Advancing Interoperability and Prior Authorization Reform.

This Viewpoint discusses the provisions and potential of the new Centers for Medicare and Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule.

Bens públicos digitais

Um dos oito princípios orientadores da transformação digital no setor de saúde promovidos pela Organização Pan-Americana da Saúde é o dos bens públicos digitais. Esta sinopse de políticas apresenta conceitos chave, linhas de ação recomendadas e indicadores para monitoramento, com o objetivo de avançar nesse domínio.

Interoperabilidade

Um dos oito princípios orientadores da transformação digital no setor de saúde promovidos pela Organização Pan-Americana da Saúde é o da interoperabilidade. Esta sinopse de políticas apresenta conceitos chave, linhas de ação recomendadas e indicadores para monitoramento, com o objetivo de avançar nesse domínio.

Redefining Health Care Data Interoperability: Empirical Exploration of Large Language Models in Information Exchange.

BACKGROUND: Efficient data exchange and health care interoperability are impeded by medical records often being in nonstandardized or unstructured natural language format. Advanced language models, such as large language models (LLMs), may help overcome current challenges in information exchange. OBJECTIVE: This study aims to evaluate the capability of LLMs in transforming and transferring health care data to support interoperability. METHODS: Using data from the Medical Information Mart for Intensive Care III and UK Biobank, the study conducted 3 experiments. Experiment 1 assessed the accuracy of transforming structured laboratory results into unstructured format. Experiment 2 explored the conversion of diagnostic codes between the coding frameworks of the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), and Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) using a traditional mapping table and a text-based approach facilitated by the LLM ChatGPT. Experiment 3 focused on extracting targeted information from unstructured records that included comprehensive clinical information (discharge notes). RESULTS: The text-based approach showed a high conversion accuracy in transforming laboratory results (experiment 1) and an enhanced consistency in diagnostic code conversion, particularly for frequently used diagnostic names, compared with the traditional mapping approach (experiment 2). In experiment 3, the LLM showed a positive predictive value of 87.2% in extracting generic drug names. CONCLUSIONS: This study highlighted the potential role of LLMs in significantly improving health care data interoperability, demonstrated by their high accuracy and efficiency in data transformation and exchange. The LLMs hold vast potential for enhancing medical data exchange without complex standardization for medical terms and data structure.

[Interoperability Working Group: core dataset and information systems for data integration and data exchange in the Medical Informatics Initiative]. / Arbeitsgruppe Interoperabilität: Kerndatensatz und Informationssysteme für Integration und Austausch von Daten in der Medizininformatik-Initiative.

The interoperability Working Group of the Medical Informatics Initiative (MII) is the platform for the coordination of overarching procedures, data structures, and interfaces between the data integration centers (DIC) of the university hospitals and national and international interoperability committees. The goal is the joint content-related and technical design of a distributed infrastructure for the secondary use of healthcare data that can be used via the Research Data Portal for Health. Important general conditions are data privacy and IT security for the use of health data in biomedical research. To this end, suitable methods are used in dedicated task forces to enable procedural, syntactic, and semantic interoperability for data use projects. The MII core dataset was developed as several modules with corresponding information models and implemented using the HL7® FHIR® standard to enable content-related and technical specifications for the interoperable provision of healthcare data through the DIC. International terminologies and consented metadata are used to describe these data in more detail. The overall architecture, including overarching interfaces, implements the methodological and legal requirements for a distributed data use infrastructure, for example, by providing pseudonymized data or by federated analyses. With these results of the Interoperability Working Group, the MII is presenting a future-oriented solution for the exchange and use of healthcare data, the applicability of which goes beyond the purpose of research and can play an essential role in the digital transformation of the healthcare system.

Extracting Electronic Health Record Neuroblastoma Treatment Data With High Fidelity Using the REDCap Clinical Data Interoperability Services Module.

PURPOSE: Although the International Neuroblastoma Risk Group Data Commons (INRGdc) has enabled seminal large cohort studies, the research is limited by the lack of real-world, electronic health record (EHR) treatment data. To address this limitation, we evaluated the feasibility of extracting treatment data directly from EHRs using the REDCap Clinical Data Interoperability Services (CDIS) module for future submission to the INRGdc. METHODS: Patients enrolled on the Children's Oncology Group neuroblastoma biology study ANBL00B1 (ClinicalTrials.gov identifier: NCT00904241) who received care at the University of Chicago (UChicago) or the Vanderbilt University Medical Center (VUMC) after the go-live dates for the Fast Healthcare Interoperability Resources (FHIR)-compliant EHRs were identified. Antineoplastic drug orders were extracted using the CDIS module. To validate the CDIS output, antineoplastic agents extracted through FHIR were compared with those queried through EHR relational databases (UChicago's Clinical Research Data Warehouse and VUMC's Epic Clarity database) and manual chart review. RESULTS: The analytic cohort consisted of 41 patients at UChicago and 32 VUMC patients. Antineoplastic drug orders were identified in the extracted EHR records of 39 (95.1%) UChicago patients and 26 (81.3%) VUMC patients. Manual chart review confirmed that patients with missing (n = 8) or discontinued (n = 1) orders in the CDIS output did not receive antineoplastic agents during the timeframe of the study. More than 99% of the antineoplastic drug orders in the EHR relational databases were identified in the corresponding CDIS output. CONCLUSION: Our results demonstrate the feasibility of extracting EHR treatment data with high fidelity using HL7-FHIR via REDCap CDIS for future submission to the INRGdc.

Building consensus on common features and interoperability use cases for community health information systems: a Delphi study.

INTRODUCTION: Information systems for community health have become increasingly sophisticated and evidence-based in the last decade and they are now the most widely used health information systems in many low-income and middle-income countries. This study aimed to establish consensus regarding key features and interoperability priorities for community health information systems (CHISs). METHODS: A Delphi study was conducted among a systematically selected panel of CHIS experts. This impressive pool of experts represented a range of leading global health institutions, with gender and regional balance as well as diversity in their areas of expertise. Through five rounds of iterative surveys and follow-up interviews, the experts established a high degree of consensus. We supplemented the Delphi study findings with a series of focus group discussions with 10 community health worker (CHW) leaders. RESULTS: CHISs today are expected to adapt to a wide range of local contextual requirements and to support and improve care delivery. While once associated with a single role type (CHWs), these systems are now expected to engage other end users, including patients, supervisors, clinicians and data managers. Of 30 WHO-classified digital health interventions for care providers, experts identified 23 (77%) as being important for CHISs. Case management and care coordination features accounted for more than one-third (14 of 37, 38%) of the core features expected of CHISs today, a higher proportion than any other category. The highest priority use cases for interoperability include CHIS to health management information system monthly reporting and CHIS to electronic medical record referrals. CONCLUSION: CHISs today are expected to be feature-rich, to support a range of user roles in community health systems, and to be highly adaptable to local contextual requirements. Future interoperability efforts, such as CHISs in general, are expected not only to move data efficiently but to strengthen community health systems in ways that measurably improve care.

recruIT: A cloud-native clinical trial recruitment support system based on Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) and the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM).

BACKGROUND: Clinical trials (CTs) are foundational to the advancement of evidence-based medicine and recruiting a sufficient number of participants is one of the crucial steps to their successful conduct. Yet, poor recruitment remains the most frequent reason for premature discontinuation or costly extension of clinical trials. METHODS: We designed and implemented a novel, open-source software system to support the recruitment process in clinical trials by generating automatic recruitment recommendations. The development is guided by modern, cloud-native design principles and based on Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) as an interoperability standard with the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) being used as a source of patient data. We evaluated the usability using the system usability scale (SUS) after deploying the application for use by study personnel. RESULTS: The implementation is based on the OMOP CDM as a repository of patient data that is continuously queried for possible trial candidates based on given clinical trial eligibility criteria. A web-based screening list can be used to display the candidates and email notifications about possible new trial participants can be sent automatically. All interactions between services use HL7 FHIR as the communication standard. The system can be installed using standard container technology and supports more sophisticated deployments on Kubernetes clusters. End-users (n = 19) rated the system with a SUS score of 79.9/100. CONCLUSION: We contribute a novel, open-source implementation to support the patient recruitment process in clinical trials that can be deployed using state-of-the art technologies. According to the SUS score, the system provides good usability.

Dual Implementation Guides in FHIR and CDA.

BACKGROUND: The Fast Healthcare Interoperability Resources (FHIR) and Clinical Document Architecture (CDA) are standards for the healthcare industry, designed to improve the exchange of health data by interoperability. Both standards are constrained through what are known as Implementation Guides (IG) for specific use. OBJECTIVES: Both of these two standards are widely in use and play an important role in the Austrian healthcare system. Concepts existing in CDA and FHIR must be aligned between both standards. METHODS: Many existing approaches are presented and discussed, none are fully suited to the needs in Austria. RESULTS: The IG Publisher has already been used for CDA IGs, beside of its intended FHIR support, but never for both in one IG. Even the International Patient Summary (IPS), existing as CDA and FHIR specification, does not solve the needed comparability between these two. CONCLUSION: As the IG Publisher is widely used and supports CDA, it should be used for Dual Implementation Guides. Further work and extension of IG Publisher is necessary to enhance the readability of the resulting IGs.

Comparison of the Performance of the Fast Healthcare Interoperability Resources (FHIR) Subscription Channels.

BACKGROUND: The Fast Health Interoperability Resources (FHIR) standard was proposed and released to solve the interoperability problems of the electronic health records. The FHIR Subscription resources are used to establish real-time event notifications from the FHIR server to another system. There are several communication channels such as rest-hook and websocket. The objective of our work is to compare the performance of the FHIR subscription using the rest-hook and websocket channels. METHODS: HAPI FHIR server, python websocket clients and HTTP endpoints were used to measure the processor and memory usage of the two subscription channels. Tests were performed with 5, 10, 15, 20, 30, 40, 50, 60, 70 and 80 clients. The performance was logged using windows performance monitor. RESULTS: The rest-hook subscription showed near six-fold increase in resource utilization when increasing the clients from 5 to 80. On the contrary, the websocket subscription channel did not reach a two-fold increase. CONCLUSION: The type of the subscription channel should be carefully selected and load distribution should be considered when the number of clients grows.

Comparison of WebSocket and Hypertext Transfer Protocol for Transfer of Electronic Health Records.

BACKGROUND: Electronic health records (EHR) emerged as a digital record of the data that is generated in the healthcare. OBJECTIVES: In this paper the transfer times of EHRs using the Hypertext Transfer Protocol and WebSocket in both local network and wide area network (WAN) are compared. METHODS: A python web application to serve Fast Health Interoperability Resources (FHIR) records is created and the transfer times of the EHRs over both HTTP and WebSocket connection are measured. 45000 test Patient resources in 20, 50, 100 and 200 resources per Bundle transfers are used. RESULTS: WebSocket showed much better transfer times of large amount of data. These were 18 s shorter in the local network and 342 s shorter in WAN for the 20 resource per Bundle transfer. CONCLUSION: RESTful APIs are a convenient way to implement EHR servers; on the other hand, HTTP becomes a bottleneck when transferring large amount of data. WebSocket shows better transfer times and thus its superiority in such situations. The problem can be addressed by developing a new communication protocol or by using network tunneling to handle large data transfer of EHRs.

Human Factor Health Data Interoperability.

Comprehensive health data interoperability is recognized as an essential element of high-functioning and accountable health service. Canada is lagging in health data interoperability compared to international comparators, and lacks a comprehensive approach to human factor interoperability, defined as system-level relationships that impact the capacity of health sector stakeholders to adopt harmonized health data standards and technology. Without addressing these system-level relationships, the adoption of harmonized health data standards and technology will be obstructed and Canadians will be underserved. The proposed health data interoperability framework articulates the factors that Canada needs to address to optimize health data design to support quality health programs and services.

Pediatric Consent on FHIR.

BACKGROUND: Standardizing and formalizing consent processes and forms can prevent ambiguities, convey a more precise meaning, and support machine interpretation of consent terms. OBJECTIVES: Our goal was to introduce a systematic approach to standardizing and digitizing pediatric consent forms, which are complex due to legal requirements for child and legal guardian involvement. METHODS: First, we reviewed the consent requirements from the Arizona regulation, and we used 21 pediatric treatment consents from five Arizona health care organizations to propose and evaluate an implementation-agnostic Consent for Treatment Framework. Second, we assessed the adequacy of the Fast Healthcare Interoperability Resources (FHIR) to support the proposed framework. RESULTS: The resulting Consent for Treatment Framework supports compliance with the state consent requirements and has been validated with pediatric consent forms. We also demonstrated that the FHIR standard has the required expressiveness to compute the framework's specifications and express the 21 consent forms. CONCLUSION: Health care organizations can apply the shared open-source code and FHIR implementation guidelines to standardize the design of machine-interpretable pediatric treatment consent forms. The resulting FHIR-based executable models may support compliance with the law and support interoperability and data sharing.

Vaccine/Vaccination Safety in the Americas: Experiences in Surveillance of Events Supposedly Attributable to Vaccination or Immunization (ESAVI), and Interoperability of Data

This report presents the background, achievements and challenges of the regional safe vaccination system in the Americas and shows, chronologically, the steps that were taken to create it. The first chapter documents the origin, process and formation of the team, the strategies that were designed to implement the training process in the Region and the formation of the Pan American Advisory Committee on Safe Vaccination (COPAVASE), as a consultative body. The second chapter describes how the Information System was formed, as one of the pillars of the system to support the collection and analysis of data. In this sense, it also describes the implementation process of the DHIS2 tool, which facilitates the interoperability of data on events supposedly attributable to vaccination or immunization. The third chapter documents how the network of sentinel hospitals was implemented for the establishment of the regional surveillance and how work began on passive surveillance. In the process, the way in which the network that carries out surveillance of the ESAVI/EVADIE was formed, its objectives, benefits, the way in which the training workshops were carried out and how the countries of the region to said system. The report was prepared as a preamble to the First Regional Meeting on Safe Vaccination – which was held in Bogotá (Colombia) during 12-14 April 2023, and begins a series of reports that will be published as reference and training material about the safe vaccination system.

Integrating a Novel Eye Imaging System into Clinical Practice: An Open-Source DICOM Simulation Platform.

BACKGROUND: The integration of innovative imaging technologies into clinical workflows requires the utilization of a standardized data exchange format. The "Digital Imaging and Communications in Medicine" (DICOM) standard is widely used in healthcare to process and transfer medical images. However, no simulation environment is ready to use for development. The objective of this paper is to provide an open-source DICOM platform for integrating a novel ocular photography system into a clinical setting. METHODS: After a thorough analysis of the available open-source tools, a subset was selected and aligned with the U-Eyecare Profile of Integrating the Healthcare Enterprise (IHE). RESULTS: Orthanc served as a PACS with a modality worklist and the OHIF-Viewer for image retrieval. Minimal interfaces for the electronic health record and image modality were created. Docker-compose further integrates all components and simulates the network protocols DICOM Message Service Element and DICOMWeb. DISCUSSION: The platform was used to develop and integrate the developed image modality and will be further utilized for teleophthalmology and processing eye images. The platform could be useful for other researchers to integrate an image modality into a clinical environment along IHE.

Vacunación segura en las Américas. Experiencia sobre la vigilancia de los eventos supuestamente atribuibles a la vacunación o inmunización y la interoperabilidad de los datos

Este informe presenta los antecedentes, los logros y los retos del sistema regional de vacunación segura en las Américas y muestra, de manera cronológica, los pasos que se dieron para su conformación. Asimismo, describe el proceso de implementación de la herramienta DHIS2, que facilita la interoperabilidad de los datos sobre los eventos supuestamente atribuibles a la vacunación o inmunización, y la instauración de la vigilancia regional activa a través de la red de hospitales centinela. El informe se elaboró como preámbulo a la Primera Reunión Regional de Vacunación Segura —que se celebró en Bogotá (Colombia) los días 12, 13 y 14 de abril— y da inicio a una serie de informes que se publicarán como material de consulta y capacitación sobre el sistema de vacunación segura.

Vacunación segura en las Américas. Experiencia sobre la vigilancia de los eventos supuestamente atribuibles a la vacunación o inmunización y la interoperabilidad de los datos / Safe vaccination in the Americas. Experience on surveillance of events presumably attributable to vaccination or immunization and data interoperability

l presente informe describe los antecedentes, los logros y los retos del sistema regional de vacunación segura en las Américas y muestra, de manera cronológica, los pasos que se dieron para su conformación. Asimismo, describe el proceso de implementación de la herramienta DHIS2, que facilita la interoperabilidad de los datos sobre los eventos supuestamente atribuibles a la vacunación o inmunización, y la instauración de la vigilancia regional activa a través de la red de hospitales centinela

Arquitectura de salud pública / Public Health Architecture

Uno de los ocho principios rectores para la transformación digital del sector de la salud promovidos por la Organización Panamericana de la Salud (OPS) es la arquitectura de salud pública. Este documento de política presenta conceptos clave, líneas de acción recomendadas e indicadores para su monitoreo con el objetivo de avanzar en la arquitectura de salud pública. De acuerdo con la definición de la OPS, este principio rector se propone diseñar la arquitectura de salud pública en la era de la interdependencia digital. "La arquitectura de salud pública, en la era de la interdependencia digital, debe enmarcarse en la agenda digital del gobierno. Debe ser transversal, para articular las distintas vertientes de gobernanza y optimizar la planificación estratégica y la gestión de los recursos. Debe basarse en el aprovechamiento de normas y procedimientos a favor de múltiples áreas, no solo de la esfera de la salud; este es el caso de la conectividad y el ancho de banda, que influyen indistintamente en salud, en educación y en todos los sectores". La mayoría de los avances en salud digital se dan como aplicaciones y sistemas de información individuales que funcionan independientemente. Esto genera islas de información, con grandes desafíos para alcanzar la eficiencia y mejorar los resultados de salud. La propuesta es lograr una arquitectura de salud como plataforma que sirva de base para que los diversos sistemas de información interoperen y trabajen juntos de manera integrada. Existen diferentes formas de alcanzar este intercambio de datos, y todos ellos implican establecer la gobernanza, un marco de confianza (dado por normativas y su cumplimiento) y de arquitectura tecnológica de interoperabilidad

Interoperabilidad / interoperability

Uno de los ocho principios rectores de la transformación digital del sector de la salud promovidos por la Organización Panamericana de la Salud es el de la interoperabilidad. Esta sinopsis de políticas presenta conceptos clave, líneas de acción recomendadas e indicadores para su monitoreo con el objetivo de avanzar en la interoperabilidad como uno de los ocho principios rectores para la transformación digital del sector salud promovidos por la Organización Panamericana de la Salud (OPS). De acuerdo con la definición de la OPS, este principio se propone implementar sistemas de información y salud digital interoperables, abiertos y sostenibles. Los sistemas de información para la salud ­acceso oportuno y abierto a datos correctamente desagregados, integración de los sistemas nacionales y locales, salud digital y TIC­ facilitan la identificación eficaz, la notificación y el análisis de casos y contactos, la búsqueda y detección tempranas de los casos y la definición y el seguimiento de la población de riesgo, de manera segura, interoperable y lo más personalizada posible

Bienes públicos digitales / digital public goods

Uno de los ocho principios rectores de la transformación digital del sector de la salud promovidos por la Organización Panamericana de la Salud es el de los bienes públicos digitales. Esta sinopsis de políticas presenta conceptos clave, líneas de acción recomendadas e indicadores para su monitoreo con el objetivo de avanzar en la creación de bienes públicos digitales. De acuerdo con la definición de la OPS, este principio se propone cocrear bienes de salud pública digitales por un mundo más equitativo. "Los bienes públicos digitales, para fortalecer la salud y el bienestar de la población mundial, deben incluir software de código abierto, normas, algoritmos, datos, aplicaciones y contenidos diseñados con la arquitectura y el licenciamiento adecuados. Estos atributos deben permitir escalarlos en poblaciones y contextos diversos, además de aplicar las adaptaciones locales que proceda. Siempre primarán la responsabilidad y la sostenibilidad, pensando en un diseño centrado en el usuario, especialmente en poblaciones vulnerables con necesidades especiales en materia de tecnología y alfabetización digital". La transformación digital en el sector salud tiene como principal objetivo el acceso universal a la atención en salud, y para ello es necesario acceder y contar, entre otras cosas, con software y estándares que permitan la mejor captura y comunicación de la información clínica, con datos y contenidos de calidad y compartidos que garanticen la mejor atención en salud, la gestión sanitaria y la toma de decisiones. Esta transformación digital en salud debe anclarse en un entramado constituido por acuerdos de la comunidad internacional, estrategias integrales, legislación que la acompañe y en políticas públicas nacionales