@aneeshchoprawww.navhealth.com

The Relentless Pursuit of the Health Internet ~

Call to Action on Standards

Hoover’s “Associative State” model boosts nascent air sector

Source: http://history.nasa.gov/SP-4219/Chapter1.html;

After dramatic reduction in aircraft manufacturing following WWI, then-Secretary Hoover encourages industry collaboration on engine, wing standards, commercialized on popular DC-3, Boeing 247

Commerce Convenes Private Sector on Standards

NIST’s “Smart Grid Interop Panel” collaborates in design of new standards

Source: https://www.nist.gov/el/smartgrid/charging-your-electric-car-smart-grid-three-key-standards

"Standards are absolutely essential to uniform and interoperable communication systems throughout the grid.” – John McDonald, chair of the SGIP Governing Board

Applied to the “Smart Grid” Marketplace

Relies on colleagues, not vendors, to commit to open specifications

PG&E’s CIO Leads Adoption, Use of Open APIs

Source: http://energy.gov/eere/sunshot/sunshot-initiative ; http://www.pge.com/en/myhome/addservices/sharemydata/customers/index.page http://www.pgecurrents.com/2012/08/14/pg-topic-is-dealing-with-data-that-comes-with-smart-grid/

“Chevrolet Volt…led to his developing the app...in…three months…his electric bill reduced an average 20 percent;” one of 50 registered apps with open access to customer energy data without fees or IP constraint

Net metering policy encourages solar adoption, API-enabled tools Policy Shift to Reward Clean Energy a Driver

Source: https://pge.wattplan.com/; http://energy.gov/eere/sunshot/sunshot-initiative ; http://www.pge.com/en/myhome/addservices/sharemydata/customers/index.page

Dept. of Energy 7-Day Solar Prize to “motivate local governments, communities, solar companies and electric utilities to collaborate towards improving the “going solar” experience…for all Americans;” finalist PG&E opens up customer data via

“Green Button Connect” open API standard

Payment Models (not MU) the Driver for ExchangeTo succeed under APMs, providers need assessment, clinical, claims data

Source: https://innovation.cms.gov/initiatives/Million-Hearts-CVDRRM/; https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus ; https://www.whitehouse.gov/sites/default/files/omb/memoranda/2012/m-12-08.pdf

CJR Bundle Data Services #Telemedicine

Services#Integrated EHR Data #SNF/HH

Assessments#PRO Survey (~$75/case)

#Home Monitoring (~$1k/case)

#CMS Claims Data

CPC+ HIT Vendor PledgeCare Plan: Establish a care plan that can be updated by patients, care team members

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2 Social Determinants: Systematically assess patients’ psychosocial needs and inventory resources and supports to meet those needs

3 Patient Reported Outcomes: Document and track patient reported outcomes, such as NIH’s PROMIS 10 survey

Health Information Exchange StandardsOpen APIs, secure “email” required under CEHRT/MU/MACRA

Source: https://www.healthit.gov/providers-professionals/health-information-exchange/what-hie; https://www.federalregister.gov/articles/2015/10/16/2015-25595/medicare-and-medicaid-programs-electronic-health-record-incentive-program-stage-3-and-modifications#p-1518

“The EP…provides access for patients to…retrieve their health information through an API …[patient data must be] available for the patient…to access using any application of their choice…”

Call to action on public/private standards to enable consumer appsKapor’s Health Internet Vision Coming to Life

Source: http://smarthealthit.org/an-app-platform-for-healthcare/meetings/itdothealth-i-2009/img_0523/; http://www.prnewswire.com/news-releases/emerging-consensus-to-create-a-health-internet-with-broad-consumer-engagement-63755647.html

“…a new "Health Internet" could arise through processes that parallel those in

the personal computer and Internet revolutions. He highlighted the catalytic role that government played in defining

common protocols for the Internet which enabled the Internet to be created from

open source and proprietary software. He also called out the critical role of consumer

applications in driving growth of the PC and the Internet...”

-summary of Kapor keynote at Harvard Health IT meeting (Oct ‘09)

“All-in” Embrace of Open APIs for Data ExchangeRegulations, industry response aligned on technical capability

“The 2015 Edition includes “application access” criteria…to the Common Clinical Data Set via an

application programming interface (API).”

MU3: “Access to ONC-Certified API”Certification Criteria (2015 Edition)

Source: argonautproject.org; healthIT.gov; https://www.healthit.gov/policy-researchers-implementers/health-it-legislation-and-regulations; http://www.vita.virginia.gov/Library/default.aspx?id=6442474293

“The purpose…is to rapidly develop a first-generation FHIR-based API and Core Data Services

specification…based on Internet standards and architectural patterns and styles.”

Voluntary, Industry Consensus EffortResults to Date

Consistent access to data (Common Clinical Data Set)

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2 Consistent schema in returned data (Data Access Framework)

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Open Implementation & Testing Framework (Sync for Science)

Clinical Reasoning – Quality Measures, Decision Support + CDS Hooks

Technical Base – API, Types, Smart, Documents, etc

Conformance – Profiles, Capabilities, Terminologies

Administration – Patient, Provider, Organization, Device etc

Summary Care Planning

Diagnostics

Medications

Payments

Source: Grahame Grieve

Let’s Look Under FHIR’s HoodA (modern) platform standard to achieve a true open, reliable API

FHIR’s Platform + Content Standards (Data Access Framework) + Argonaut Testing Program + “Sync” Features (Sync for Science) = Formula for Dependable, Open API

Not so Fast…Regulatory Wrinkle in Near TermVendors allowed to set terms & conditions, ship proprietary APIs

Source: https://www.federalregister.gov/articles/2015/10/16/2015-25597/2015-edition-health-information-technology-health-it-certification-criteria-2015-edition-base#p- 1112;

ONC Issues Aspirational Call for Open APIs: “By requiring that documentation and terms of use be open and transparent to the public by requiring a hyperlink to

such documentation to be published with the product on the ONC Certified Health IT Product List, we hope to encourage an open ecosystem of diverse and innovative applications that can successfully and easily interact with

different Health IT Modules’ APIs.”

Emerging Era of Connected ApplicationsCan we help navigate patients towards nearest vaccination location?

Boosting vaccinations an important priority for population health organizations, but understanding the breadth of patient choice limits capacity to recommend options; an open data collaboration between

Children’s Hospital of Boston and CDC makes information freely available for developer useSource: http://vaccine.healthmap.org/

Call to Action for all BuyersDraft language to get us closer to an open API

Require that APIs that meet MU3/CEHRT rules provide consistent access to data, returned with a consistent schema (as constrained by Argonaut IG)

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2 Require access to conformance testing in the field to prove that the provider is getting a truly open API (using “sync for science” testing tools)

3 Require the ability to offer “ad-hoc” API access to connect any patient facing app of their choice

Source: http://argonautwiki.hl7.org/index.php?title=Implementation_Guide

@aneeshchoprawww.innovativestate.com