by Eric Pupo, MBA, CPHIMS, FHIMSS, Deloitte and Sandy Dolabany, Deloitte
Non-Existent Mobile Device Protocols
For some newer devices, there is limited protocol support and understanding that would support the exchange of information. Also newer devices, such as fitness trackers, lack any specific standardized protocols to draw from as numerous vendors implement different types of devices and algorithms. This is of specific relevance to HIEs as the need for interoperability between newer consumer devices and larger healthcare organizations is real and growing, and HIEs will need to support a growing number of potential standards.
IHE Patient Care Device (PCD) profiles and Continua consumer-device focused specifications offer a path to potentially linking together many disparate smart devices using protocols that will standardize the information available and also allow for this information to be aggregated with other clinical and administrative data that might be available within the HIE environment. This is especially useful in hybrid or cloud HIE environments where the information from mobile devices may already be captured in a private cloud.
Medical Device Standards – The Emergence of UDI
The unavailability of specific and standardized medical device data encumbers the exchange of accurate and timely medical device information. A Universal Device Identifier (UDI) complements a health information exchange (HIE) and allows for the exchange of data on medical devices associated with encounters, administration of medications, and diagnosis of chronic conditions. If UDIs are utilized within an HIE, a number of valuable uses, such as supply chain optimization, efficient identification of patients affected by a recall, and enhanced billing capabilities for payers can be realized.
By facilitating the scanning and retention of numerous UDIs, HIEs can also help in facilitating improvements to the healthcare system that are envisioned by new value-based payment models. These improvements include fraud and regulatory compliance activities for different classes of medical devices, and the exchange of needed device information during public health emergencies or natural disasters. New HHS payment model initiatives can also be supported by UDIs, which could help hospitals make sure they are accurately charging for devices, and capture data for inventory and supply chain purposes.
Currently it is difficult for providers to track events associated with medical devices over a spectrum of care. HIEs are ready to support these identifiers as they are being standardized in clinical and administrative exchange standards to make the use of device identification data elements more ubiquitous throughout the health information exchange environment. By embracing the exchange of UDIs, HIEs will have the opportunity to support improvements to the management and delivery of healthcare.
What HIMSS is Doing
The HIMSS HIE Committee has worked on several surveys to gauge the current level of usage for the Direct and CDA standards in the HIE community. From this set of surveys, the committee will look to further examine where HIEs are in their support for mobile health devices and what standards may be needed in the future to support HIE implementation of mobile health data services.
This work is occurring in close coordination with the HIMSS Interoperability and Standards (I&S) Committee. The next steps for these committees is to evaluate current usage and issues with CDA in the HIE community, to determine HIE readiness to support a standard such as FHIR, and to provide recommendations to the HIE industry on best practices to support mobile health devices in their environment.
The HIMSS I&S Committee has also focused to increase education on FHIR in the HIE community and to health IT stakeholders, and this work will continue to evolve as implementers use FHIR and other standards. HIMSS and its members are at the forefront of the rapidly changing world of mobile health and the HIE Committee and its work is a bountiful source of real world experience and expertise in implementing and improving the U.S healthcare interoperability environment