This discussion continues on from the last episode of Chief Among Friends with Orion Health Vice President of Public Sector Solutions, Chad Peterson, on the 21st Century Cures Act and the related rule making, and the potential role to be played by HIEs. The 21st Century Cures Act is the latest in several efforts by CMS and ONC to advance the development and use of Health Information Technology for two important purposes – patient access to their data and interoperability. 

In the next episode of his podcast series, Chris talks to Orion Health Vice President of Clinical Portal, Chris Lucas, about how technology companies approach meeting the 21st Century Cures Act requirements, considering their solutions are likely to be used internationally with the requirement of meeting different mandates in different countries. The following is a summary of the full conversation.  

Providing interoperability globally for 20+ years

Orion Health has a wealth of experience in this area, being responsible for the development of population health software used across many sites around the world. Chris describes how interoperability and integration have always been at the heart of Orion Health, beginning over 20 years ago with Symphonia messaging validation.  

The development of Orion Health Clinical Portal allowed hospitals to connect up best of breed systems into a singular view for clinicians, enabling them to review a patient’s entire record and access all of the applications and information associated with a patient. Following this in the early 2000s Rhapsody (now Lyniate) was developed which took messaging and integration to next level, orchestrating information flow at an enterprise level.  

Orion Health has spent many years bringing together different information and systems, and this is leveraged across the world with our solutions being deployed in the UK, Canada, the USA, Europe, New Zealand and more, many of which having different focuses from integrated care records, health information exchanges (HIEs) and national and regional electronic health records (EHRs). 

FHIR: The bright shiny object 

Orion Health has a deep background with respect to FHIR. Chris discusses how the company’s efforts date back to 2015 when FHIR first emerged, and over the past five-six years has built several versions of the standard. 

Comparing FHIR with HL7 V2, FHIR enables a much wider array of technology and approaches.  FHIR 4.0 is normative, meaning these parts won’t be fundamentally changed and can be relied upon for longer. This should see wider adoption from vendors and health IT organisations [1].   

Orion Health has been working towards bringing FHIR 4.0 aspects to our stack for some time. Chris acknowledges that different solutions exist with data potentially being stored in remote systems and describes how Orion Health has built technology to support aggregating all of this data in real-time to that which is stored in our system. This gives the Orion Health platform great flexibility.    

Real-world application

When it comes to the new US regulations it’s not all about FHIR APIs. There is also a requirement for Medicare and Medicaid hospitals to send electronic notifications when a patient presents at or is discharged from the emergency department to their primary care provider or other provider they have an established relationship with. This is known as Admission, Discharge, Transfer Notifications (ADT).  

If a HIE is deployed with notifications capability then it is already on its way to meeting the ADT requirements, and potentially can do much more, for example notifying on labs or sharing lab data.  

Another consideration when it comes to real-world application of the Patient Access API is how will patients gain access to their data and what happens when that data leaves the clinical system? Ultimately, to quote Dr Don Rucker, Chris says this comes down to “liberating health information” and the balance between ease of access, ease of use and privacy.  

In their full discussion Chris and Chris talk in more detail about these topics, what it means for HIEs and the prospect for HIEs when it comes to handle some of these activities on behalf of participating organisations.