The synergy of artificial intelligence (AI) and medical imaging has opened new horizons for healthcare. AI-mediated computer vision has been in use in oncology for more than 20 years; however, its arrival in other medical fields, notably dentistry, is more recent. Dentistry is particularly notable here, because while relatively few people have seen an oncologist, almost everyone sees a dentist at least every few years. The application of AI in dentistry, thus, extends to a much broader population. Rapid advances in AI oblige us to consider system design choices in light of possible futures that we may discern only indistinctly today. In healthcare, the stakes are high–higher, arguably, than in any other areas of AI deployment.

The family of machine learning algorithms most often used in medical imaging and diagnostic applications is called “discriminative,” as they are techniques for discriminating between existing data points. Discriminative systems are trained to classify data in order to determine the likelihood that a feature exists in the signal data (an early-stage lung nodule in a chest CT scan, for example). These algorithms should not be confused with the “generative” algorithms applied in popular new AI tools like ChatGPT or DALL-E, which create – or “hallucinate” – entirely new data points that in some way resemble the data on which they are trained. 

The ability to fabricate outputs so believable that we are unable to see that they are fabrications has raised concerns about the application of generative algorithms in some arenas–including medicine, where human health is at stake. Those concerns will no doubt moderate the deployment of generative algorithms in healthcare. The algorithms with the greatest immediate utility in medicine, however, are discriminative. Discriminative algorithms are measured by the objective accuracy of their output, not their semblance of accuracy, and, like all machine learning algorithms, they are able to ingest and draw value from data at a rate that far exceeds human capacity.

The linkage between AI and data clearly has enormous potential significance for medicine. Unfettered access to medical data hones the precision of diagnostic tools and the ability of AI to detect patterns in large volumes of data will reveal connections and interactions that we do not now suspect. The bottleneck of hypothesis – the requirement to begin with a theory in order to define and obtain funding for medical research – is eliminated when the data itself yields answers without waiting for questions to be asked.

Currently, medical information systems are largely of the “walled garden” type: They are held within a practice, insurer, or medical center with limited outside access. In order to make the best use of data generated within these systems, methods of anonymizing and pooling large masses of patient data will be needed, together with scalable AI systems capable of scouring immense reservoirs of multimodal data. 

Of course, unchecked access to medical data adds to the ethical considerations that attend any discussion of AI-integrated healthcare. As AI technologies require vast amounts of data to improve accuracy and efficacy, the question of how to protect patient privacy while leveraging data insights becomes increasingly complex. The General Data Protection Regulation (GDPR) in Europe and the Health Insurance Portability and Accountability Act (HIPAA) in the United States offer frameworks for data protection and privacy, but they currently fail to account for the considerable value that data brings. 

As interoperability of digital systems continues its exponential growth, we can expect an overwhelming increase in the novel information that is produced by AI. Consider that the rapid advancement of AI technologies often outpaces regulatory measures, however, and it becomes apparent that finding an ideal balance between innovation and privacy will require considerable effort from all corners of the healthcare system. That effort must begin with thoughtful collaboration between policymakers, technologists, and healthcare providers.

To maximize tomorrow’s benefits, we need to think today about the most efficient ways to foster interconnectivity and the most effective ways to overcome complex questions about privacy, ownership, intellectual property, and system supervision. We should, for example, develop ethical guidelines around health data that account not only for the privacy of patients (as GDPR and HIPAA do) but also for the benefits that new innovative technologies can bring to patient care.

In medicine – as opposed to, say, advertising – data is a public good. The challenge for medicine in the digital age will be to find ways of pooling information for the common benefit of all patients, while still protecting individual privacy and preserving the privatized nature of our healthcare system. 

About Cambron Carter
Cambron Carter is the Co-Founder and Chief Technology Officer at Pearl, the global leader in dental artificial intelligence solutions. Prior to co-founding Pearl, Cambron served as the Director of Engineering, Computer Vision at GumGum.

Patient data interoperability sounds like industry jargon, but it’s a vital piece of providing timely and accurate patient care. Since 1996, when the Health Insurance Portability and Accountability Act (HIPAA) became law, there have been good advances in patient data interoperability, but as a whole, the industry has not embraced them. 

Sharing data through faxing and CDs is still very common. As recently as 2023, between 30  and 47 percent of hospitals across all sizes reported still using fax or mail to send and receive patient records, according to the Government Accountability Office. 

Only 40 percent of hospitals electronically integrated data from other hospitals outside of their system and a meager 30 percent of skilled nursing facilities exchanged data outside of their walls, according to the Office of the National Coordinator for Health Information Technology. 

Relying on outdated record-sharing methods can delay the opportunity for patients to take advantage of life-altering care. Hospitals and healthcare systems can do better.

The time to referral should be days, not weeks (or longer)! A leading opportunity to improve patient outcomes is by decreasing the time it takes for patients to receive appropriate treatment and get on the road to recovery as quickly as possible. 

Healthcare interoperability – it’s so promising, but confusing at the same time. 

In 2009, the Health Information Technology for Economic Clinical Health Act (HITECH Act) was passed, incentivizing the use of electronic medical records (EMRs). This drove the use of Electronic Health Record systems (EHRs) in acute care hospitals to 84 percent by 2015. As recently as 2022 the Trusted Exchange Framework and Common Agreement (TEFCA) was published to establish universal governance and policies for interoperability, simplify the secure exchange of information and allow individuals to gather their healthcare information. 

While we have made leaps, the challenges are still vast. The number of channels to obtain records has grown: 

• Direct to provider
• Direct to ROI (release of information) vendor
• HIE (health information exchange)
• Network

Within those channels, there are still a wide array of methods for information to be exchanged: 

• API
• Portal
• Secure messages
• Fax/call
• Mail

Progress has been made, and the infrastructure is there, but it’s not being leveraged by everyone or even by every organization. This makes the process more complex than it needs to be. If a provider needs records and images for a patient, where do they start? In which channel do those exist? What is the fastest method to receive them? How do they request and receive those records? The list of questions goes on and on. 

Now is the time for healthcare systems to embrace interoperable technology to gain a competitive market edge and improve patient outcomes. 

We have the capability to seamlessly collect, clinically organize and deliver comprehensive medical histories for patients — but why are hospitals and clinics still sending faxes and calling providers? If these organizations were to fully embrace the available technology, it would not only improve patient outcomes but enhance the clinician experience as well. 

One of the largest delays in care is caused by the time it takes to collect, organize and deliver medical histories. Without access to a patient’s comprehensive past, that critical first appointment can be delayed for days or weeks and can negatively impact potentially life-changing treatments. 

Maximizing healthcare interoperability and even integrating technology like Artificial Intelligence (AI) can help efficiently determine the best, most efficient route to gather and request complete medical histories. This allows medical professionals to offer patients more immediate care and enables enhanced communication between physician providers and patients. 

The benefits of embracing healthcare interoperability include improved clinician experience, more meaningful first appointments, reduced patient leakage, reduced time to treatment and improved patient outcomes. Leveraging EHRs and supporting healthcare technology helps providers connect efficiently with other providers and release of Information (ROI) vendors, HIEs and networks in the right way. From there, clinically organized, comprehensive medical histories can be delivered in a timely manner. 

Instead of physicians waiting days or weeks and then having to sift through hundreds of pages of disparate medical records to find a few items of importance, healthcare systems can embrace interoperability and AI to decrease the time to treatment for patients. Requests for records, images and pathology materials can be received directly through EHRs and, in turn, a clinically organized, complete medical history can be delivered. That information can also appear seamlessly within the clinical workflow. 

Clinicians can avoid the need to hunt for information within a mountain of unorganized records and, instead, spend more time focusing on their patients.  

Let’s all keep the goal in sight: Advance the delivery of life-altering care by providing clinicians with clinically organized patient histories in a timely manner—a top solution to help improve patient outcomes. 

About Dan Torrens

Dan Torrens is CEO of eHealth Technologies, a leading healthcare technology company advancing the delivery of life-altering care through innovative record retrieval and image exchange solutions. 

What You Should Know: 

– The Office of the National Coordinator for Health Information Technology (ONC), along with The Sequoia Project, Inc., a Recognized Coordinating Entity (RCE), has released Common Agreement Version 2.0 (CA v2.0).

What is the Common Agreement?

The Common Agreement establishes a set of common rules and technical standards for secure health information exchange across different health information networks (HINs) and their users. This essentially creates a common language for healthcare data, enabling seamless and secure sharing of critical clinical information.

Benefits of CA v2.0

This new version of the Common Agreement brings several key improvements:

• Focus on FHIR API Exchange: CA v2.0 mandates support for Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface (API) exchange. FHIR is a modern, standardized approach to sharing healthcare data electronically. This standardization will significantly improve the ease and efficiency of information exchange between TEFCA participants, including health information networks and healthcare providers.
• Empowering Patients: By enabling easier information exchange, CA v2.0 empowers patients to access their healthcare information more readily. Patients will be able to use their preferred health apps to access their medical records through TEFCA, fostering greater patient engagement and care coordination.
• Reduced Legal Burden: The release of Participant and Subparticipant Terms of Participation provides a standalone document that can be incorporated into existing data use agreements. This streamlined approach reduces legal complexities and costs associated with connecting to TEFCA, further encouraging wider adoption.

“The initial exchange of clinical data began within 24 hours of the nation’s first Qualified Health Information Networks achieving designation in December 2023,” said Mariann Yeager, The Sequoia Project CEO and RCE lead. “Today’s release includes framework enhancements, including greater use of FHIR, better support for use cases beyond treatment, and simplified onboarding for Participants like clinicians, digital health apps, public health agencies and other end users of health data.”

What You Should Know: 

– Particle Health, a healthcare data platform company, is addressing concerns about a reported data access disruption with electronic health record (EHR) giant Epic. 

– Particle Health emphasizes that the vast majority of its customers continue to receive data from Epic uninterrupted, despite recent announcements suggesting otherwise.

The Dispute and Its Impact

However, Particle Health acknowledges a dispute with Epic that began in March 2024. While the nature of the dispute is unclear, it appears to involve three specific Particle Health customers. Unfortunately, Epic’s response has impacted a larger group of unrelated Particle Health customers, hindering their ability to access patient data. These customers haven’t been accused of any wrongdoing.

Particle Health highlights the negative impact this has had on patient care, as some treatments rely on this data access.

Efforts to Restore Connections

Particle Health has been actively pushing Epic to restore connections for all affected customers. They report some success, with connections already re-established for several customers. Efforts are ongoing to restore service for the remaining impacted parties.

Transparency and Adherence to Standards

Particle Health emphasizes its role in the Carequality interoperability network, a system facilitating data exchange in healthcare. They maintain a positive and constructive dialogue with Carequality and assure they consistently adhere to all network guidelines.

Uncertainties Remain

While Particle Health clarifies the situation, the specific details of the dispute with Epic remain unclear. It’s also uncertain how long it will take to restore connections for all affected customers.

“We will address our dispute with Epic through procedural channels,” said Jason Prestinario, CEO of Particle Health. “The remaining customers impacted by the failure to respond are not involved in this dispute and Epic has not even suggested that they have done anything wrong. We sincerely hope that Epic’s failure to respond to queries of these customers was unintentional and will be resolved shortly. We expect that Carequality will resolve the dispute in Particle Health’s favor. Our priority has and will remain enabling safe and effective access to medical records to facilitate better patient care. Any suggestion otherwise indicates a gross misunderstanding of our company values and the mission of Particle Health,” Prestinario emphasized. 

What You Should Know:

– Rhapsody, a leader in digital health enablement, has unveiled a groundbreaking technology called Rhapsody Autopilot.

– The first-of-its-kind solution utilizes machine learning (ML) to automatically link patient records, ensuring a comprehensive view that aligns with each customer’s specific preferences.

The Problem: Drowning in Data

The healthcare industry faces a growing challenge: a constant surge of patient information. Managing this data effectively, particularly ensuring accurate patient identity across records, is crucial but resource-intensive.

The Solution: Automating Data Stewardship with AI

Rhapsody Autopilot acts like a digital assistant, mimicking human decision-making to resolve data linking and quality issues. It automates preferred actions, leading to several key benefits:

– Improved Data Credibility: Streamlined data linking enhances downstream data reliability for clinicians and other healthcare professionals.

– Reduced Workload: Data stewards and clinicians can focus on more critical tasks as Autopilot handles repetitive tasks.

– Enhanced Patient Safety: Lower duplicate rates translate to fewer errors and ultimately, improved patient safety.

The Benefits: Accuracy, Savings, and Efficiency

Rhapsody Autopilot offers several advantages for healthcare organizations:

– Consistent Decision-Making: This AI-powered solution consistently makes data linking decisions based on pre-defined guidelines, exceeding human consistency rates (72-85%) significantly.

– Measurable Efficiency: Studies show that healthcare organizations using Autopilot achieve a 98% alignment rate with their data matching guidelines. This translates to significant time and cost savings. For instance, automating data stewardship can save teams $150,000 per 100,000 data quality tasks and 50,000 hours of work.

Transparency and Control: Rhapsody Autopilot prioritizes user control. Customers retain full transparency regarding data linking decisions, the underlying data used, and a clear lineage of data handling.

“Healthcare organizations seek ways to drive higher-quality data while reducing cost. Using AI to automate data stewardship is the perfect use case for technological advancements to achieve those goals,” said Sagnik Bhattacharya, CEO of Rhapsody. “With Rhapsody Autopilot, we’re helping improve the effectiveness of teams and products otherwise hampered by poor data quality and incomplete views.”

What You Should Know:

– The Sequoia Project, a leader in promoting nationwide health IT interoperability, has partnered with the American Health Information Management Association (AHIMA) to launch a groundbreaking data usability validator tool.

– The new validator tool aims to significantly improve the quality and usability of health information exchanged across the United States.

Data Usability Taking Root Movement Gains Momentum

This initiative is part of the “Data Usability Taking Root” movement, which encourages organizations to adopt The Sequoia Project’s Data Usability Implementation Guide Version 1. This guide outlines best practices for ensuring health information is accurate, complete, and easily understood by all healthcare stakeholders. Organizations committed to implementing this guide can now subscribe to the first-of-its-kind data usability validator tool.

Benefits of Data Usability Validator Tool

The data usability validator tool offers a multitude of benefits:

Improved Data Quality and Usability: The tool helps organizations ensure their health information exchanges adhere to the Data Usability Implementation Guide Version 1, leading to more accurate, complete, and readily interpretable data.

Enhanced Testing Services: The tool complements existing testing services offered by The Sequoia Project, providing a comprehensive approach to health information exchange quality.

Sequoia Project’s Longstanding Commitment to Data Quality

The Sequoia Project has been a champion of data quality since 2018. Their efforts include supporting content testing programs and providing valuable feedback to HL7®, the organization responsible for the Continuity of Care Document (CCD) standard, to continuously improve data quality.

What You Should Know:

– Trinity Capital Inc. (NASDAQ: TRIN), a leading provider of growth capital to innovative companies announced a $25M investment in Moxe Health, a healthcare interoperability leader.

– The $25M investment from Trinity Capital will empower Moxe to expand its reach and further establish itself as a leader in healthcare interoperability, invest in ongoing development and improvement of its data exchange solutions, and offer new services.

Moxe: Streamlining Healthcare Data Sharing

Moxe Health, based in Madison, WI, uses technology to simplify and improve the secure exchange of clinical data and crucial insights between healthcare payers and providers. Moxe leverages innovative technology to:

– Improve collaboration: By connecting healthcare stakeholders with high-quality clinical data, Moxe fosters meaningful collaboration within the healthcare ecosystem.

– Optimize operations: Faster, more cost-effective data exchange empowers providers and payers to streamline operations and improve outcomes.

– Connecting the Healthcare Ecosystem: Moxe connects various stakeholders, including major health systems and national health plans representing over 150 million US lives.

– Leveraging APIs: Moxe utilizes APIs (application programming interfaces) compatible with leading Electronic Health Records (EHRs) for seamless data exchange.

“Moxe appreciates Trinity’s support and partnership as we further advance clinical data exchange to drive affordable healthcare,” said Dan Wilson, CEO and Founder of Moxe. “We’re excited to scale and innovate, further enhancing our Release of Information and Point of Care Insights solutions to improve healthcare operations and deliver financial and clinical outcomes for our customers.”

What You Should Know:

– Health Level Seven International (HL7®) and The Sequoia Project, leaders in promoting healthcare information technology (health IT) interoperability, announced a strategic collaboration to accelerate the adoption of the HL7 Fast Healthcare Interoperability Resources (FHIR®) standards in the US and globally.

– The HL7 FHIR® Accelerator (FAST) program, initially spearheaded by the Office of the National Coordinator for Health Information Technology (ONC), will continue under HL7’s leadership. This program has played a crucial role in addressing scalability challenges associated with FHIR adoption.

Boosting Interoperability Through Collaboration

This partnership aims to:

Standardize data exchange: By promoting the widespread adoption of FHIR, the collaboration strives to create a common language for exchanging healthcare data between different systems, fostering seamless information flow.

Enhance patient care: Improved interoperability allows for better coordination and communication among healthcare providers, leading to more informed decisions and potentially improved patient outcomes.

Reduce costs and complexity: Streamlined data exchange can lead to reduced administrative burdens and healthcare costs.

Focus Areas of Collaboration

The collaboration will initially focus on aligning efforts in several key areas:

Security: Ensuring secure and trustworthy data access through standardized registration, authorization, and authentication processes.

Patient identification: Implementing consistent and reliable digital identity and patient matching mechanisms.

National directory: Establishing a centralized directory for healthcare providers and organizations.

Hybrid/intermediary data exchange: Supporting seamless data exchange between different systems and platforms.

Consent management: Enabling efficient and secure patient consent for data sharing.

“At HL7, we are delighted to continue the journey toward meaningful interoperability with The Sequoia Project,” said Charles Jaffe, M.D., Ph.D., HL7 CEO. “Close collaboration is certain speed to market health IT interoperability improvements to reduce the strain on health systems, diminish clinician burden, and improve the lives of our patients.”

CMS and Medicare are trying to change the dynamics of American healthcare. No need to rehash the well-known issues but what is new is the change in the hotspot. For the last 20 years, Medicare Fee for Service has been the hotspot of spending and value. You’ve heard the mantra (which dates at least as far back as 1906 with George Bernard Shaw’s play, “The Doctor’s Dilemma”). If you pay a set rate the medical establishment has an incentive to increase volume. Now fast forward to today and Medicare Advantage has more beneficiaries. And the hotspot of healthcare economics has moved to Medicare Advantage (MA). 

MA plans are paid by capitation for each patient. Now the incentive, or as economists say the “moral hazard,” has shifted from doing more in Medicare FFS to doing less in MA. Capitated health plans can provide great care (disclaimer: I worked at Kaiser, the OG of capitated care, for several years). But we can’t ignore all the folks, including Don Berwick, former acting administrator of CMS, and my ONC predecessor David Blumenthal, suggesting that we are paying some MA plans far more than we should. 

CMS is at the center of our country’s efforts to fix healthcare. Which policies should CMS pursue and in particular what policy levers CMS has to address the clinically appropriate allocation of care.  The picture of this challenge is best crystalized in prior authorization policies that are designed, for better or worse, to limit care. And simultaneously we are in times where our lives are being transformed by digital technologies – a fact known to every reader of this piece. The team at CMS is aware of both of these dynamics and has been quite interested in leveraging the best of modern computing to bring value to the American public. Digitally, this started with the bi-partisan BlueButton™ initiative to allow Medicare beneficiaries access to their data.

CMS is now harnessing the power of digital interoperability to improve the accountability, transparency and ultimately availability of care, in particular in MA. In a move in the works for the last year, CMS just announced a new mandate to do just that: the Interoperability and Prior Authorization Rule Final Rule.

CMS has identified two pieces in this process. 

1. Doubling Down on API Implementation

First CMS is doubling down on APIs (application programming interfaces) to make payer data on the care rendered widely available. The new rule extends the current payer-side Patient APIs and adds new APIs to allow providers and other payers to get data from current or past payers. What makes these APIs technically feasible are the rapid advances in modern Internet API protocols (most notably the RESTful approach to programming) and refined JSON-based FHIR healthcare data standards which finally allow computing on claims and clinical data using a single data representation. (Sorry about the RESTful and JSON FHIR jargon but both terms are worth searching and understanding).

2. Modernizing Prior Authorization Processes

In parallel, CMS is saying “enough is enough” to the burdensome and antiquated prior authorization processes that are ensnaring doctors, hospitals, and most importantly patients throughout the country. In a push toward real accountability, CMS has put several requirements to achieve greater transparency into the new Prior Authorization and Interoperability Rule. 

Most immediately, CMS is requiring that by January 1, 2026, affected plans (MA plans, Medicaid/CHIP programs, QHPs on the FFE) need to answer “expedited” prior auth requests within 72 hours and “standard” requests within 7 days, and provide an explicit reason for any denials. All of this is also required to be publicly reported on the payer’s website though the reporting is in aggregated form. 

The real transformation will come a year later with the requirement for a Prior Authorization API and parallel incentives for doctors and hospitals to use this API. With this API, providers can get prior authorization of their non-drug orders digitally and bi-directionally. Currently Prior Authorization is done with flurries of faxes, phone calls, and private portal log-ins. An HL7 standards group FHIR accelerator called DaVinci is leading the way with specific technical implementation guides. DaVinci participants include many constituencies including payers and providers. Some of these standards will be an evolution and in progress over the next three years but care approval and payment is trending in the direction of the consumer economy where we can order and have almost anything delivered to our homes. 

At their face, these new CMS policies seem largely technical but the ultimate result will be a seamless digital healthcare with computational transparency and accountability. We are finally going to be able to get value-based care.

About Donald Rucker, MD

Donald Rucker, MD is Chief Strategy Officer for 1upHealth, where he is helping to set the direction for the company’s ongoing innovations in FHIR-enabled computing and bring these to customers to help them meet the evolving clinical, technical, and reimbursement demands for modern data. Prior to 1upHealth, Dr. Rucker was the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, where he led the formulation of the federal health IT strategy and coordinated federal health IT policies, standards, programs, and investments. As part of his tenure with ONC, he led the development and issuance of the 21st Century Cures Act Final Rule, a pivotal mandate supporting patient access and interoperability of health data.

What You Should Know:

– A new survey reveals that the healthcare industry is making significant strides towards interoperability, thanks to the adoption of standards-based application programming interfaces (APIs).

– The research, conducted by the Office of the National Coordinator for Health Information Technology (ONC), reveals that a majority of digital health companies are using the FHIR standard to integrate with electronic health records (EHRs).

The Rise of FHIR

The Cures Act Final Rule mandated the use of FHIR for certified APIs, promoting data standardization and simplifying connectivity between EHRs and third-party applications. The survey data demonstrates that both EHR vendors and digital health companies are complying with these regulations, paving the way for smoother information exchange.

Most Digital Health Companies Embrace Standards-Based APIs for EHR Integration, But Challenges Remain

Key findings of the survey include:

– 73% of surveyed digital health companies use standards-based APIs, primarily the FHIR standard, to integrate with EHRs.

– Companies connecting with multiple EHRs exhibit higher FHIR adoption (75%) compared to those with single EHR integrations (25%).

– Despite widespread adoption, concerns about high fees, lack of testing data, and limited data elements hinder broader API utilization.

– ONC initiatives like Lantern, Inferno, and the recent HTI-1 rule address barriers and expand data access through standardized APIs.

Looking Ahead

This survey offers valuable insights for stakeholders across the healthcare landscape. Developers, providers, and policymakers can leverage these findings to address remaining challenges and accelerate the realization of seamless electronic health information exchange.

Like tales of Bigfoot and UFO sightings, talk of Qualified Health Information Networks (QHINs) has been met around the health industry with some skepticism, with some in health IT asking, “Are QHINs real?”

Though the question was posed partly in jest, doubts about the reality of QHINs have been somewhat understandable. QHINs were created as part of the Trusted Exchange Framework and Common Agreement (TEFCA), a set of regulations designed to improve healthcare interoperability by establishing standards and infrastructure to ease data exchange among key stakeholders such as providers, payers,  and their information technology partners. 

The first draft of the TEFCA was unveiled all the way back in January 2018 by the U.S. Department of Health and Human Services (HHS), through the Office of the National Coordinator for Health Information Technology (ONC) – leading many to wonder whether QHINs would ever see the light of day. 

Now, however, those doubts can be laid to rest, as a result of a major milestone the healthcare IT industry reached as HHS announced in December 2023: TEFCA is now operational and QHINs are finally real. 

What are QHINs?
QHINs are a centerpiece of TEFCA. QHINS are networks of organizations that work together to share data and connect directly to each other to ensure interoperability between the networks they represent.

“QHINs are the pillars of TEFCA network-to-network exchange, providing shared services and governance to securely route queries, responses, and messages across networks for eligible participants including patients, providers, hospitals, health systems, payers, and public health agencies,” according to ONC. 

The ONC’s December announcement noted that five organizations have been officially designated as QHINs after undergoing a rigorous onboarding process: MedAllies, eHealth Exchange, Epic Nexus, Health Gorilla, and KONZA. As a result of the designation, these QHINs can begin supporting healthcare data exchange under TEFCA’s technical requirements and policies. 

These five QHINs, as well as two QHIN candidates working through the implementation process, operate networks that cover most U.S. hospitals and tens of thousands of providers and process billions of annual transactions across all 50 states, ONC stated. 

What QHINs will do for interoperability
Designating official QHINs, however, was just an early step in getting TEFCA off the ground. The real value of TEFCA will accrue as QHINs onboard more and more customers, and those customers realize the benefits of seamless healthcare data exchange. Here are four ways that QHINs will improve healthcare interoperability: 

1. Connect more healthcare organizations: It’s estimated that around 70% of hospitals and more than half of ambulatory providers are connected to a national network. While most large provider groups across the country are connected, smaller rural providers and non-traditional providers such as post-acute care and home health have lagged. As QHINs streamline the technical requirements and reduce potential legal burdens of data sharing, more health entities will establish connections with national networks. 
2. Increase the usability of healthcare data: One of the greatest barriers to widespread interoperability has been the challenge of messy healthcare data, which is often incomplete, inconsistent in terminology, and fragmented across multiple information systems. TEFCA and QHINs will help solve this problem by providing technical standards and framework to underpin health data exchange. With more accurate, complete, and up-to-date data, physicians can make better decisions to generate better health outcomes. 
3. Expand the use cases for healthcare data: The major use case of improving patient care and treatment through better healthcare data sharing has been well-established to date. However, QHINs are expected to support several emerging use cases, including individual access service, public health, benefits determination, and payment and operations. Many health IT stakeholders are still working through the details of these additional use cases. 
4. Break down industry siloes: The more complete and accurate flow of information between healthcare entities will allow QHIN participants to improve collaboration and care coordination, breaking down many of the siloes that continue to affect the industry. With more comprehensive patient information at their fingertips, providers can make better diagnosis and treatment decisions, reduce unnecessary and duplicative tests and procedures, and more productively work together across different areas of medicine. 

The tongue-in-cheek debate is finally over and QHINs are indeed real – and well-positioned to drive legitimate, tangible progress toward achieving the elusive goal of interoperability by driving better usability and broader uses of healthcare data.

About  John Blair, MD

A. John Blair, III, MD, F.A.C.S., III, MD, F.A.C.S. is the CEO of MedAllies, a national healthcare connectivity services provider. He is a health care and technology executive with broad experience across the health care industry including clinical practice, hospital planning and governance, revenue cycle management, managed care, public health and health care informatics. Prior to establishing MedAllies in 2001, Dr. Blair worked as a general surgeon for twenty years before becoming the President of the Taconic Independent Practice Association (TIPA), a network of over 5,000 physician members.

What You Should Know:

– The healthcare industry sits on a goldmine of data, yet 97% of it remains unused, according to the World Economic Forum. To unlock the immense potential of this information, digital healthcare leader Innovaccer has joined forces with Wolters Kluwer, a global provider of professional information and software solutions.

– The strategic partnership aims to transform raw data into actionable insights, ultimately improving patient care and driving healthcare innovation.

Bridging the Data Gap for Better Care

One of the biggest challenges in healthcare is the fragmentation of data across different systems and formats. Normalizing and unifying this data is crucial for gaining a holistic view of patients and making informed decisions. This is where Innovaccer comes in.

Innovaccer’s data platform excels at bringing together disparate data sources, including structured and unstructured clinical records. By leveraging Wolters Kluwer’s Health Language Platform, a terminology services platform, Innovaccer can:

• Harmonize information: Remove inconsistencies and misinterpretations by applying standardized medical terminology.
• Codify patient data: Convert unstructured data into structured formats for easier analysis and utilization.
• Create a 360° view of patients: Provide healthcare providers with a comprehensive understanding of each patient’s medical history, current status, and potential risks.

Realizing the Value of Clean Data

This collaboration benefits various stakeholders in the healthcare ecosystem:

• Health plans: Improve risk adjustment and population health management with accurate and insightful data.
• Life science companies: Generate valuable research insights and develop targeted interventions.
• Provider organizations: Optimize clinical workflows, personalize care delivery, and make data-driven decisions.

Kanav Hasija, Co-founder and Chief Product Officer at Innovaccer, emphasizes the significance of data quality: “Dirty data hinders the healthcare industry’s ability to improve patient care and reduce costs. Our partnership with Wolters Kluwer empowers us to deliver clean, reliable data that unlocks its full potential.”

What You Should Know:

– MEDITECH, a healthcare information technology company, is joining forces with the Biden administration’s ambitious Cancer Moonshot initiative to improve cancer care through data standardization and collaboration.

– Announced at the ONC Annual Meeting, this partnership signals a significant step towards achieving better health outcomes for millions of Americans impacted by cancer.

Standardizing Cancer Data for Improved Care

The Cancer Moonshot initiative, aligned with the USCDI+ for Cancer objective, aims to:

• Standardize crucial cancer data elements: By establishing consistent data definitions across electronic health records (EHRs), healthcare systems, and research institutions, the initiative seeks to facilitate seamless data exchange and analysis.
• Drive advanced cancer research: Standardized data fosters collaboration and unlocks the potential for groundbreaking research, leading to the development of more effective treatments and personalized care pathways.
• Improve patient outcomes: Access to timely, high-quality data empowers clinicians to make informed decisions, optimize care coordination, and ultimately improve patient survival rates and quality of life.

“Better integration of health care delivery and human services is critical to strengthening “whole-person” care, advancing health equity, and improving customer experience,” said Micky Tripathi, Ph.D., National Coordinator for Health Information Technology. “ONC has focused for many years on increasing patient-centered health care interoperability, and we are eager to support the HHS Data Strategy’s vision for human services interoperability.”

What You Should Know:

– The U.S. Department of Health and Human Services (HHS) has released its comprehensive Data Strategy, outlining a vision for leveraging data as a powerful tool to improve health outcomes and advance the Biden Cancer Moonshot.

– The strategy expands the Office of the National Coordinator for Health Information Technology (ONC)’s role to encompass human services interoperability in addition to its existing focus on healthcare interoperability. This ensures seamless data exchange across the entire health and human services ecosystem, leading to a more unified and effective system.

Data Strategy Overview

Key pillars of the new data strategy include:

– Data Accessibility and Equity: The strategy emphasizes making data available, accessible, timely, and equitable for all stakeholders, including HHS, its partners, and the public. This ensures informed decision-making and promotes equal access to data-driven benefits.

– Cancer Research and Moonshot Support: The strategy prioritizes data access for cancer research, aligning with President Biden’s Unity Agenda and the Biden Cancer Moonshot’s ambitious goal of halving the cancer death rate within 25 years. By unlocking data’s potential, the strategy aims to accelerate breakthroughs in cancer prevention and treatment.

Five Priorities for Data Transformation

The strategy outlines five key priorities for transforming HHS’s data infrastructure and capabilities:

– Cultivating Data Talent: Building a qualified and future-proof data workforce to manage and utilize data effectively.

– Fostering Data Sharing: Establishing trusted, high-quality data sharing mechanisms within HHS and with external partners, promoting collaboration and innovation.

– Integrating Administrative Data: Weaving data into routine program operations and decision-making at all levels for better resource allocation and program effectiveness.

– Enabling Whole-Person Care: Connecting human services data to create a comprehensive view of individuals’ needs and well-being, enabling “whole-person” care delivery.

– Responsible AI Leverage: Utilizing artificial intelligence (AI) ethically and safely to improve quality,  efficiency, access, and outcomes in health and human services.

“Better integration of health care delivery and human services is critical to strengthening “whole-person” care, advancing health equity, and improving customer experience,” said Micky Tripathi, Ph.D., National Coordinator for Health Information Technology. “ONC has focused for many years on increasing patient-centered health care interoperability, and we are eager to support the HHS Data Strategy’s vision for human services interoperability.”

What You Should Know:

– The U.S. Department of Health and Human Services (HHS) took a major step forward in healthcare data sharing and artificial intelligence (AI) transparency with the finalization of the Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) rule.

– This rule was finalized after months of public feedback, promises to revolutionize how healthcare data is used and accessed in the United States.

Key Highlights of the HTI-1 Rule

This final rule builds upon the proposed rule released in April 2023 and addresses four key areas:

1. Algorithm Transparency

The HTI-1 rule establishes the first-ever nationwide requirements for transparency around artificial intelligence (AI) and other algorithms used in certified health IT. This affects the vast majority of healthcare providers, with ONC-certified health IT supporting over 96% of hospitals and 78% of office-based physicians.

This groundbreaking move aims to promote responsible AI by empowering clinicians with a consistent set of information about the algorithms they use to inform their decisions. This includes details about the algorithms’ fairness, appropriateness, validity, effectiveness, and safety.

2. USCDI Version 3

The rule adopts USCDI Version 3 (v3) as the new baseline standard for data exchange within the ONC Health IT Certification Program. This updated standard focuses on capturing more accurate and complete patient characteristics data, potentially reducing disparities and supporting public health data interoperability. Developers will have the option to move to USCDI v3 earlier than the January 1, 2026, mandatory adoption date.

3. Enhanced Information Blocking

The HTI-1 rule revises certain information blocking definitions and exceptions to facilitate data sharing between healthcare providers and patients. It also introduces a new exception to encourage secure and efficient data exchange under the Trusted Exchange Framework and Common Agreement (TEFCA).

4. New Interoperability Metrics

The rule implements the 21st Century Cures Act’s requirement for certified health IT developers to report specific metrics about how their products are used in healthcare delivery. This will provide valuable insights into the real-world impact of health IT and inform future improvements.

“The HTI-1 final rule is a major win for patients, providers, and the future of healthcare,” said Micky Tripathi, Ph.D., national coordinator for Health Information Technology. He emphasized the importance of continued efforts to build a stronger digital foundation for healthcare and ensure that technology serves to improve patient access, care quality, and well-being for all Americans.

The HTI-1 final rule is posted at HealthIT.gov/HTI-1 and will be submitted to the Office of the Federal Register (OFR) in the coming days