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I think the most useful value-add that an HIE can add is an API that is based on FHIR. This is true of an XDS based HIE, Regional Exchange (XCA), Vendor based EHR, nationwide Exchange, and Direct HISP. It is something I expected to be more included in the WISHIN Future is bright conference. At an HIE level: Initially I would focus on enabling Apps to query for and read the data available in the HIE.  Later adding capability to publish new content. Initially I would focus on Document sized objects,  Later moving to more element level. Likely move to publishing Documents before element level access For targeted Apps, that is the most highly vetted and trusted, they will be Reading and Writing at the Organization level.  Documents There has been much focus lately on the publication side of Document Sharing. Great advancements in CDA content formatting. This work done largely by a set of people that work within IHE Patient Care Coordination (PCC) and the HL7 StructuredDoc wor...

The last item on the WISHIN future list is moving to "Shared Responsibility for Managing Care" from "Providers & Payers working Separately" . This seems to be an indication that is mentioned elsewhere, where Payers are being added to the WISHIN network. It is mentioned Payer access with WISHIN will become a reality Q1-2018 I wrote a short note about this in the Single Connection Hub article. In that article I emphasized that the technology is enabled for many purposes, including "Payment" purposeOfUse.  So the technology is not going to get in the way.  Managing Care is a team sport I think the point of this item is that getting Payers more actively aware of what is happening with the Patients they cover will help improve the Care outcome. This is controversial, and indeed most Privacy theories use just this scenario as a forewarning of bad things. These stories say that when the Insurance company gets too much knowledge of the Patient they will inc...

The next item on the HIE Future is Bright list is movement from "Multiple Point-to-Point Connections" to "Single Connection to Hub". This change is purely administrative, but is still significant.  Again, I will state that I was not at the WISHIN meeting , so I don't know what they said about this. I will guess, but will keep my guesses here limited. I welcome comments to fill in details on what you think this transition means. I suspect that this is more a statement about what the WISHIN organization will do to help the remaining organizations get connected. The existing organizations already have the connections, and are likely not going to gain anything by reducing 3 interfaces to 1 interface. A healthcare provider organization that has not yet connected would find one interface vs 3 interfaces to be a significant reduction in work. WISHIN is three networks I picked on the number three because it is the number of big services, but there are many services. Th...

At the WISHIN conference this discussion would have interested me most. I might then have become distracted. By the title, and given my background, I would have thought that this was a mechanism to inform the Patient of when their data was used. A really important Privacy Principle . However I think that it is more a growth of a very interesting use-case that drove the very early HIE within Wisconsin, well before the push in the last decade. Wisconsin, as I understand, had a network among the large hospital systems in the South-West (Milwaukee, Racine, Kenosha). This was Pre-ObamaCare. This was Pre-HITSP. I think this was back in the 90s. The network was created to help detect malicious patients that would go to various Emergency Room sites seeking dispensing of narcotic drugs. The network would be used in the Emergency Room to detect these patterns, and stop them. Two benefits: A bit of paternalism effort to cut down on drug use, but the main benefit is that any drugs dispensed would...

The whole concept of   Health Information Exchanges , that I have been involved with, is there to improve Health outcomes for the Patient. So I often get frustrated when someone says that the HIE needs to become Patient Centered. I am a Patient in Wisconsin, and I feel the impact of WISHIN . There is no other purpose of an HIE besides the Patient. I have to take a few breaths and remind myself that better outcomes for the Patient is fantastic, but that the Patient doesn't 'feel' like they have any say or involvement. It is this that needs to improve. In Wisconsin we do have Consent, specifically there is a state wide system for a Patient to choose to NOT allow their data to be shared over the exchange . This does not give them much other than ON vs OFF. But it is more than some.  So, this is usually first step in moving from a Provider-Centered to a Patient-Centered model. This level are not fantastic, but it is far better than what we had a handful of years ago when ther...

I think it is important to celebrate what we have today in Health Information Exchanges . They are not fantastic yet, but they are far better than what we had a handful of years ago.  However there is a bright future for the Health Information Exchange too . I want to expand upon the future transition from Manual to Automated, as a trend that is already underway. Manual HIE Today we have Health Information Exchanges that enable Providers to send Directed Secure E-Mail messages to other Providers. This s a conscious thought, usually when referring a patient, or when a patient asks for this to be done. This is basic PUSH capability. The word basic should not be viewed as easy or trivial. There is a huge progress that gets us to the point of being able to say that this capability exists and is mostly ubiquitous.  We should celebrate getting to this point. But we should not stop here. The Query model of Health Information Exchange also enables a Provider to publish a document th...

The Wisconsin HIE (WISHIN) held a summit last week . I signed up, but was unable to make it due to schedule conflicts. Their slide decks are now available and I am very sad I missed it.  The following diagram clearly shows Wisconsin leadership This is such an exciting perspective of what the Wisconsin HIE delivers today, and where they are targeting for future support. The other slide decks further elaborate on this plan. It is driven by delivering Value, not just Volume.  They had a segment that focused on Care Coordination as a driver of these changes. They also have a comparison of nationwide HIEs, that is hard to disagree with the slide deck as there is so little detail present. There does seem to be a decidedly Wisconsin bent to the comparison. Focused on CareEverywhere (Epic solution), and on viewing WISHIN themselves as a solution. This is all expected, but not very helpful for use of the evaluation elsewhere. I also found interesting the statistics slides. I don't h...

I have been in a few discussions lately where the question came up on how to add additional information to an ATNA Audit Message (aka FHIR AuditEvent). This additional information is not the kind of information that needs to go into an 'extension', as the Audit Message schema has support for what needs to be recorded. But there is a need to setup some things. Here are the use-cases In a service oriented transaction there is a 'transaction identifier' that is specific to that transaction. When all audit events are recorded with their transaction identifier, then one can see all the audit events caused by one transaction. This transaction identifier might be in  SOAP header, or might be in an HTTP header, or might be elsewhere. For the purpose of this article it doesn't matter were it comes from, but rather that many different audit logging events can record the transaction identifier so that later the many different audit log entries can be correlated. In a layered s...

I went to a blockchain conference yesterday. All the experts were clear that this early days. Caution, but excitement. They were all full of encouragement to try stuff out. All recognized that there is much misinformation and hype. All recognized anyone using blockchain is taking a big risk. None would state any prediction of the future. They also all recognized that those that have succeeded have reaped great rewards. They are all fully committed and excited... No surprise, I have said this too: What are THEY doing? The experts that presented are focused on the financial flows. Not just money, like bitcoin. They are working on other financial flows including bank-to-bank money transfers, insurance payments,  payments based on contract terms, etc.  When pressed it was because these things can be made fully virtual, leverage the fact money is a concept in blockchain, and the biggest problem these flows have is the double-spend problem. The double-spend problem is well addressed...