by Eric Pupo, MBA, CPHIMS, FHIMSS, Deloitte and Sandy Dolabany, Deloitte
There is amazing potential in making health data open and machine-readable, with increasing progress in standing up new application programming interfaces (APIs) that enable organizations to retrieve health data from any device on demand. This type of trend is especially true in the area of mobile health, which has seen tremendous advances in making more unique data sets available to patients, providers, payers and other health data consumers. Recent advances in mobile health have empowered consumers to control their health and provided more diagnostic tools that can allow for use of healthcare data in multiple settings. But to support these mobile health advances, HIEs and other organizations that are involved with the transfer of health information must adapt to the evolving climate of data on demand for any device. Without this adaptation, HIEs and the mobile health market run the risk of being out of sync with the demands of patients, data consumers, and vendors.
As this new mobile health trend evolves, it will become increasingly important for Health Information Exchanges (HIEs) to support a certain level of on-demand access to health information. There are several issues in doing so, however. This blog post will explore what those issues are, work in the industry that is ongoing to tackle these issues, and what HIMSS and its HIE membership is doing to embrace the role of HIEs in mobile health interoperability. The emergence of these mobile health data trends has led to an increased awareness of the infrastructure needs for consumers, and how these needs will translate into increased requirements on HIEs and their services.
Inadequacy of Current HIE Protocols
The current protocols used to exchange information between healthcare organizations were not designed with the specific requirement of supporting mobile. Similar to how HTML evolved in the late 1990’s to begin to support smaller screens, slower bandwidth, and limitations in overall data usage, mobile health will also require HIEs to adapt to newer technologies and support additional standards. The urgency of this need to revise existing protocols has been compounded by the explosion of healthcare data driven by EHR implementation and implementation of various aspects of health reform.
One approach being used is to take existing standards used by HIEs and adapt them to better support mobile devices. Newer protocols such as the Integrating the Health Enterprise (IHE) Mobile access to Health Documents (MHD) protocol, soon to be in trial implementation, focus on mobile support. These adapted standards offer, or will soon offer, the ability to use existing protocols for health information that are adapted to use current web technologies commonly used for other mobile applications, such as Facebook and Twitter.
For example, Facebook uses the OAuth standard, which is a relatively simple web standard for authorizing a limited link between one server and another without exposing a consumer’s credentials to an application they don’t know or requiring that the consumer enter those credentials; for example a consumer can authorize limited access to the consumer’s patient records on an HIE for their provider without a further sign in by going through an authorized intermediary sign in like Facebook or Google. It is a similar process to a valet key where you give the valet the ability to drive your car only a short distance and without access to secure storage like your trunk. OAuth, by working seamlessly across the Internet, enables cloud-based and patient-centered EHR architectures that will drive decision support for clinicians, informed consent for patients and rapid innovation for institutions, as health records portability becomes the norm.
The healthcare industry is also looking to develop enhanced protocols for use by HIEs that offer services such as patient matching and patient demographic queries. As an example, new profiles such as IHE RESTful Patient Identifier Cross-Referencing (PIX) profile are taking existing standards used by HIEs to query an Enterprise Master Patient Index (EMPI) and adapting them to support patient identification by sending and receiving patient identification data elements from mobile devices and health sensors. These queries will be used to send out broader queries across a wider variety of organizations, including Accountable Care Organizations (ACOs) and multi-organization HIEs, to identify richer sets of demographic data.
This effort to modernize HIE protocols for mobile health is critical because without this rapid modernization of standards, the industry risks creating standards that are not optimized to take advantage of the rich market of personal health tools and services becoming available.
Newer Content Formats
Many HIEs have been designed to support content formats that are aligned to Meaningful Use Stage 1 and Stage 2, such as the Clinical Document Architecture (CDA) and messaging protocols to support laboratory and immunization information exchanges, such as those established by Health Level 7 Version 2.x. This is now evolving though as HIEs are asked to serve as data intermediaries in routing and storing information received from patient wearable devices, mobile phones, and other sources of potential healthcare data spread out across the United States and globally. These technologies have necessitated a fresh look at new standards for content formatting that recognize the tremendous complexities of healthcare but also provide more opportunity to easily implement data sharing with smaller, more discrete data sets.
By reducing the total infrastructure required to support different types of content, mobile health will require flexibility and adaptability by HIEs, which has led to HIEs looking at the FHIR standard. While current standards exist to support mobile device interoperability in other industries, they are slowly but surely evolving in the healthcare industry.