP Content for Interoperability Requirements • Inherently Involving Multiple Vendors Products • Classify as Transport, Content, Vocabulary,
Security/Privacy Related • Review High-level HIT Standards Documentation /
Diagrams for Potential Fit IHE Profile Summaries
A Pragmatic Info Exchange Transport Framework
Quality, Research & Public Health Domain
Form Filler
Form Manager
Form Receiver
Content Creator
Information Source
Content Consumer
Information Recipient
Share Content (CDA)
Retrieve Form
[ITI-34]
VRDRFeed [QRPH-38] BFDRFeed [QRPH-39]
(Message)
Vital Records Form
VRDRFeed [QRPH-38] (VRDR Message)
Share Content (CDA)
Form Receiver
CDA Exporter
Submit Form [ITI-35]
Form Receiver Message Exporter
QRPH: Vital Records Reporting Profiles Basic Process Flow in VRDR and BFDR
Value Proposition • Establish interoperable electronic exchange of VR data
between EHR and VR Systems • More timely data release • Higher quality data for demographic and epidemiologic
surveillance and research • Less costly electronic vital registration systems • Greater integration with other stakeholder electronic systems • Greater standardization of electronic Vital Records data collection
and exchange*
• Support from HL7 (messaging and document standards) and IHE (content profiles) including some international interest
* Source: HL7 EHR-S Vital Records Functional Profile, Release 1 - US Realm Chapter 1: Overview
Leverage IHE Concepts / Experience in the RFI/RFP
• Define Requirements in Terms of Functional “Actors” and “Transactions”
• Determine the Appropriate HIT Transport to be Used • Review IHE Product Registry to Inform the Target List
of Vendors [ http://www.ihe.net/IHE_Product_Registry/ ]
Aligning Interoperability Req to Operational Value
• Transition Conversation from “IT” to “Clinical / Admin Workflow”
• Engage Key Stakeholders and “Champions of Change”
• Understand Current Pain Points and Challenges • Understand Organizational Objectives and
Innovation Targets • Apply HIMSS STEPS™ Value Model
The HIMSS STEPS™ Value Model shows
Ways Interoperability Can Improve The Value of Health IT Interoperability can impact each of the STEPS™ !
- Satisfaction (e.g., Consistent and automatic flow of data between clinical contexts and users) - Treatment/clinical (e.g., Reduce errors and duplicate and wasteful treatment; Doing the Right things right! - Electronic Secure Data (e.g., Consistent application application of well-established security protocols leverages proven, testable eCommerce solutions.) - Patient Engagement and Population Management (e.g., Like travel and banking, it becomes far easier for patients and families to locate complete medical and health data at a finite number of portals; Enables consistent public health data analysis. - Savings ( e.g., Standards-based interoperability lowers the cost for all parties, reduces the learning curve for users, improves patient safety and the costs of errors.
Sales / Contracting Implications
Key Contracting Points for Interoperability Services
IT • Multi-vendor Sales and Technical Partners • Robust Test Environments – Dev and Pre-Prod • Leverage Industry-sponsored Programs for
Conformity Assurance Testing and Certification • Include Conformity to Standard Security Protocols
via Actual Connectivity Tests • Extended Timeframe for Production Onboarding
Clinical / Admin
• Ensure Acceptance Includes End-to-End Operational Workflow Validation
• Validate Deliverables via User-level Conversations with Existing Customers
Conformance Testing and Certification
ONC CEHRT Program ATLs
Drummond Group
ICSA Info Guard National Tech
Systems (NTS) SLI Global
ACBs Drummond
Group ICSA Info Guard
ATLs Kereval ICSA (2016)
ACBs Determined by
Regional Deployment Committee
ATLs ICSA
ACBs ICSA
Sample of ISO Accredited Programs
Commenced 2015 In-Progress for 2016
Impact on Sales/Contracting Schedule
• Required Business Associate Agreements and other Legal Documents
• Multi-product/vendor Testing Scheduling Pilot implementation phases typical
• Detailed SLA and Business Continuity Commitments
Remember…this is typically the beginning of a long-term partnership
Remember…you have the most leverage BEFORE you sign the contract
Operationalizing the Selected Solution
Nuances of Interoperable Systems in Production
• The Interoperability Paradigm is a Healthcare Industry “Works-in-Progress”
• IT Processes for HIT Maintenance More Complicated and Challenging to Schedule
• Continue to Leverage Industry CA/Cert Program Deliverables ISO - non-conformity complaint management procedure and
industry surveillance Standards continue to evolve, e.g. HL7 FHIR
Nuances of Interoperable Systems in Production
• Interoperability and HIT Innovation are “Joined at the Hip”
• Clinician Community Evolving to be Better “Requestors” of HIT and External Resources
• Patient Community Evolving to be Better Participants in HIT Ecosystem
… basically, you’ve jumped on a moving train who’s tracks are just being laid ahead of it !!
Questions?
• Understanding the key components of interoperable systems across different kinds of technologies
Key Take-aways
• Value of selecting solutions that have achieved milestones through conformance testing and certification programs Leveraging external programs improves onboarding efficiency Engage with standards entities to establish testing/cert
priorities
• Identify tips that will ensure the organizational success during the acquisition, implementation, and maintenance phases
Key Take-aways
KPI Pre-requisite = Associate acquired HIT solution to clinical/ administrative workflows
Develop value metrics (per STEPS) early in project lifecycle Establish ongoing “conformance” process for installed HIT
products
John T Donnelly, MBA, MSc, CPHIMS President, IntePro Solutions Inc, and Board Member, IHE International and NJ HIMSS
[email protected], 908-693-7162 (m)
https://www.linkedin.com/in/john-donnelly-897681
Thank You!