Solutions Guide – EMRs/EHRs

Sept. 25, 2015

Information Exchange

What APIs bring to EMR/EHR interoperability
By David Boerner, Senior Solution Consultant, Orion Health

Much has been made of embracing an open application program interfaces (API) strategy to achieve interoperability, but what does this actually entail? Think of APIs as programmatic gateways to allow access to information in a controlled manner. The Centers for Medicare & Medicaid Services (CMS) has proposed the use of APIs for EMRs, which would allow providers to enable new functionalities to support data access and patient exchange.

So what is an open API strategy’s role in helping achieve interoperability? Let’s delve a little deeper.

What do open APIs solve?

  • Connectivity: APIs can solve connectivity between systems by clearly defining transmission and security rules.
  • Expansion: APIs can grow the healthcare ecosystem by allowing applications to share data with any other system.
  • Vision: An open API strategy supports future-proof healthcare strategies like Fast Healthcare Interoperability Resources (FHIR).

What don’t open APIs solve?

  • Integration: End systems still require clearly defined message standards dictated by their clinical systems. Just because you’ve sent data to a system doesn’t mean the system is capable of interpreting it.
  • Workflow: Arguably the most complex interoperability challenge, APIs can only connect the dots, not determine which dots to connect.
  • Services: An open API strategy will expose connections, but they are meaningless without the services behind them to actually do something. These will need to be developed.

Why should you look at an open API strategy? Cost is one major factor. The financial savings could be impressive. If the API strategy is implemented soundly, there could be major implications for reimbursement, speed, and ease of deployment of new interoperable services. Safety is the other major factor. Security of patients’ protected health information (PHI) could be increased due to more effective and secure interoperability standards.

As far as deployment goes, open API strategies are starting to be used in the healthcare ecosystem, especially in the healthcare startup world, where they are following widely successful use in the social media (Facebook, Twitter) and e-commerce (Amazon, eBay) industries.

Federal organizations such as the Office of the National Coordinator for Health Information Technology (ONC) have taken note and included an open API strategy as a path toward meeting thresholds for the eight measures in Meaningful Use Stage 3 (MU3).1 Meanwhile, healthcare providers and payers are seeking new paradigms to increase the adoption and speed of interoperability amongst the players in the healthcare ecosystem.

But when could we realize any tangible benefits? If two parties have already fully implemented an open API strategy, then yesterday. The reality is that most have not, and it will require time to design, implement, document, expose, and connect the systems together.

How do I embark on an open API strategy?

  • Evaluate: Look at your current strategy. Is your organization struggling with interoperability and integration? If it isn’t broken, don’t fix it.
  • Investigate: Explore the ecosystem of products your organization interacts with. Do they have plans to expose APIs? Open API is only effective when everyone works together.

It is important to realize that, although an open API strategy serves a role within the interoperability puzzle, it isn’t the solution. If implemented soundly, an open API strategy could enhance the interoperability landscape, all while growing your pool of integrated applications and services. The challenge lies in understanding that APIs aren’t a panacea for all interoperability challenges and will require significant development behind the scenes to create and expose useful Web services.




Alliance’s info swap keeps growing

Five Cerner clients in the Pacific Northwest have agreed to use CommonWell Health Alliance services to securely exchange patient data with a growing number of provider sites across the United States. CommonWell Health Alliance is a not-for-profit association of health IT companies working together to create universal access to healthcare data.

Cerner clients Virginia Mason Medical Center, Seattle Cancer Care Alliance, EvergreenHealth, Tuality Healthcare, and Mason General Hospital & Family of Clinics will share records with regional physician practices that use Greenway Health and athenahealth EHRs, as well as with the acute and ambulatory healthcare provider organizations nationwide who already use CommonWell. The alliance expects to have more than 5,000 provider sites enrolled in CommonWell services by the end of the year. Cerner is a founding alliance member.

CommonWell services address four key challenges in healthcare interoperability:

  1. Patient identification and linking: Assist healthcare IT suppliers to identify patients more quickly and accurately as they transition through care facilities.
  2. Patient access, privacy, and consent management: Potential future capabilities include a patient-authorized means to simplify management of data-sharing consents and authorizations.
  3. Record locator and retrieval: Help providers locate and access their patient records, regardless of where the encounter occurred, by providing a “virtual table of contents” that documents available data from each encounter location.
  4. Trusted data access: Provide authentication and auditing services that facilitate secure data sharing among member systems.

The CommonWell approach to patient record accessibility is unique. Services are built directly into the CommonWell members’ EHR workflows, enabling clinicians to access participating patients’ medical records from outside healthcare organizations that connect to the CommonWell network.

Systems Evaluations

Nurses give EHRs thumbs up, thumbs down

There’s good news and bad news when it comes to electronic health records, at least when you poll nurses.

In a recent satisfaction survey of nurses, conducted by HIMSS Analytics on behalf of Allscripts, a majority of respondents agreed that EHRs help improve patient safety (73 percent), avoid medication errors (72 percent), make it easier to find comprehensive patient information (70 percent), and enhance collaboration with clinicians inside their organizations (73 percent).

But among the 626 registered nurses surveyed – who represented users of multiple EHR vendor technologies, types of care settings, and roles – less than a majority were likely to agree that EHRs help efficiency through enabling collaboration with clinicians outside their organizations (49 percent), eliminating duplicate work (43 percent), or giving nurses more time with patients (33 percent).

In the big picture, though, almost three-quarters of nurses would not consider going back to paper-based medical records (71 percent).

“Results show that nurses have the highest levels of satisfaction around how EHRs improve the quality of clinical decisions,” says Brendan FitzGerald, Research Director at HIMSS Analytics. “But there are also findings that indicate EHR vendors could do more to improve nursing workflows.”

Interested parties can download an Allscripts white paper that features the HIMSS Analytics Nursing Healthcare Satisfaction Study results at
Source: HIMSS Analytics


Get integrated secure text messaging

athenaText, a secure text messaging service that is fully integrated with athenahealth’s cloud-based EHR platform and accessible through the standalone athenaText and Epocrates mobile apps, is now available, at no cost, to all 1 million-plus healthcare professionals on the athenahealth network. This includes every athenaClincials EHR and Epocrates user. Whether using athenaText via Web-based athenaClinicals, a mobile phone, or Apple Watch, providers can leverage the power of the new text messaging service to communicate with teams in dynamic environments, create care networks for curbside consult or patient referrals, and access clinical intelligence through Epocrates. Later this year, physicians will be able to exchange patient charts securely across care settings via athenaText. athenahealth


Built to handle the U.S. Coast Guard
The U.S. Coast Guard is using the InterSystems HealthShare health informatics platform to enable strategic interoperability for its Integrated Health Information System (IHiS), making it possible, for the first time, to view a comprehensive EHR across the Coast Guard’s disparate systems. As the Coast Guard transitions from legacy systems to a commercial EHR solution, HealthShare provides standards-based interoperability to unify health information from civilian and Coast Guard care providers. Clinicians can now view longitudinal health records for Coast Guard and U.S. Department of State beneficiaries. The IHiS encompasses ambulatory care, urgent care, dental, physical therapy, optometry, behavioral health, occupational health, immunizations, audiology, radiology, pharmacy, and laboratory records. InterSystems

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