FHA director discusses progress of health IT interoperability projects

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We interviewed Vish Sankaran, director of the Federal Health Architecture program, about how the FHA is advancing its mission of health IT interoperability with such open source tools as Connect and popHealth. He explains how Connect provides a universal client framework, allowing innovators to build applications that will add intelligence to health data as it moves through a secure pipe. The popHealth tool, which is a prototype, can be downloaded and integrated into an existing electronic health record, or EHR, system to automate population health reporting.

According to Sankaran, one of the most important lessons attendees of the HIMSS10 annual conference should have taken home is that health IT interoperability is gaining traction. He believes health organizations are moving beyond theory and into implementation, noting the numerous real-world examples of interoperability being demonstrated at the FHA booth at this year's conference.

Watch this video to see what else Sankaran has to say about the future of health IT interoperability.

Let us know what you think about the story; email [email protected]

Read the full transcript from this video below:

FHA director discusses progress of health IT interoperability projects

Don Fluckinger: We are here at the SearchHealthIT.com booth with Vish Sankaran, Program Director for the Federal Health Architecture. Thank you for joining us today.

Vish Sankaran: Thank you for having me.

Don Fluckinger: Well, explain to those watching us on the web today, what exactly the Federal Health Architecture is, and your role in it?

Vish Sankaran: Federal Health Architecture is a coalition of over 20 federal agencies with health-related activities in the federal government.  The vision of FHA is to advance interoperability among the federal agencies, because we do business across agencies, also with our stakeholders outside, which includes states, tribal, the local and the private sector. We pretty much make sure that when we do business we do it in a very interoperable fashion. That is one aspect of what we try to do.

The second aspect is to build common solutions for common problems, and avoid repeating that. That way we can reduce our cost to the process, also increase the quality of the service we provide to our citizens, because the end goal for us, from a federal government
perspective is to provide citizen-centric, information-driven services.

Don Fluckinger: Would you consider yourself cutting-edge adopters of a lot of the technology that the hospitals and physicians who are here walking the HIMSS show floor, what they are going to be doing in the next five years?

Vish Sankaran: I would say the federal government is one of the early adopters of many of the technologies, but we have to also make sure we address all the security and privacy concerns of adopting any new technologies. It is the kind of population we take care of, and the
responsibility that we have is also to make sure that we do it in the right, organized, thoughtful process. We could see more of these technologies being adopted in the federal government. A good example is the Connect Project, that I know we are going to talk even more about, but that is one of those early projects that happened. Information exchange had to happen, agencies came together, they build a common solution, and they are adopting it. Last year we had 7 agencies, we have 12 here today.

Don Fluckinger: So the announcement that was made in the last hour, how does that affect your work?

Vish Sankaran: Can you. . .

Don Fluckinger: The . . .

Vish Sankaran: NHI and Direct?

Don Fluckinger: The certification of the HRs, does that affect anything that . . .

Vish Sankaran: Not directly on the Connect Project, but at the same time, the federal agencies, the ones that provide care like the DODs, the VAs, the IHSs, will be looking into those certification processes to make sure they are also compliant with the national agenda.

Don Fluckinger: Right. In effect, you are going to be eating that cooking as well?

Vish Sankaran: That is correct.

Don Fluckinger: Ok.

Vish Sankaran: We got to eat our own dog food, yes.

Don Fluckinger: I would not eat dog food, but. Last week, Kathleen Sebelius announced an inter-agency Health IT task force, last Thursday. How does that affect what you're working on, or does it not?

Vish Sankaran: That is a good question. If you look at the announcement, there was a mentioning of Federal Health Architecture, as part of it, and Federal Health Architecture is an operation arm, not a policy arm; the technology arm. The ONC defines the national strategy, and we need to make sure, among the federal agencies, that we are advancing that goal, interoperability, making sure we meet some of the
needs of the different agencies as part of the process. What comes at the national-level - policies, governance, and nationwide health information that Dr. Doug Fritzmer talked about - our role is to make sure, among the agencies, that they all agree; their feedback also gets into the process, so when there are policy decisions made, or technology decision made at the ONC level, the Federal Health Architecture community, which is made up of all these federal agencies, will come together. They will say, 'OK. What’s their in and out,' so when meaningful use requirements comes out, the federal agencies provide their comments back to the process. Why I call the Federal Health Architecture high-level, it is the voice of the federal government, federal agencies that has to be reflected in the national agenda.

Don Fluckinger: What are the major issues you are going to be tackling this year, and what are your goals here at HIMSS with the projects you are showcasing?

Vish Sankaran: The most important thing, when you walk through those demonstration areas at the Federal Health Architecture; it is real. These are not theory, these are not paper documents. Organizations are coming together. It is even beyond the federal government, even though this project started within the federal government, it has gone even beyond the federal government. Multiple state entities are engaged, cities are engaged, counties are engaged. You got the private sector entities supporting them, entities like Mayo and Kaiser Permanente. At the same time, you also have small providers. When we release the Connect software to the public, a small 90-bed hospital out of Nebraska, called Thayer System, took the software, implemented the software in their organization, and connected their existing Health IT system, and they were able to reduce medication error.

These are stories that, our expectation as part of the process, was to create the platform for innovation and the platform for collaboration. You are going to see more entities coming along, moving that forward, things that you may or may not know. And that is fine, that was thinking that we had behind that overall approach for Connect.

Don Fluckinger: Speaking of Connect, I heard you present last month in Boston, at the Healthcare Stimulus Exchange. You mentioned how some developers may be making apps for Connect. Give me a background or a little more details on the apps that people might develop for Connect.

Vish Sankaran: If you look at the way Connect has been structured, it is the pipe for the movement of information. You get data from point A to point B in a secular fashion over the internet. That is a software implementation of the NHIN specifications and standards. What we want to do . . . can I, if you do not mind, just the last part of your question again.

Don Fluckinger: You were talking about, you were encouraging private sector developers to consider building apps for Connect. Explain how that would work, and what would the apps do?

Vish Sankaran: Got it, Ok. If you look at that as the pipe to getting data from point A to point B. As part of our Connect Suite, we are providing what we call a universal client framework that allows organizations, innovators, to really start building more applications with the data
they collect at the end of the pipe, or what they sent through the pipe. We want to get more intelligence on the edge of the pipe. A good example is multiple universities around the country have come together and they are going to challenge the students, as part of the thesis
for undergraduate computer students, if they can build applications as part of it. At the Connect Code-a-Thon that is going to happen in Florida next month, there is a challenge issued by the university and whoever can build this particular kind of application at the edge is going to win that challenge.

You are going to see a lot more innovation happening because we are going to make the data available to the organization, and one of the goals of really releasing Connect as open sources is we wanted to raise the bar on information exchange. We wanted to make information exchange a commodity, and once the data comes out of these pipes, that is where the innovation happens. Let me add one more thought, this might be a 10 to 15 year thought. That is, today we talk a lot about EHRs and PHRs.

Don Fluckinger: Right.

Vish Sankaran: This is my personal view on this; it is a boxed concept. What I mean by that is, we want to really get to a point where it is not just moving data from point A to point B. When you move data, you want to make data entering the pipe and knowledge coming out of the pipe. What that means is, applications have to be self-formed based on the doctor's needs and the patient's situation. That is a concept at a high level, if you to look at it, that is where the industry will be moving in the coming years, where the applications that when you go to the same doctor and I go to the same doctor, it is not the same applications. The applications have to be self-formed based on the patient's situation and the doctor's needs.

Don Fluckinger: On condition, or demographic, or . . .

Vish Sankaran: Exactly.

Don Fluckinger:. . .sorted by your personal filter.

Vish Sankaran: Exactly. When the data flows through the pipe, Connect, if you consider that as a pipe, one of the opportunities that organizations have to build as part of that, is to build knowledge. You got data coming into the pipe, but you have intelligence running inside the
pipe, so when it comes out from this end, depending on who is going to use it for what purpose, on the context you get knowledge coming, rather than raw data coming out, then you have another set of engines that need to run to make it knowledge.

Don Fluckinger: Now explain what POP Health is.

Vish Sankaran: POP Health, the concept is, as part of the meaningful use discussions that are going on, organizations are required to shift quality measures to CMS, from the EHR; it is a requirement of meaningful use 2011. We do not have enough applications today to make that as part of existing workflow. The problem today is you have to collect it, then you have to have an intelligence process, you have to analyze the data, mine the data, ship it to CMS. CMS then may or may not come back and say, 'This information is correct. It is not correct, we need to correct it'; it is a very long process, so it is costing organizations. If you can make it a part of the existing workflow of an organization - so POP Health was designed, it is a prototype. It can be downloaded; you can add that onto your existing EHR that can create a C32 document. If a requirement for meaningful use is to create a C32, it can generate a C32, you can apply this patch, what I call, just like what we do on the internet; we need an additional software, you
download that, add that. If you have the patch, that patch has got an engine in it which will take the C32 and create these buckets of information based on whether its immunization information, quality measures, case reporting to public health. Then it will, the organization -  this all happens within the organization - and the organization can then ship that information to the appropriate agency when they are needed. That is one goal of the
application, to create the reporting requirements.

The second area is to allow the organization, whether it is a two-position office or it is a multi-bed facility, this tool will allow someone, which has got a graphical interface and an intelligence
engine to it, to do analysis of the population health, to know the health of my population, the people I take care of, how much of them are well-managed from cholesterol, diabetic, or smoking cessation, all these things can be identified based on the information that is gathered in the database. That is what we released as a prototype.

There is another product out of New York called POP CCR, which has been doing some of this advanced work - intelligence, they got a lot more intelligence into the product; this is also available as an open source in the coming months. There are two products right now, and we will figure out what the strategy is to go forward with this, but our expectation is EHR vendors will start integrating these features directly into the product. We are not expecting this to be a standalone product, we want this to be available as part of the existing workflow of these products.

Don Fluckinger: Right. OK. What would you have to say to our readers? We are looking at CIOs of hospitals, physicians, people working at small clinics; they are looking for health IT information. You have the platform, if you had one thing you could say to them, what piece of advice or bit of encouragement?

Vish Sankaran: Encouragement is, yes, things are moving forward, things are very much moving forward. They should look at some of these connectivity solutions, like Connect and other vendors, a lot of vendors who are taking connect and building solutions. Try to make that as part of their existing solution, and over a long period of time, I would say in the next five to ten years, we should not be talking about interoperability as a separate piece. It should be well integrated into the products we have, and interoperability and electronic health records should allow organizations to improve the quality of care they provide, but also, improve their efficiencies of that particular organization.

Don Fluckinger: To the single physician in a single office, in a small town, in the United States somewhere, it must be comforting to know that there is a guy like you, who estimates, 'These Federal Agencies do the same thing,' but he just has to do for his or her patient populations.

Vish Sankaran: Yes. What is exciting about the Federal Health Architecture and I want to give full credit to the federal agencies, because there was a business need at the right time that they all decided to come together to advance the goal forward, so you see that kind of encouragement from the federal agencies, they want to work together well, and it is really exciting to see your government is really pushing together on this concept of advancing the overall agenda.

Don Fluckinger: Eating their own dog food.

Vish Sankaran: Yes.

Don Fluckinger: Thank you very much for your time.

Vish Sankaran: Thank you very much. Thank you.

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