February 17, 2016
ConCert by HIMSS: Evolving standards and the value proposition for interoperability
By Mark W. Stevens, Contributing Editor for HIT Leaders & News

Interoperability is HOT. ONC’s Interoperability Roadmap is ambitious. Organizations like CommonWell Health Alliance and the Center for Medical Interoperability, an offshoot of the San Diego-based West Health/Gary and Mary West Health Foundation are doing great niche work through facilitating industry collaboration to advance common methodologies and standards. And the most recent addition, an industry interoperability survey lead by KLAS (Source: Health Data Management, February 5). But standards are elusive. On the standards front, there’s the Argonaut Project which leverages HL7’s Fast Healthcare Interoperability Resources (F.H.I.R.), the Sequoia Project and its Carequality Interoperability Framework. While all of these programs have made significant contributions, they are currently in their early or pilot phases.

In a recent interview in Becker’s Health IT & CIO Review, “Why Interoperability Still Eludes Healthcare: Q&A with Dr. Charles Jaffe CEO of HL7,” one of the world’s foremost experts on interoperability and an originator of F.H.I.R. offered his insights on the state interoperability: “I think interoperability is the key. There are many different definitions of interoperability, though — semantic interoperability, which the technophiles like to throw around, or business interoperability, workflow, utilization, and so forth,” said Jaffe.

“The ultimate question is “interoperable for whom?” If you have a business case to share data between the lab, the electronic order entry, the billing entity, patient care providers and tax systems, it is one level of requirement. But to share it outside of your entity requires either a unified system or one-off mapping of resource to resource.” On standards, Jaffe concluded saying “I spoke at a FHIR for the U.K. in November and they were very interested in the technology as a means to solve those policy problems. FHIR doesn’t require some of the business models other software solutions do, so when you identify a need, getting to interoperability is far easier with FHIR… which has driven a level of cooperation and collaboration [between EHR vendors] that frankly we’ve never seen.”

Open for business – ConCert by HIMSS

Unlike the other programs and initiatives, though, ConCert by HIMSS, an interoperability certification program for vendors run by HIMSS in partnership with IHE, Verizon’s ICSA Labs and Stella Technology is fully operational and has already issued certifications of interoperability. ConCert is the only comprehensive, vendor-independent interoperability testing and certification program in the industry – and one that is certifying vendors currently (F.H.I.R. is conservatively still 2 years out). ConCert recently completed its pilot phase, with eleven (11) initial vendors participating in the program, and four (4) of those receiving certification.

“These companies have completed a rigorous testing program – the first certification program based on interoperability – to ensure their systems can communicate and enable data exchange in a way that ensures the right person has access to the right data at the right time,” said Joyce Sensmeier, RN-BC, MS, CPHIMS, FHIMSS, FAAN, Vice President, Informatics, HIMSS North America. “With this program, providers, consumers and patients will have access to critical information that will empower the best point-of-care decisions.”

“Interoperability certification creates clarity and direction for electronic health record (EHR) and health information exchange (HIE) vendors in the market,” said George Japak, Managing Director, ICSA Labs. “Healthcare providers that recognize the value of delivering better, more integrated care, will look for certified solutions to integrate with their IT systems.” (Source: HIMSS.org).

Interoperability testing tool

The company which created the Interoperability Testing Tool (ITT) used by the ConCert by HIMSS program is Silicon Valley-based Stella Technology. “The ITT was commissioned in late summer 2013 by the New York eHealth Collaborative (NYeC), which was at the time leading the EHR|HIE Interoperability Workgroup (IWG), an industry alliance of 19 States and over 40 EHR and HIE vendors. IWG had developed a series of specifications, based on existing standards and profiles from Integrating the Healthcare Enterprise (IHE) and Direct, with the vision to enable end-to-end, “plug-and-play” interoperability.

“In November 2014,” Kizaraly continued, “IWG entered into a strategic partnership with HIMSS and IHE USA to take the program to the next level, and at HIMSS15, ConCert by HIMSS was launched! Four of the original 11 participants (Caradigm, iPatientCare, MEDfx and Qvera) have successfully completed the certification, and were honored on January 27 during the 2016 IHE North American Connectathon Awards at the HIMSS Innovation Center in Cleveland, OH (more are expected to complete it by HIMSS16 and will be announced then). Looking ahead, we expect the program to evolve into an established brand for a variety of certification initiatives in our industry.”

Concluding, Kizaraly added, “As for Stella’s background in interoperability, our team has been involved in clinical data integration since 1998, and has designed, developed and operationalized over 40 statewide, community and private HIEs. In 2015, we were honored to support NYeC and the state’s leading Regional Health Information Organizations (RHIO) on their historic journey to build a connected network across the entire state, known as the Statewide Health Information Network of New York (SHIN-NY) project, which went live in July and is one of the largest healthcare IT interconnectivity projects in the country.”

Certification – and certified!

The interoperability standards that serve as the framework for ConCert by HIMSS, including Integrating the Healthcare Enterprise (IHE) and Direct, have been recognized by the U.S. Department of Health and Human Services, Office of the National Coordinator for Health IT (“ONC”). But why when a vendor pays HIMSS to have their product(s) be certified as “interoperable”, what does that really mean? To answer that question, we spoke with Chief Commercial Officer, Matt Asiaf, a member of the leadership team of one of those vendors which received certification, MEDfx.

Stevens: Congratulations on receiving certification from ConCert by HIMSS! Certification wasn’t free – or easy, so what value did MEDfx see in certification to justify the investment, and how do you feel it will differentiate Medfx in the marketplace?

Asiaf: Thank you. We are very excited to receive the ConCert by HIMSS certification for our Ambulatory EHR. The ConCert investment was strategic to MEDfx in that we are an Ambulatory EHR-PM vendor, as well as an HIE vendor focused on interoperability. These assets are all built on the same framework, configuring them together made passing certification an obvious next step. Unlike other certifications, ConCert interoperability requirements are highly constrained specifications. One key thing that blocks interoperability in the industry is the lack of constraints and automated testing, thereby resulting in variability based upon a vendor’s interpretation. With the ConCert certification, any organization investing in MEDfx has confidence they’ve invested in an interoperable “plug-and-play” EHR solution. This lowers costs to practices, with the added benefit of enabling intuitive clinical workflows to enhance the user experience. This is accomplished with interoperability and data. The “walled garden” should be built around patients and their care.

Stevens: Who are MEDfx’s customers? Do you do work outside of the United States? What is the difference in perspective overseas versus our country in regards to interoperability?

Asiaf: MEDfx services two core markets, enterprises and practices. Our enterprise solutions are used by hospitals, health systems, health exchanges, healthcare organizations and government agencies in healthcare for services such as data integration and normalization to support analytics initiatives and health information exchange to support sharing data and enhanced clinical workflows across EHR platforms. Our practice solutions include our ConCert certified ambulatory EHR-PM, and are used by primary care and multi-specialty provider groups.

We are currently involved in a number of initiatives in Europe, the Middle East South America for nationwide projects. The incentives of what drives HIT investments can vary greatly in the U.S. as compared to internationally. There are pressures on individual organizations to achieve financial sustainability and growth in the U.S. market. Internationally, Governments often carry more responsibility for establishing a healthcare infrastructure to its support citizens, which includes investments in healthcare technology. Therefore, internationally, interoperable ecosystems are largely driven from the top down, whereas in the U.S. we see approaches from both ends resulting in a network of networks.

Stevens: What are your thoughts about other standards initiatives, such as F.H.I.R and the Sequoia Project? How about ONC’s Interoperability Roadmap? Are its goals and timeframes realistic?

Asiaf: MEDfx applauds the standards initiatives. Our solutions support nearly all standards, including X.12, HL72.x, HL73.x, Direct, IHE, eHealth Exchange and FHIR. Our open platform has been engineered to support bi-directional exchange leveraging any standard that a connecting EHR vendor has invested in.

It’s our vision to provide last mile EHR integration enhancing the care delivery process at the point of care by providing the right data at the right time. The ConCert certification is in alignment with our vision because it provides a certification process leveraging existing standards for an EHR to be interoperable today – and tomorrow. This creates a common currency of exchange to ensure “plug-and-play” EHR interoperability which reduces costs.

Meaningful interoperability requires being able to deliver data and clinical insights developed by 3rd party analytics platforms directly into the workflow of providers in their EHR systems. Having the ConCert certification will enable enhanced workflows across multi-vendor EHR communities.

Stevens: How would MEDfx define the value proposition of interoperability, and what do you see in the future for interoperability?

Asiaf: Informed care. We see the value proposition as enhancing clinical workflow and care coordination for care teams on multi-vendor EHR platforms who are managing the same patients. Providers going “at-risk” for patient care are being asked to do more with less. Hospitals, ACO’s, HIEs are all investing in analytics to help derive best practice guidelines on populations of patients. The value of interoperability is to support delivery of data and the clinical insights derived from data analytics, at the point of care, within the context of provider clinical workflows, so that providers and care teams are empowered to deliver the most cost-effective best practices for patients. MEDfx can layer on top of existing HIE’s and EHRs to facilitate these types of workflows, as well as provide the ambulatory EHR that leveraging data and clinical insights to enhance workflow and overall quality of care. This is our focus at MEDfx today.

The future of interoperability is patient-centric. Engaging patients as more active participants in their own information related to their care presents the opportunity for the industry to redefine interoperability. As we move beyond technical barriers and focus on innovation, we’ll see rapid development of targeted applications that will make shared health information a standard of care.

Interoperability is HARD. Standards – and technology – are evolving. So is healthcare, and the ways in which it is delivered, regulated and consumed. It will be the savvy and innovation-minded entrepreneurs, physicians, payors and consumers who invest their thinking and resources in the future who are the ones which will benefit the most.

Editor’s note: While you’re at HIMSS’16 in Las Vegas this year, don’t forget to stop by the Interoperability Showcase, and check out the ConCert Roundtable panel discussion on Wednesday, March 3rd from Noon – 12:30PM, featuring moderator Vinny Sakore of Verizon; Michelle Knighton of ICSA Labs; Salim Kizaraly of Stella Technology; Scott Stuewe of Cerner and Matt Asiaf of MEDfx.