Medicity has a wide range of customers, including state and regional HIEs, enterprise-sponsored HIEs, ACO and PCMH infrastructures, and ambulatory physician-to-physician HIEs that have grown up organically in their community. We are fully immersed in optimizing care coordination, doing tangible work in the trenches, learning every day, making our solutions increasingly congruent with clinical practice and care improvement – and ultimately helping everyone derive more and more value from our software and from their existing systems by all meaningful metrics.

In addition to our work in the trenches, Medicity takes an active role in industry workgroups and standards-setting bodies. For example, we have been involved in the NHIN Exchange since 2007 and sit on Direct Project workgroups. In fact, we have deployed technology in Direct Project pilots and in several states. We also participate on IHE committees and have issued IHE Integration Statements. This range of involvement – from the everyday work on the ground to participation with standards bodies – ensures that standards both respond to real-life needs and are, in turn, implemented to facilitate interoperability.

No homogenous structure or network is going to emerge overnight; rather, interoperability work and developments will be happening in parallel. A lot of people are working on the interoperability issue at the same time, and no one-size interoperability solution will fit the needs of all. For accountable care organizations (ACOs) to operate effectively, the ACO will need to deploy HIE functionality. At the same time, states and regions are deploying HIEs. Even decentralized, peer-to-peer exchange networks are beginning to emerge.

All of these separate players and operators will converge somehow in the future, but no one need get caught up in the details of that convergence right now. It will happen organically over time. Over time, network infrastructures may be rolled up or consolidated, but without tangible efforts now, that day will never come.

Connected health will be in a good place seven to eight years from now. For the moment, there is a ton of momentum, and the progress won’t stop anytime soon.

Healthcare organizations need to focus on solving their core business problems today. Convergence with other interoperability-minded organizations will come in time when it makes the most logical sense and is driven by market demand. The key is to adopt a flexible interoperability infrastructure that can adapt to changing market needs without requiring any wholesale rebuilds of the system.

Organizations also have to be careful not to get confused by the standards initiatives. Rather than get too caught up in the details of these initiatives, decision-makers need to focus on ensuring that the approach they take for deploying a health information network today is flexible enough to account for evolving standards and frameworks for security and communication. They need to take care that the solution they select for interoperability has demonstrated the ability to exchange information via both “legacy” standards (HL7 2.x, flat files, etc.) and contemporary ones (IHE standards and web-services-based exchange of CCDs). This range and experience with exchange standards is a good indicator of a solution’s future performance in an evolving industry.

MHC licenses Medicity’s iNexx Referrals app to connect healthcare providers and facilities of many types, including primary care, specialists, community clinics and long-term care. The free app gives providers the ability to send, receive and manage electronic referrals in their office with any other provider in the MHC network.

Medicity designed the referrals app to solve a major practice pain point. The manual process of referring patients to other practices involves filling out and faxing paper forms, followed by numerous phone calls between practices to ensure all of the information is passed from the referring provider to the receiving provider. This process has to be repeated in reverse if the referring provider wishes to follow up on the results of the referral. Since gaps in the care record frequently occur at the transition of care, providing electronic referrals functionality not only eases administrative processes in the practices but also improves care coordination and quality across the community.

MHC has successfully deployed the Referrals app to nearly 1,000 physicians in 278 offices, 28 counties and 206 specialties. The Referrals solution – provided to independent community-based providers at no cost – electronically connects providers across transitions in care regardless of their electronic medical record (EMR) system or if they still use paper charts.

But the real story driving interoperability is accountable care organizations (ACOs).  “Accountable care” is a concept of organizing and delivering health care which strives for:

• Better care
• Lower cost
• Enhanced patient experience

Tying these together are new provider payment strategies that encourage a higher quality of care at a higher value. An accountable care organization is an existing group of providers, typically a health system, who agree to follow the new accountable care concept of health care delivery and to focus on optimizing the health of a population of patients.

To deliver on this new model of care delivery, providers must be electronically connected so they can collaborate in new, efficient ways never seen before in the United States – and interoperability is at the core of this effort. Because of this, the blank stares we got a few years ago when we evangelized the concept of online collaboration have turned into nodding heads. This shift validates that technologies like ours are not just nice-to-haves, but must-haves.

The result: “Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.”

To flesh out their definition, this same committee also called out several dimensions of interoperability:

• Uniform movement of healthcare data from one system to another
• Uniform presentation of data
• Uniform safeguarding data security and integrity as data moves from system to system
• Uniform protection of patient confidentiality
• Uniform assurance of a common degree of system service quality

(Read the HIMSS paper. [PDF])

With more than 10 years under our belts of enabling health information systems to interoperate, Medicity is at the forefront of making true interoperability a reality. Join us here over the next few weeks as we share our insights on a number of aspects of interoperability.

What does our success at the IHE Connectathon mean? That we are able to walk the walk – not just talk the talk – when it comes to implementing the entire gamut of standards-based health information exchange. It also proves our ability to integrate seamlessly within the workflow of EHR systems.

We passed every profile we tested at the event, focusing particularly on those related to the following HIE services:

• Identity Management Services: PIX v3 (manager), PDQ v3 (manager)
• Record Locator Services: XCA (initiating and responding gateway) and XCPD (cross-community patient discovery)
• Audit and Logging: ATNA (client and server), CT (consistent time)
• Exchanging data within the workflow of an EHR system:  (eXchange Document Service – XDS.b and the associated security profiles)

Health IT vendors that we demonstrated interoperability with during testing included:

• EHRs:
  • Allscripts (Enterprise, Professional, My Way and Sunrise)
  • Cerner (PowerChart, BrowserSoft)
  • NextGen
• HIE vendors:
  • CertifyMD
  • Oracle
  • Harris/CareFx
• And many more …

IHE is a recognized leader, both nationally and internationally, in creating healthcare industry standards related to the exchange of clinical information across organizational boundaries. Key IHE standards were adopted by the Nationwide Health Information Network Exchange (NwHIN Exchange) and the Direct Project. And many statewide, regional, and private HIEs leverage IHE standards.

What does a stable partner look like? Many companies have come into healthcare IT simply because the opportunity is rich and there is money to be made. Stability, however, comes from companies that are fully invested in healthcare and in technology solutions designed to assist providers in their efforts to lower costs, improve quality, and navigate the changing healthcare landscape. Medicity has been in the business of creating technology for healthcare providers since 1999 and remains solely focused on serving the healthcare market. Find out more about what a stable partner can do for you.

Medicity technology facilitated the exchange of Direct messages between physicians’ offices in Lima, Ohio, and Biloxi, Mississippi. Mississippi’s state-designated HIE – the Mississippi Health Information Network (MS-HIN) – is also a Medicity client.

“We at ONC are excited to see this first productive use of Direct protocols for the exchange of health information between two states,” said Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology.

The Partnership also performed live instances of Direct messaging within the state of Ohio. Get more details from the Ohio press release that circulated today.

With these successful exchanges of Direct messages accomplished, the Ohio Health Information Partnership and Medicity are finalizing a mass deployment plan to provide all Ohio practices with our Direct application. We look forward to additional breakthroughs and firsts in this new frontier of health information exchange.

Specifically, emerging HIE technology is making collaboration possible at lower levels of care. For example, technology now enables point-to-point referrals from one physician practice to another. This means that a physician practice’s staff can conveniently manage what is happening in the care of the patient on each end of the referral. Just being able to see when a patient is scheduled and whether he or she shows up for the appointment adds a transparency that significantly improves management of the patient’s care. These are simple concepts, but they have enormous impact on the health care provider and systems themselves, Robert says.

HIE technology will evolve in two layers – the top layer being aggregating information, normalizing it, creating an entire view of a population; the lower layer facilitating the care of a particular individual. A social-networking approach to sharing health information will emerge, Robert predicts, with micro HIEs appearing to create a network around a patient that involves only members of that specific patient’s care team, regardless of brick-and-mortar boundaries between these providers.