What’s the Glue Holding EHR Migration and Conversion Projects Together?

Caristix is sponsoring a series of blogs posts on John Lynn’s Hospital EMR and EHR blog. You can read the latest post, What’s the Glue Holding EHR Migration and Conversion Projects Together? here: http://www.hospitalemrandehr.com/2015/08/13/whats-the-glue-holding-ehr-migration-and-conversion-projects-together-optimize-healthcare-integration-series/

We’re focusing on the particular issues of QA. What are the tools you need to support the work of your QA teams?

What Can HIEs Do to Overcome Interoperability Barriers?

Cost and technical barriers?

Overcoming interoperability barriers

As soon as you hear the word “interoperability” in healthcare, “cost” and “complexity” are right around the corner. If you’re a technical leader at an HIE, this won’t come as a shock. In a recent survey, 59% of HIEs see the cost of interface development as a barrier. And another 38% view technical difficulty in interfacing as their biggest hurdle.

So what’s the solution? 

For starters, there is no easy technical fix. Direct messaging can tackle some use cases. You can look at FHIR down the road. And maybe regulators will scrap the use of standards that are still under development (C-CDA, we’re looking at you).

But there’s no waving a magic wand and making HL7 v2.x interfaces disappear.

Here are 5 recommendations to deal with the core need and make it easier to develop and manage interfaces and overcome interoperability barriers:

  1. Get a hold of the requirements process. Better HL7 requirements give you better communication, with more trust and confidence around what the team is actually developing – and less revisiting the obvious. Read more about HL7 requirements
  2. Agree on testing upfront. Here’s a testing checklist to get you started
  3. Document workflows for your interfaces. Not convinced it’ll help? Read why you should
  4. Make sure the test environment is set up right. Here’s how to get started
  5. Documentation HL7 profiles and specs. Not just for development requirements but also for the rest of the interface lifecycle. Read our two-part series on documenting HL7 profiles and specs: Part 1 and Part 2.

 
Caristix software and HIEs: interface lifecycle management 

You can cut interface development time – and cut waste from the entire interface lifecycle with Caristix software. Learn more via the Caristix Workgroup on-demand demo.

Resources for CDA, CCD, and Consolidated CDA Documents

In our discussions with vendors and providers on these new standards, we’ve seen a wide range of learning curves. Some people are just getting started, while others are knee-deep in live exchange. What are the tools and resources that are out there? This blog post gives you a handy list  of resources for CDA, CCD and consolidated CDA documents to get started.

Start with HL7 International

HL7 International is the standards developing organization for healthcare data exchange and integration. They provide the fundamental resources you’ll need to implement CDA. One good place to start is the Implementation Guide for CDA R2 CCD.

Another great resource is Keith Boone’s healthcare standards blog, Motorcycle Guy. Keith blogs extensively on how healthcare data standards are developed, and he provides insight into how to implement CDA. In fact, he wrote the book on CDA. Check out his “Great Stuff” column for a list of CDA-related tools.

Meaningful Use Stage 2 Requirements

Go to the source for Meaningful Use Stage 2 requirements.

High-Level Intros

EHR vendor Practice Fusion has two solid introductory articles (first article, second article) on developing the clinical exchange documents to meet MU2. If you’re an analyst or developer, you may already be familiar with the content. But keep in mind that these are good for sharing with people who don’t need the technical implementation details , but who need to understand the why and how of the big picture.

If you need a high-level introduction to Meaningful Use itself, check out out this video from EHR vendor Hello Health.

SMART C-CDA Scorecard

This consolidated CDA tool was developed by Smart Platforms, an ONC-funded project that aims to create a platform architecture for medical apps – one analogy might be iPhone apps or the Salesforce AppExchange. They see CDA as a key component of the architecture. The Scorecard helps you evaluate the quality of the clinical summaries relative to Meaningful Use Stage 2 requirements and the consolidated CDA specification.

Also check out the blog posts on the Smart Platforms site. Start with the C-CDA posts here: http://smartplatforms.org/interoperability/

Frameworks and Tools

Don’t forget about the S&I framework and NIST tools. These are essential for understanding how your work is going to meet MU2 and CDA requirements. A bonus: CDA Guideline Validation from NIST.

What Caristix is Working On

We see a need to address gap analysis in order to ensure that best practices are followed, and the structure and content meet standards. David Kreda and Joshua Mandel on the Smart Platforms site summarized the issues well; here’s an excerpt:

  • material ambiguities in the C-CDA specification
  • accidental misinterpretations of the C-CDA specification
  • lack of authoritative “best practice” examples for C-CDA generation
  • errors generated by certification itself, i.e., vendors are incentivised to produce documents that set off no warnings in the official validator (rather than documents that correctly convey the underlying data)
  • data coding errors that reflect specific mapping and translation decisions that hospitals and providers may make independent of EHR vendors

Other Resources

What other CDA, CCD and consolidated CDA document resources should we list? Leave a suggestion in the comments below.

Gap Analysis and CCD Document Specification

Bridging the Gaps

CCD document specification gap analysis

In a previous post on CCD, C-CDA, and CDA, we compared HL7 v2 messaging to CCD development. This week’s article is about the biggest roadblock with CCD document specification: gap analysis.

What is Gap Analysis?

Simply put, gap analysis is about understanding the differences in the data between two systems. The output of a gap analysis process is a list of all the differences between two systems charted in a requirements document. With HL7 v2 messaging, many organizations create their own gap analysis templates and include items such as field mapping tables, the development work involved with bridging a gap, and an issue tracker. To fill in the template, they do a spec cross-walk, look at messages with text or HL7 editors, run queries using messaging tools, and manually document their findings. Some use Caristix software to automate this process.

What about the CCD Document Specification and Gap Analysis?

You’ll need to apply the same process with CCD document specifications and messages. The manual gap analysis process can be onerous with HL7 v2.x messaging. That doesn’t change with CCD.

Gap Analysis Questions

With CCD document specifications, you’ll need to answer the following questions during the gap analysis process:

  • Built into the standard is the ability for both source and destination systems to handle all tags. How does each system handle extra tags built for special needs?
  • Are the systems using the same version of the standard? The standard is evolving, so systems might be on different versions.
  • Are there any differences between the format or structure in each system? If so, what are they? 
  • Are there any optional data elements that are required in one system?
  • Do both systems use the same content? They may use the same code sets, but they may be using slightly different sets of constraints. For instance, take LOINC or SNOMED. It’s all well and good to say these are specified in the standard, but these are vast data sets. Is there a perfect match in all fields/tags? You need to check during gap analysis.
  • What about data attributes like length or optionality?
  • Is there any custom information that must be documented or explained?
  • Is the data semantically consistent? In other words, does the data mean the same thing in both systems?

Why You Need to Do the Gap Analysis

The gap analysis is a critical requirements document. Without one, you won’t uncover your systems’ unique needs before development, so testing and validation will drag on. Every single difference or customization will require extra time, money, and effort to troubleshoot and resolve. The result cascades into extended go-lives, more expensive maintenance, and unhappy end-users.

Our two cents: do the gap analysis. It’ll save time, money, and headaches down the road. 

HL7v2 to CCD

Confused? Start with What You Know

CCD-HL7-get-startedOver the past few months, we’ve heard a lot from our hospital-based customers about CCD and C-CDA readiness. There’s more urgency with Meaningful Use Stage 2 deadlines, even with the extension.

But the funny thing is: hardly anyone ever says, darn, but this is confusing.

Sometimes people express their frustration. “What the heck are those regulators doing? Why are they pushing more stuff at us, when we’re barely able to keep up as it is?”

Others bury their heads in the sand. “We’ll get to it. It can’t be that hard. Just go download a few Implementation Guides and we’ll get it done.”

And few and far between, there are the rare people who say, “This is hard. This is confusing. How do we start?” This post is for those folks who find it confusing. Here are some suggestions for getting started.

For starters, you’re an interface expert – either an analyst or developer. You’ve already got an extensive body of knowledge in HL7 v2.x messaging.

How do you add CCD to your toolkit? Simple. Start with what you know: HL7 v2.x. Here are some answers to the questions we’ve often come across.

With HL7 2.x interfacing, scoping and validation is a big part of the work. Will this volume of work be reduced with CCD?

No. And here’s why. CCD, which is based on Clinical Document Architecture (CDA), is an evolving standard and it parses a number of discrete elements. And as an implementer (either as a vendor or a provider), you can define or tweak your own templates.

Sure, there are specific templates that are prescribed by Meaningful Use. And these are publicly available, with a full set of schemas (which define the structure or format), content, and of course use cases.

The validation or conformance templates are also available, so it’s easy to define the rules they have to conform to.

The danger here is that implementers still have to meet their organization’s own needs, therefore they will need to define custom formats – similar to z-segment in HL7 v2.x. They’ll meet their immediate needs.

If the CCD spec or schema is more constrained, shouldn’t the interoperability work be easier?

You would expect that to be the case. The CCD specification is more constrained than the HL7 v2.x standard from a structure or format point of view. But keep in mind that the CCD spec (because it is based on on XML) is huge. And the content is varied. One analyst said, “it’s all over the map. I have no idea where to start.” So the idea of creating profiles – what Caristix Workgroup software enables — is attractive, since it facilitates the gap analysis process. (More on gap analysis and CCD next week.)

How do I manage custom elements and variations?

Documentation is important. An XML schema, while complete, is hard to read and represent easily. They are self-referring. You’re going to scroll a lot. Our goal, with our profile approach, is to makes this process easier. Coming soon: another article on the biggest roadblock with CCD: gap analysis.

Stay tuned. Tell us: What else would you like us to cover? Leave a comment.

What is One-Hour Interoperability?

The Status Quo

This is the world interface analysts, developers, and quality testers work in:

  • 2 weeks to get a list of code values for a single field
  • 1 week to get a list of custom field formats like lab order codes
  • 20 hours to code a schema in an engine from a spec in Excel
  • 9 days on gap analysis
  • 30 days to test a 10-minute code change
  • 8 versions of a spec before it’s baked enough for development

Productivity with Caristix

With our software, especially with the new version that just came out, you can move these numbers dramatically:

  • 15 minutes to get code values for all fields
  • 15 minutes to get a list of custom field formats
  • 1 minute to generate a schema for an engine
  • A half-day on gap analysis
  • 10 minutes of automated validation to test a 10-minute code change
  • 1 version of a spec before it’s baked enough for development

So, yes, we’re paying attention to all those things that get in the way of interoperability.  We are removing roadblocks. We’re helping interfacing teams become more productive and get interfaces into production much faster than before, with fewer manual steps than before.

But we’re aiming higher.

Vision: One-Hour Interoperability

one-hour-interoperabilityThe vision we have for interfacing and interoperability is much bolder. We aim to build interoperability technology that makes analysts and developers so productive, they’ll deliver One-Hour Interoperability. Not weeks. Not days. A single hour.

With One-Hour Interoperability, a team will gather requirements, then configure, test, validate and take in the interface live, glitch-free, in an hour. A bold vision? Absolutely. And that’s where we are taking our customers.

You’ll find the building blocks of One-Hour Interoperability in the Caristix v3.0 release. We’ve made gap analysis simpler and easier to use, cutting hours off scoping mapping tables. Remove noise with filters. Capture just the gaps that are relevant to developers. Clearly designate inbound and outbound systems. Easily build transformation tables. Use the matching filter to spot differences in product versions. Highlight data differences with message comparison.

We’re working on a CDA product, so that everything you do today for traditional HL7 v2.x interfacing, you’ll be able to do for CDA. EHR implementation, Meaningful Use, and related deliverables all happen on time…and on budget.

Learn more about what we’re doing with CDA and the other building blocks. You’ll get the latest in our newsletter. Sign up here.

Workgroup Software Demo Webinar: Part 6

A 16-minute Introduction to Caristix Workgroup: Part Six

We’re wrapping up our Introduction to Workgroup with Part 6 (1:30 minutes) We designed this demo webinar to give you a bird’s-eye view of Workgroup software. And we’ve covered a lot in a short 16 minutes, demonstrating just how comprehensive Workgroup truly is.

In the wrap-up, you’ll learn:

  • the key business reason why analysts and developers need more than ad-hoc tools to deliver interoperability
  • what enables better customer collaboration
  • why Workgroup

http://youtu.be/XiTjGLoVC8Q

We’re open to any and all feedback about the demo and about Workgroup. Are we missing something that would help you or your organization do your work? We want to hear about it.

Missed the first five parts?

In Part 1 (4 minutes) we introduced you to Workgroup, what exactly it is and why and who we designed it for.

In Part 2 (4 minutes) take a deeper dive into Workgroup functionality, and see how to speed up the requirements-gathering or scoping process, while dramatically increasing interface quality.

In Part 3 (3 minutes) see how to automate your documentation within Workgroup and simplify Gap Analysis step-by-step.

In Part 4 (2 minutes) learn about the automatic testing capabilities within Workgroup, using your workflow to drive validation.

In Part 5 (2 minutes) we took you through Workgroup’s 4 step de-identification process.

The Full 16-minute Webinar

Like what you saw in the parts above? The full webinar – just 16 minutes and not the usual 30 or 60 – is available for viewing on-demand right now. Click this link to see the full video.

For more information about Workgroup, visit the Workgroup product page.

We’d be glad to take you through a more involved demo or proof of concept. Contact us at info@caristix.com or call us at 418- 872-4000.

Workgroup Software Demo Webinar: Part 5

A 16-minute Introduction to Caristix Workgroup: Part Five

When you work with patient data, you need to be vigilant about protecting privacy. Caristix Workgroup software covers the critical concern of removing PHI from HL7 data. The de-identification capabilities in Workgroup let you remove protected health information from production data and replace patient names, identifiers, and related data with either blanks or dummy data. This means the message flow looks and acts like realistic data with all customizations, Z-segments, and non-standard field lengths — even in OBX fields with text-based notes.

So analysts and testers will catch crucial interfacing issues and avoid delaying project delivery along with increasing costs and resource demands.

In Part 5 (2 minutes), you’ll learn:

  • How a simple 4-step process lets you generate clinically valid data for interface development,testing and analytics
  • Which features let you remain compliant with your organization’s HIPAA PHI policies and procedures
  • How you can cover all 18 HIPAA identifiers in your data
  • The one-click button to create de-identification reports for your audit and quality needs

http://youtu.be/IUGqWcLCDIw

Missed the first four parts?

In Part 1 (4 minutes) we introduced you to Workgroup, what exactly it is and why and who we designed it for.

In Part 2 (4 minutes) take a deeper dive into Workgroup functionality, and see how to speed up the requirements-gathering or scoping process, while dramatically increasing interface quality.

In Part 3 (3 minutes) see how to automate your documentation within Workgroup and simplify Gap Analysis step-by-step.

In Part 4 (2 minutes) learn about the automatic testing capabilities within Workgroup, using your workflow to drive validation.

The Full 16-minute Webinar

Like what you saw in the parts above? The full webinar – just 16 minutes and not the usual 30 or 60 – is available for viewing on-demand right now. Click this link to see the full video.

For more information about Workgroup, visit the Workgroup product page.

We’d be glad to take you through a more involved demo or proof of concept. Contact us at info@caristix.com or call us at 418- 872-4000.

Workgroup Software Demo Webinar: Part 4

A 16-minute Introduction to Caristix Workgroup: Part Four

Ready for the next piece of our 16-minute webinar on Caristix Workgroup? Learn what Workgroup can do for you and your team to prevent costly project reworks and delays. Save time and dollars by removing the major bottleneck that testing often becomes.

In Part 4 (2 minutes), you’ll learn:

  •  All about using your workflow to drive validation
  • How to generate hundreds of test messages automatically
  • How one-step setup can save hours of testing time

http://youtu.be/J7D1I41zRnY

Missed the first three parts?

In Part 1 (4-minutes), we introduced you to Workgroup , what exactly it is and why and who we designed it for.

In Part 2 (4-minutes), we take a deeper dive into Workgroup functionality, and show you how to speed up the requirements-gathering or scoping process, while dramatically increasing interface quality.

In Part 3 (3-minutes), we talk about how to automate your documentation within Caristix Workgroup and take you through Gap Analysis step-by-step.

The Full 16-minute Webinar

Like what you saw in the parts above? The full webinar – just 16 minutes and not the usual 30 or 60 – is available for viewing on-demand right now. Click this link to see the full video.

For more information, about Workgroup, visit the Workgroup product page.

We’d be glad to take you through a more involved demo or proof of concept. Contact us at info@caristix.com or call us at 418- 872-4000.

 

Workgroup Software Demo Webinar: Part 3

A 16-minute Introduction to Caristix Workgroup: Part Three

Not much time? That’s why we’re offering our 16-minute webinar on Caristix Workgroup Software in small easy-to-consume pieces for quick viewing.

In Part 3 (3 minutes), we introduce you to:

  • The documentation strengths of Caristix Workgroup software
  • Automatic Gap Analysis, for easy mapping table creation

http://youtu.be/XX8TDYo7Z8c

In case you missed the first two parts:

In Part 1  (4-minutes), we introduced you to Workgroup , what exactly it is and why and who we designed it for.

In Part 2 (4-minutes), we take a deeper dive into Workgroup functionality, focusing on Scoping and creating a spec/profile including reverse engineering.

 

The Full 16-minute Webinar

Like what you saw in the parts above? The full webinar – just 16 minutes and not the usual 30 or 60 – is available for viewing on-demand right now. Click this link to see the full video.

For more information, about Workgroup, visit the Workgroup product page.

We’d be glad to take you through a more involved demo or proof of concept. Contact us at info@caristix.com or call us at 418- 872-4000.