Industry Watch

May 19, 2021

Interoperability

ONC HITAC Recommends Expanding USCDI Version 2 Data Elements

During an April 15 meeting, an advisory committee to the Office of the National Coordinator for Health IT approved sending ONC a task force’s recommendations to add nine data elements to the United States Core Data for Interoperability (USCDI) version 2, including social determinant of health data.

In January 20201, ONC released a draft of version 2 of USCDI, which defines a standardized set of health data classes and data elements for health information exchange. Version 2 introduces incremental and modest changes, including nine new data elements and two new data classes.

The USCDI establishes a baseline set of data that can be commonly exchanged across care settings for a wide range of uses. Version 1 was adopted as a standard in the ONC Cures Act Final Rule published May 1, 2020. The standard was included as a required part of certain certification criteria in the 2015 Edition Cures Update and is also referenced in the context of information blocking. The final iteration of version 2 is expected to be published on July 1, 2021.

During the April 15 meeting of the ONC Health Information Technology Advisory Committee (HITAC), Steven Lane, M.D., M.P.H, clinical informatics director for privacy, information security & interoperability for California-based Sutter Health, gave a briefing on the USCDI task force’s recommendations. He serves as task force co-chair.

In the ONC draft version 2, there were two new data classes that were introduced for diagnostic imaging and encounter information and a handful of new data elements. Lane said that while the task force members appreciated the work that ONC did to narrow things down in their draft version 2, “there was a general feeling that we should be more inclusive, that there were more data elements that really were important to include in version 2.”

As well as asking ONC to clarify language about several of the data types required, the task force recommended adding nine data elements to version 2, some of them contingent on HL7 being able to complete implementation guides within the same timeline.

Among the data elements they recommend be added was care team members, because it supports communication and coordination between care team members and automates information routing. Another recommendation involves diagnostic studies and exams with results, including colonoscopies, echocardiograms, electrocardiograms, and pulmonary function tests. Diagnostic studies represents a significant gap area in USCDI version 1 and draft version 2, Lane explained. “All the systems that deal with Medicare and Medicaid patients certainly have the ability to capture these,” he said, “so they are in broad use, and we thought that they should be included in version 2.”

Health IT Market

Stock Market, Analysts, Observers React to Microsoft’s Acquisition of Nuance

The day after the announcement by executives of the Redmond, Wash.-based Microsoft Corporation that the tech giant will buy the Burlington, Mass.-based Nuance Communications in an all-cash deal worth $19.7 billion, the financial markets and industry observers reacted to news of the acquisition.

“Microsoft stock was flat on Monday while Nuance stock rocketed on the news,” Investor’s Business Daily’s Patrick Seitz reported on April 12, at the time of the close of business on the day on which the announcement was made. Seitz quoted Wedbush Securities analyst Daniel Ives, who told Seitz that the acquisition was a “no brainer” move for Microsoft.

According to Seitz’s report, “Nuance ‘represents a unique asset on the health-care front,’ Ives said in a note to clients. ‘We also believe Microsoft can further integrate Nuance’s advanced speech technology throughout its consumer and enterprise ecosystem over the coming years to leverage this potential M&A move.’ About 77 percent of U.S. hospitals use Nuance technology. Plus, more than 55 percent of physicians and 75 percent of radiologists in the U.S. use Nuance products. Doctors use its software to transcribe their spoken notes into patient records…Nuance is at the forefront of digitizing the health-care industry,” Seitz wrote.

Industry analysts and observers shared a range of reactions to the business move. “I think this is one of many steps that Microsoft needs to take to solidify their business in the health care market,” Jefferies analyst Brent Thill told Yahoo Finance’s Daniel Howley after the announcement had been made public. “Obviously, Amazon is making a push into the industry as well, and I think everyone is going after the golden ticket of health care,” Thill told Howley.

Meanwhile, Ben Rooks, founder and managing principal of the Sonoma, Calif.-based ST Advisors, told Healthcare Innovation Editor-in-Chief Mark Hagland that “Microsoft has said they want to get more aggressive, from an M&A perspective. More than half of Nuance’s business is healthcare. I look at Microsoft’s track record of successful M&A in healthcare, which is to say, nonexistent, and to me, it seems like they’re making a very big bet on what is admittedly a promising industry. At the same time,” Rooks said, “one should also consider Microsoft’s past stumbles in healthcare. In particular, he cited Microsoft’s February 2010 acquisition of the Andover, Mass.-based Sentillion, an identity management solutions vendor, and its challenges with Caradigm, a population health management vendor.

More broadly, Rooks told Hagland, “There’s a lot of VC [venture capital] money being spent now on the holy trinity of AI, ML, and NLP [artificial intelligence, machine learning, and natural language processing] in healthcare. And that level of investment does have the potential to be, if not transformational, evolutionarily important. The ability to parse medical records and data-mine from them, is it significant? Yes.”

As to how this acquisition might produce a different result from some of Microsoft’s past investments in healthcare, Rooks said, “I can’t predict the future. If I were on Microsoft’s board, I’d be asking the deal’s champions and the CEO, why we might be successful at this, when to date, none of Microsoft’s acquisitions were successful? So this is definitely a ‘prove-it-to-me’ kind of story.”

Health IT Market

Provider Customers Rank Nuance, Epic Highest for COVID-19 Response

Responding to the long and challenging COVID-19 pandemic has certainly tested the healthcare IT and services communities. Which vendors have truly been partners, and which have fallen short in their response? Who showed they are up to the challenge of working through inevitable future crises? A new report from the Utah-based KLAS Research—the second in the firm’s series on the topic—analyzes the market and surveys customers on how their vendor partners are supporting them.

In the spring of 2020, KLAS began collecting provider organizations’ feedback on the response of their software vendors and services firms to the COVID-19 pandemic and how well these companies supported customers throughout the crisis.

The data in this report (an update to the early look KLAS published in July 2020) was collected from April 1, 2020, to December 31, 2020, and includes ratings from 6,300 in-depth interviews with providers and IT professionals at healthcare organizations. In part one of the series, of the 58 measured vendors in that report, 79 percent were rated higher for their COVID-19 response than for overall customer satisfaction.

Overall, the vendor community has responded well to the COVID-19 crisis, as 75 percent of customer ratings for the question “On a scale of 1.0–9.0, how well has your vendor supported you through the COVID-19 crisis?” are an 8.0 or higher. And among large vendors—defined in this report as having at least 15 ratings for their COVID-19 response in two or more measured market segments—eight are rated 8.0 or higher.

Specific vendors called out in the report include Nuance (8.3) and Epic (8.2) at the top of customers’ COVID-19 response ratings. According to customer feedback, Nuance was ready in a variety of ways to help customers, from supporting a mobile, work-from-home workforce, to offering some customers free licenses to meet surge needs. Nuance’s quality management customers rated their vendor a perfect 9.0 (based on limited data), citing their excellent work quickly adding COVID-19 quality measures.

Meanwhile, Epic customers reported a myriad of ways in which the vendor has supported them throughout the crisis. Repeatedly, customers said that when they were struggling, Epic emphasized meeting critical needs over cost and contracting. Many software upgrades were quickly released to meet a plethora of customer requests.

Other large software vendors that received scores above 8.0 for their COVID-19 response include PerfectServe, Health Catalyst, 3M, GetWellNetwork, symplr (API Healthcare), and Meditech, according to the report.

Among vendors that have not performed as well, customers nearly universally said their vendor made efforts but sometimes failed to follow through, communicate effectively, or deliver when clients needed help most.

Interoperability & HIE

Wide-Ranging Study of HIEs Reveals Most Plan to Participate in TEFCA

A study of health information exchanges (HIEs) across the U.S. reveals that 56 percent plan to participate in the government’s Trusted Exchange Framework and Common Agreement (TEFCA) framework that aims to connect islands of electronic data sharing via a single “on-ramp” to nationwide connectivity.

The research, conducted by Julia Adler-Milstein, Ph.D., a professor of medicine and director of the Center for Clinical Informatics and Improvement Research, School of Medicine, at the University of California San Francisco (UCSF), and others at UCSF and the Office of the National Coordinator for Health IT (ONC), was published in the May issue of Health Affairs.

The researchers noted in their piece that the TEFCA national framework creates new potential opportunities and challenges for state and local HIEs. As such, they undertook their sixth national survey to assess the current state of HIEs and to newly examine anticipated responses to TEFCA. They identified 89 operational HIEs—or as the authors refer to them throughout the article, HIOs (health information organizations)—down from 106 in 2014. Although more than half of these health information exchanges struggled with financial viability and competition from health IT vendor–based HIE networks, many are large in scale, offer a breadth of services to diverse participants, and engage in network-to-network connectivity, they concluded.

Looking ahead, 56 percent of HIEs reported that they plan to participate in TEFCA, and 41 percent were unsure. As the Trusted Exchange Framework and Common Agreement advances basic network-to-network connectivity, HIEs that have experience with such connectivity while also offering value-added services will be well positioned for sustainability and growth, the researchers opined.

The 56 percent of HIEs that plan to participate in TEFCA were similar to HIEs not planning to participate or didn’t know, in terms of size, duration operational, financial viability, selling or providing their infrastructure to other HIEs, buying or using infrastructure from another HIE, and connecting to other HIEs in the same state.

However, they did differ on two characteristics: whether they connect to other HIEs in different states, with 64 percent of TEFCA participants saying they do, compared with 38 percent of those that were not planning to or not sure about TEFCA participation; and whether they participate in at least one national network, with 90 percent of TEFCA participants saying they do, compared with 72 percent in the other group.

In the end, the researchers concluded, on the HIE landscape in the U.S., “A subset appears particularly well positioned to take advantage of new opportunities under the Trusted Exchange Framework and Common Agreement, based on their experience with network-to-network connectivity and by offering a breadth of services to attract new participants.” But, they added, “persistent HIO concerns about competition from health IT vendors’ HIE networks suggest that some HIOs may struggle to participate in TEFCA and grow their base of participants and revenue unless they offer value-added services.”

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