2Q 2016ALLSCRIPTS MAGAZINE

Executive Insight: Population Health Technology

Patient-Centered Care for People with Autism Spectrum Disorder

Startup Mindset: Innovation communities at work around the world

6 Most Common Billing Process Headaches (and How Ambulatory Practices Can Find Relief)

A Beginner’s Guide to FHIR: Answers to frequently asked questions about the emerging interoperability standard

SAFETY

FIRSTAtlantic General Hospital’s closed-loop system reduces medication errors

3 Executive Insight: Population Health Technology

By Martha Thorne

Technology is aiding the transition to a new model of more integrated health care, but which capabilities will truly help providers succeed?

4 Safety First: Atlantic General Hospital’s closed-loop system reduces medication errors

Teams of clinicians use Allscripts Sunrise™ to standardize and automate several processes, reducing medication errors by 86% over three years.

7 Patient-Centered Care for People with Autism Spectrum Disorders

By Meredith Hilt

By thinking about each aspect of care from patients’ perspectives, The Autism Center at Hospital for Special Care becomes the first outpatient clinic to earn Patient-Centered Specialty Practice designation.

8 Startup Mindset: Innovation communities at work around the world

By Tina Joros

To help create healthier populations, Allscripts collaborates with innovation communities, such as the Center for Digital Innovation (Israel), Dalhousie University (Canada) and MATTER (U.S.A.).

12 6 Most Common Billing Process Headaches (and How Ambulatory Practices Can Find Relief)

By John Lauraitis

Allscripts clients are successfully tackling the most common billing headaches and refocusing their time and attention on what matters most — providing great patient care.

14 A Beginner’s Guide to FHIR: Answers to frequently asked questions about the emerging interoperability standard

By George E. Cole, Jr.

Has FHIR “kindled” your interest? Learn about this emerging interoperability standard and what it could mean for healthcare providers.

Allscripts 222 Merchandise Mart Plaza, 20th Floor Chicago, IL 60654

1.800.654.0889

www.allscripts.com

Editor-in-Chief

Tom Lynch

Senior Editor

Meredith Hilt

Operations Manager

Haley Yanello

Designer

Margaret Puckett

Continuum Magazine

Copyright ©2016 Allscripts Healthcare Solutions, Inc.

3

2Q 2016

Healthcare providers around the world are grappling with the same challenges: Patients are aging. Demand for services is increasing. Chronic disease management and related costs are escalating. At the same time, government and private payers are increasingly scrutinizing payment rates and tying them to value-based models of reimbursement.Technology is aiding the transition to a new model of more integrated care. Allscripts CareInMotion™, our population health management platform, is the adaptable framework that is helping our clients address specific population health priorities, such as predictive analytics, care coordination and patient engagement.

What aspects of population health technologies will enable a successful transition? A few significant capabilities will make the difference:

Harmonized view of the patient

Clinicians need secure, convenient access to data in disparate clinical information systems. It’s also important that technology aggregates and normalizes all clinical content into a single view, enabling providers to find relevant information quickly. Because

when it’s available at the point of care within existing workflows, actionable data is a foundation for more informed decision-making and effective care management.

Putting care plans into action

One patient usually has multiple care plans across multiple care teams. This fragmentation can obstruct providers’ ability to collaborate to improve outcomes and meet payer requirements. Health care is a team effort, and having full visibility into patient care plans can help providers build assessments, monitor results, track outcomes and address gaps in care. Forward-looking solutions enable care teams to interact with multiple care plans linked to individual patients, enabling them to add comments, assign tasks and perform other actions.

Patient-centric engagement

Patients are perhaps the most important member of the care team. To encourage the behaviors needed to improve health and wellness, providers must engage patients more directly and consistently—through ongoing communication, better education and regular interaction. Today’s

patients understand the power of becoming more involved in their care, increasing the demand for engagement options.

Full enterprise financial performance management

Analytics have the power to bring together vital clinical, claims, financial and operational data. It can help optimize financial performance through capital management, operational budgeting, strategic planning, cost accounting and decision support.

Successful providers are the ones willing to drive greater control over their ecosystem and enable improved revenue in risk-based contracts. True integration creates the alignment they need to pursue value-based arrangements, meet rising demand for services and improve overall cost and quality. Having the right technological capabilities makes it possible to better engage patients, analyze trends, connect and coordinate care across the continuum.

Population Health Technology:Which capabilities lead to truly integrated care?

EXECUTIVE INSIGHT

By Martha Thorne, Senior Vice President and General Manager, Population Health

4

CONTINUUM

SAFETY

FIRST

Atlantic General Hospital’s closed-loop system reduces medication errors

5

2Q 2016

When Atlantic General Hospital (Berlin, Maryland, U.S.A.) set out to improve medication safety, the effort was deeply rooted in clinician experiences, such as this one shared by Vice President of Patient Care Colleen Wareing:“To this day, I can remember standing in an ICU 37 years ago with a 15-year-old patient who had just delivered a baby. And I was mixing meds. I was tired, I was at the end of a 12-hour shift, and I was a very young nurse…As soon as I injected it into the IV, I knew it was wrong and wanted to take it back….It still creates a strong emotion in me 37 years later…Every nurse could tell a story like that…Fortunately the patient was okay, but it was frightening.”

She’s right; every nurse could tell a story like that. Even the most talented, compassionate, thorough caregivers need the right tools to help them deliver medication safely.

Clinicians from across Atlantic General Hospital worked together to standardize and automate several processes. In three years, the organization reduced medication errors by 86%.

Launching an initiative to reduce adverse drug events

A five-year strategic plan guides Atlantic General Hospital’s efforts to support its mission: to create a coordinated care delivery system that

will provide access to quality care, personalized service and education to improve individual and community health.

In 2010 Atlantic General Hospital launched an initiative to improve patient safety by reducing adverse drug events. According to an Institute of Medicine (IOM) 2006 report, between 380,000 and 450,000 preventable adverse drug events occur in the United States every year. The estimated additional hospitalization cost of each event is $8,750.

“We really wanted to reduce our medication error rate by 75%. We knew from the evidence-based literature that could be done,” Wareing says. “We wanted to reduce potentially longer length of stay for patients, as well as the costs, associated with adverse drug events.”

Overcoming challenges with quality improvements

A lack of standardization in administering medications created several challenges for Atlantic General Hospital. For example, the organization had a basic electronic health record (EHR) without barcoding or computerized physician order entry (CPOE). Staff conducted medication reconciliation on paper, which led to inconsistencies, and the pharmacy workflow was poorly defined and executed. Finally, Atlantic General Hospital was not using smart pump technology.

“Medications were not being administered in a timely manner. At our baseline, we found 22 of 100 medications were given late,” says Director of Pharmacy James McGinnis. “Medications were not always available on the floor…missing medications was the chief complaint from nursing.”

Atlantic General Hospital gathered representatives from various disciplines — including nursing, pharmacy and information technology — to participate in a quality improvement program based on Lean principles. The team

standardized categorization and reporting for adverse drug events, focusing on the errors that touch the patient (i.e., National Coordinating Council for Medication Error Reporting and Prevention Categories C & D).

“We went around the country trying to find a compatible vendor with a similar vision to ours, that had the tools that we need to improve our processes in the pharmacy and reduce our errors,” McGinnis says. “We selected Allscripts Sunrise because of its full Knowledge-Based Medication Administration (KBMA), electronic medication reconciliation and CPOE capabilities.”

Closed-loop medication system improves collaboration

Through Sunrise, Atlantic General Hospital implemented a closed-loop medication system, which uses smart technology to improve the entire medication administration process. First, physicians use the EHR’s clinical

0

2

4

6

8

10 9.2

2012

3.8

2013

1.3

2014

0.08

2015

Average medication safety events per month

6

CONTINUUM

decision support to make evidence-based decisions about prescriptions, then enter that information directly into the hospital’s EHR.

CPOE then links the order by provider to the pharmacist. Pharmacists can quickly review and verify prescriptions online, avoiding potential handwriting misunderstandings and transcription errors. A communication tool also helps pharmacy and nursing staff provide coordinated care.

Sunrise enables Atlantic General Hospital to start medication reconciliation upon arrival of the patient, using all available data in the EHR system. Upon decision to either admit or place in observation, the pharmacist collects medications, doses and frequency along with the patient’s preferred pharmacy. The operating room can also obtain medication information. The physician performs the final medication reconciliation upon discharge.

Increasing pharmacy’s involvement with clinical decisions

McGinnis says that the closed-loop medication initiative significantly changed the role of the pharmacist. “Prior to this process, the pharmacist’s role was primarily distributive,” he says. “With Sunrise, the pharmacist could become more clinical and actually be part of the medication reconciliation process.”

Clinicians at Atlantic General Hospital agree. “Prior to Pharmacy’s involvement in the medication reconciliation process, it was one of the weakest

links in the medication administration process," says Gregory Stamnas, M.D., FHM, Medical Director of the Hospitalist Program. “With Pharmacy’s involvement, this is now one of the strongest programs in the safe administration of medications to our patients.”

Improving medication safety with collaboration

Atlantic General Hospital has seen improvements in several areas since launching its patient safety initiative to reduce adverse drug events. “We reduced late medication administrations from 22% in 2012 to 3.6% in 2015,” McGinnis says. “Using the tools in Sunrise, nurses are able to communicate effectively through the work list to pharmacy, and pharmacy is responsive to that communication.”

According to McGinnis, compliance with KBMA has also improved, which in turn helps improve results. “KBMA enables us to review compliance at the department level and the individual level,” he says.

All of these efforts helped reduce medication errors by 86% from 2012 to 2015, exceeding the original target of 75%. That means the average monthly total of 9.2 adverse drug events in 2012 dropped to 0.08 in 2015.

“Atlantic General Hospital reduced potentially avoidable errors costs from $962,500 in 2011 to $140,000 in 2014, or a savings of about $800,000 each year,” McGinnis says. Given the program’s success, the organization plans to expand it beyond the four

walls of the hospital and take closed-loop medication administration into the community.

Atlantic General Hospital will continue to pursue projects that help improve patient safety, for better patient outcomes and to meet rising industry demands. “Now that reimbursements align with our mission to improve care for patients, it’s very exciting, but very challenging,” Wareing says. “Things like our medication delivery improvement effort are helping us succeed as a small hospital in a standalone environment.”

BY THE NUMBERS

Atlantic General Hospital Berlin, Maryland, U.S.A.

ABOUT

62-bed independent not-for-profit hospital

194 physicians

OUTCOMES

Reduced medication errors by 86% between 2012 and 2015

Saved approximately $800,000 in potentially avoidable medication error costs annually

Reduced late medication administration from 22% in 2012 to 3.6% in 2015

Atlantic General Hospital (Berlin, Maryland, U.S.A.)

7

2Q 2016

with autism spectrum disorders

Imagine someone is telling you what to do, but the words don’t make sense.

All the while, the fluorescent lights are flickering and patterns on the floor are vibrating. A deafening mix of voices competes with incessant mechanical beeping, whirring and clicking. The fabric on your chair chafes your skin like sandpaper.

You realize the people in front of you may be waiting for your response, but you’re not sure.

Sensory overload and communication are two common challenges for people with autism spectrum disorders (ASD). Hypersensitivity to ordinary sensory experiences and inability to interact socially can cause frustration and make it difficult to seek help for healthcare needs.

Hospital for Special Care (New Britain, Connecticut, U.S.A.) observed there was little coordination among services for ASD, such as health care, education, vocation and family support. It created The Autism Center at Hospital for

Special Care, an outpatient clinic that provides a variety of diagnostic, assessment and consulting services for children and adolescents with ASD.

By thinking about each aspect of care from patients’ perspectives, Hospital for Special Care became a more welcoming, effective place for patients with ASD. It used six core measures, as defined by The National Committee for Quality Assurance (NCQA), to help meet the unique needs of these patients.

For example, given the struggle many ASD patients have with communication, it was important to remove as many barriers as possible. The Hospital for Special Care arranged to have an on-demand video interpreter service available to both patients and caregivers in their language of choice.

Hospital for Special Care also acknowledged how difficult it is for children with ASD to receive services in multiple locations. For example, parents are often reluctant to take them to labs

because of the children's anxiety of unfamiliar surroundings and behavioral challenges. Now, The Autism Center has a registered nurse who serves as care coordinator for these families to improve the experience.

Collecting data and targeting specific actions through Allscripts Sunrise™ helped Hospital for Special Care improve a number of clinical processes and patient experiences. For example, it set a goal that patients would wait no longer than 10 business days between the referral and first appointment. The organization improved the number of appointments meeting that goal from 18% to 45% in a short period of time.

The NCQA recently recognized The Autism Center at Hospital for Special Care as the first outpatient clinic of its kind to earn Patient-Centered Specialty Practice designation. The recognition affirms the organization’s focus on patients with ASD, reducing barriers between them and the care they need.

By Meredith Hilt

Patient-centered care for people

8

CONTINUUM

Health care has become an exciting new frontier for high-tech entrepreneurs. Venture capitalists, angel investors and business incubators are fueling a new generation of startup founders to build the next Facebook or Uber, but for health care.

Allscripts is playing a role in this new wave of digital disruption. Recently we have partnered with healthcare innovation communities around the world to increase our involvement with up-and-coming technologies.

This approach benefits everyone involved. New ideas keep us on our toes and help us to continuously deliver

innovation for clients and their patients. Our clients benefit as we incorporate new technology that enables us to deliver better software. And innovators benefit by receiving expertise and know-how from someone who’s been there before.

Our Open philosophy enables access to new ideas born outside of our company. In that spirit, we want to share news from our collaborations with external innovators, specifically with the Center for Digital Innovation (CDi), Dalhousie University and MATTER.

Innovation communities at work around the world

Startup

By Tina Joros Director, Allscripts Developer Program

9

2Q 2016

Israel has been a hotbed of technology innovation for years. In 2009, the book “Start-Up Nation” explained Israel’s meteoric rise as a technology powerhouse and why, despite its short 60-year history, Israel has more companies listed on the NASDAQ than any other country after the United States.

The Center for Digital Innovation (CDi) is the next chapter in Israel’s healthcare technology history. Co-founded by Ziv Ofek, one of the co-founders of Allscripts dbMotion™ Solution, CDi is a business incubator and nonprofit that helps Israeli entrepreneurs bring their innovative healthcare solutions to the world’s largest market, the United States.

“There are so many great ideas here, but only 1% of them make it to market,” Ziv Ofek says. “CDi provides startups with the direction and guidance they need to get an idea ready for market while it is still relevant, get the technology ironed out and make sure it can solve real problems. With this approach, more great ideas will succeed.”

The focal point of our collaboration is the Allscripts-CDi Lab. Pioneered by CDi, the Lab is a high-quality demo environment where CDi members can test their solutions with our acute electronic health record (EHR) solution, Allscripts Sunrise™. When CDi opened its doors in August 2015, Allscripts Chief Executive Officer Paul M. Black and Senior Vice President Martha Thorne announced our founding partnership and congratulated the first CDi member companies, many of which had never seen an EHR system before.

Since the launch, many entrepreneurs from across Israel have applied to CDi just to access the Lab. Along with doctors and nurses, we are seeing mathematicians, data scientists, video game designers and security researchers in the Lab. CDi members have made great strides in building software around the clinical workflows of our EHRs, and we’ll invite select companies to participate in the Allscripts Developer Program to distribute their solutions through the Allscripts Application Store.

These efforts are well underway. In January of this year, members of CDi and our Innovations team convened in Israel to collaborate and code using Allscripts Open Application Program Interfaces (APIs). We’re also looking at ways to expand opportunities in the lab with more Allscripts solutions. As these projects mature and come to market, the real beneficiaries will be Allscripts clients, as they gain access to the best new products coming out of the “Start-Up Nation.”

Center for Digital Innovation (CDi)Be’er Sheva, Israel

Leaders gathered at the launch of Allscripts-CDi Lab in 2016 included (from left) Sharon Sasportas, Martha Thorne, Boaz Gur-Lavie, Ziv Ofek, Paul Black and Professor Rivka Carmi.

10

CONTINUUM

Dalhousie UniversityHalifax, Nova Scotia, Canada

Known for its world-class research, Dalhousie University is also very interested in providing its researchers and students with opportunities to apply their learning in real-world

environments. Dalhousie, having identified the growing importance of EHR systems within modern healthcare, set out to create a computing lab in which its health informatics students could explore the creation of new health applications, with the assistance of Allscripts.

Dalhousie and Allscripts have formed an academic alliance to benefit and advance both organizations, and ultimately improve health care. For example, in January 2016, Dalhousie University’s Master of Health

Informatics program brought together students from medical and computer science disciplines for a two-day code-a-thon to equip students with the knowledge and tools to build new applications on top of the EHR.

During the hands-on workshop, the Allscripts Innovations team educated Dalhousie members on the developer toolkits and Open APIs available to clients that wish to integrate third-party applications.

“When you look at something as complex and large-scale as health IT, it’s not one little piece of software, but a whole environment,” Dr. Rau-Chaplin says. “Partnering with companies is an opportunity to connect the academic setting to concrete examples in a number of dimensions.”

The alliance exemplifies consumer participation in health care at its best. For participants, the goal of the code-a-thon was to gain a deeper understanding of the Allscripts solutions already used throughout Canada, so that they could develop ancillary software to be used alongside them. Dalhousie understood very quickly that to make healthcare technology work, you have to make it your own.

Allscripts recognizes the benefits of our open platform, which is why we spend time outside the Allscripts walls educating others on methods to integrate third-party solutions and homegrown technologies. Still, we know we can learn a lot, which is why we will be offering internships to Dalhousie University students to work with our teams in the coming months.

MATTERChicago, Illinois, U.S.A.

Chicago’s first businesses were established at Wolf Point, where the three branches of the Chicago River converge. It’s no surprise then that innovation continues within the walls of Wolf Point’s massive landmark building, the Merchandise Mart, home to Allscripts headquarters and MATTER, Chicago’s first healthcare startup incubator.

MATTER is home to more than 100 startup companies building new products in the fields of IT, medical devices, diagnostics and biopharmaceuticals. Like CDi, MATTER seeds healthcare entrepreneurship by providing programming, networks and a physical office space for entrepreneurs to launch their companies.

It’s a vibrant, open space with ample places for members to collaborate and share resources, such as 3D printers and, coming soon, a (re-)configurable surgery and emergency department simulation environment for stress-testing MATTER members’ latest hardware and software prototypes.

As the only EHR vendor providing support for MATTER, we offer expertise in EHR technology and workflow. Over the past year Allscripts associates have held countless meetings with MATTER members, office-hour sessions and API development workshops. We’ve also participated in roundtables with representatives from the U.S. Department of Health and Human Services, the American Medical Association and local government.

Allscripts believes in harnessing the power of collective wisdom and fresh thinking. Our purpose in partnering with these three communities is to engage with bright, forward thinkers who, like us, are focused on improving healthcare delivery. Allscripts Chief Innovation Officer Stanley Crane routinely says “healthcare IT should be a team sport.” This is how we are fielding the best team in healthcare IT today.

Allscripts Director of Client Programs Robert Dickau (second from left) works

with code-a-thon participants Ying Zhan, Suyog More and Hossein Hassanzadeh.

11

2Q 2016

AUGUST 9–11, 2016LAS VEGAS, NV, USA

The Allscripts Client Experience heads to Las Vegas for three days of networking, learning and fun at the famed Mandalay Bay. Conference attendees will meet and exchange ideas with like-minded individuals and have the opportunity to attend many education sessions that will ultimately benefit their organizations.

Register today at www.allscripts.com/ace2016

The Power to Connect, Learn and Innovate

12

CONTINUUM

Managing the revenue cycle can be challenging for ambulatory practices. It can drain staff time and attention from what matters most — providing great patient care. Here’s how some Allscripts clients are tackling their most common billing headaches:

High staff turnover

“Our billing department was experiencing a lot of turnover, which affected our ability to fix things that weren’t working,” Mesa Pediatrics (Tempe, Arizona, U.S.A.) Practice Administrator Karen Daugherty says. “We couldn’t figure out why we were seeing more patients and had less revenue…it was hard to manage all of the parts.”

Revenue cycle experts helped automate and optimize the billing process, enabling Mesa Pediatrics to focus on patient care.

Improved communications and processes have helped the practice realize positive financial outcomes. Mesa Pediatrics has reduced Accounts Receivable average time by 17%, and the organization has reduced the number of claim denials and is increasing cash collections.

Collecting money from patients

Higher co-pays and deductibles have shifted more financial responsibility to patients. Varying payment rules among payers can cause billing confusion for the patients and physician practices. It also can put caregivers in the awkward position of having to ask patients for money.

Checking eligibility prior to the appointment and validating patient data at registration can help improve the collection processes.

1 2 3

6

Leaving money on the table

When Cardiovascular Consultants Medical Group (CCMG) (Los Angeles, California, U.S.A.) used in-house billing processes, it did not realize the practice was missing charges. Revenue cycle experts helped give the organization visibility into problem areas.

For example, one report shows encounters that do not have a bill date and the reasons encounters may be on hold. This useful tool helps ensure that all charges have been billed.

“Allscripts helped us find charges we didn’t even know were missing,” CCMG Practice Administrator Kelli Nicholas says. “With that information, and access to other services from Allscripts, we were able to start reducing costs while creating an incentivized collection strategy.”

At Mesa Pediatrics, Daugherty notes another example of leaving money on the table. “My people aren’t coders, so we weren’t getting full value out of some of our vaccinations and procedures,” she says.

Physicians must code vaccines — such as measles, mumps and rubella — in payer-required formats to receive the full amount of revenue. Daugherty observed, “Allscripts Revenue Cycle Management Services helps us find these gaps in our billing and coding process.”

By John Lauraitis, Regional Vice President, Small Physician Practice Field Sales

MOST COMMON BILLING PROCESS HEADACHES(and How Ambulatory Practices Can Find Relief)

13

2Q 2016

Managing multiple technology platforms

Billing processes require a sound technological foundation to function properly. The charge capture process should be integrated between the practice management system and electronic health record (EHR).

A solid technology stack offers a rules-based engine that automates billing tasks and workflows. A Software-as-a-Service (SaaS) environment can eliminate the need for IT specialists and server hardware.

Managing denials with analytics

North County Women’s Specialists (NCWS) (Escondido, California, U.S.A.) wanted to know how well the practice was performing against national benchmarks. Custom monthly reports with analytics gave the team more visibility.

NCWS Administrator Dobrila Undheim says, “I was always interested in understanding denials and it was nice to have a precise picture of why there were denials and how we are doing compared to national benchmarks.”

Keeping up with regulatory changes

As the industry shifts from fee-for-service to value-based reimbursement models, billing processes must also evolve. This trend will continue, as the U.S. government is signaling that a greater number of payments will be tied to value-based arrangements, including as many of 50% of Medicare payments by 2018.

Having a solid EHR and practice management core can help keep pace with regulatory change. Revenue cycle management experts can also make sure billing processes meet shifting regulatory requirements now and in the future.

4 5 6

14

CONTINUUM

A B E G I N N E R ’ S G U I D E T O

Answers to frequently asked questions about the emerging interoperability standard

Interest in FHIR is growing as the standard for exchanging healthcare information takes shape. What is it and what will it mean for healthcare providers? Here are some frequently asked questions and answers:

What is FHIR?

FHIR (pronounced “fire”) is a newly emerging international specification that standardizes the exchange of electronic healthcare information. First sponsored by HL7 in 2011, FHIR incorporates the best features from previously developed standards.

How is FHIR different from other interoperability standards?

The major difference between FHIR and other standards is simplicity and flexibility. Fast — the F in FHIR — expresses the intent to make this standard faster to learn, develop and implement.

Essentially, each application of the FHIR standard requires a resource approach to the information model (e.g., Medication, Procedure or Immunization), which is more granular than other standards. Systems can use those FHIR Resources to then create commonly used content groupings that we see today, such as lists and documents. FHIR is flexible and can enable faster and easier implementations.

FHIR supports four information exchange paradigms, most notably REST, the software architectural style that forms the basis for the World Wide Web. This

approach aligns FHIR development more closely to other Internet development efforts outside of health care.

FHIR’s flexibility also means it will work across the entire spectrum of health care — from an orthopedic surgeon in Urbandale, Iowa, U.S.A., to a pediatrician in the heart of London.

How do FHIR Resources compare to Clinical Document Architecture?

The HL7 Clinical Document Architecture (CDA) is an interoperable content standard to help organizations exchange clinical data. CDA takes a document approach, providing the ability to group related content about the patient into a single document format.

In contrast, FHIR presents discrete elements of information — individual lab results, demographic information, medications and more — as data representations called Resources. An excellent overview is the Summary

By George E. Cole, Jr.

15

2Q 2016

Introduction to HL7 FHIR. We can still aggregate information into larger constructs, similar to documents, using the Composition FHIR Resource.

What is the current status of FHIR?

FHIR is currently a Draft Standard for Trial Use (DSTU2). The ONC 2016 Interoperability Standards Advisory lists FHIR as a Draft Standard, with Piloted Implementation Maturity, Low Adoption (less than 20%), Free Standard, with no currently available test tool to evaluate conformance.

Essentially, we expect to see Implementation Maturity, Adoption and Test Tool development accelerate rapidly in 2016. FHIR is expected to be final in 2017.

What is the Argonaut Project’s role with FHIR?

The Argonaut Project is a group of volunteer healthcare providers, health IT companies and universities working together to test the interoperability of FHIR implementations and profiles. Think of it this way: FHIR defines what can be sent, and Argonaut defines what must be sent. One of the strengths of FHIR is that the healthcare community is defining how to use it and what works best for the community’s needs.

Argonaut phase one focused on both data and document queries in support of U.S. Realm requirements, mostly as expressed by the Common Clinical Data Set. Phase two has continued with a focus on security for cross-enterprise authentication.

What is Allscripts doing with FHIR?

Allscripts supports the ongoing work with the development of this new standard and participates in the Argonaut Project testing workgroup, HL7 Working Groups and Connectathons. We’ve completed initial development of a web service that will enable user applications to request and receive clinical data using FHIR. We expect to share more about client access and application developer access in 2016.

Because we’ve written our own Open APIs, we have extensive experience

addressing interoperability challenges across multiple systems. Having this set of robust, commercially proven APIs will make it easier for us to help our clients succeed with FHIR and interoperability more broadly.

What happens at an HL7 FHIR Connectathon?

FHIR Connectathons are hands-on collaborative coding sessions for developers that usually take place over the course of a weekend. These events have been growing in attendance over the last few years, attracting about 125 people to an event in January 2016.

Before the event, HL7 proposes functionalities that the industry may want to implement as FHIR Connectathon Tracks. For example, this year the clinical track looked at clinical decision support. On Saturday, participants work on their projects, and on Sunday they have an opportunity to demonstrate their final product to the group.

Anyone who is a member of HL7 is welcome to participate or just to observe. FHIR Connectathons draw people from across the industry, including EHR vendors, insurance companies and client application developers. FHIR architects and subject matter experts also attend.

How does FHIR relate to the API requirement for 2015 certification?

To achieve 2015 certification, ONC requires EHRs to be able to retrieve patient data using APIs. ONC did not specify FHIR as a requirement for the API certification, categorizing FHIR in the 2016 Draft Interoperability Standards Advisory as piloted with low adoption. However, ONC’s documentation reflects FHIR in its phrasing and direction, so it’s clear that ONC is generally supportive of the evolving standard.

What should healthcare providers be doing to prepare for FHIR?

Preparing for FHIR is more of a technical issue for health IT companies to incorporate and test, so there are no immediate action steps providers need to be doing. Of course, healthcare providers should already be working

toward meeting requirements aimed at improving interoperability, such as Meaningful Use Stage 3 and the 2015 Certification API requirements, which will likely be tied to FHIR in future versions.

FHIR is an exciting standard that we believe will become widely adopted. It is a logical next step along the path Allscripts started in 2007 with our own Open API, and we look forward to working with others in the industry to keep the progress happening.

ACRONYM GUIDEAPI Application Program

Interface, a set of tools and specifications for how software should interact

EHR Electronic Health Record

FHIR Fast Healthcare Interoperability Resources, an emerging interoperability standard from HL7

HL7 Health Level Seven International, a nonprofit organization that creates standards for health information exchange

ONC The Office of the National Coordinator for Health Information Technology, the U.S. federal entity that coordinates national health technology efforts and electronic health data exchange

REST Representational State Transfer, the software architectural style of the World Wide Web

222 Merchandise Mart Suite 2024 Chicago, IL 60654

This advertisement was sent by Allscripts

Well-designed solutions — those that focus on what users need and want — can help improve patient safety and clinician efficiency. Learn more about the five key components of best-practice user-centered design (UCD).

The Power to Connect. That’s the Power of Allscripts.

Improve EHR usability

Copyright © 2016 Allscripts Healthcare Solutions, Inc.

Download a free white paper at www.allscripts.com/UCD

“At its core, a good UCD process is about involving users early and often, and using proven patterns in software design…EHR vendors must be vigilant when it comes to UCD; patient safety is at stake.”—Ross Teague, Ph.D., Allscripts Senior Manager User Experience