Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

FHIR is on Fire

Posted on December 5, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Ever since the announcement yesterday about Project Argonaut, FHIR has been getting some widespread coverage. Although, even before this important announcement, I was hearing a lot of people talk really optimistically about the potential of FHIR for healthcare. However, with Project Argonaut, you get all of these big name organizations on board as well:

  • athenahealth
  • Beth Israel Deaconess Medical Center
  • Cerner
  • Epic
  • Intermountain Healthcare
  • Mayo Clinic
  • McKesson
  • Partners HealthCare System
  • SMART at the Boston Children’s Hospital Informatics Program
  • The Advisory Board Company

That’s quite a list of powerhouses that are investing money behind FHIR. I’m excited that the majority of major hospital EHR are represented in that list. Although, I do wonder if this is a lot of the same people who ruined CCDA. Let’s hope I’m wrong and they learned their lesson.

FHIR was also the topic of today’s #HITsm chat. Here are some of the tweets from the chat that caught my eye.

How’s that for optimism about the future of FHIR? Keith is deep in the trenches of health IT standards so he’s got a very informed opinion on what’s happening.

A very good sign since everyone I talk to seems to hate CCDA. They say that it’s bloated and really not usable.

I agree with Donald. The real question I have is whether FHIR will get us open APIs to the data we want. I need to investigate more to know the answer to that question.

I generally think this is true also, but not if it is a limited set of data. If you limit the data and don’t provide write back function, then there’s a real limit on what you can do with that data. Of course, you can start with some functionality and then build from there.

I’m still early on in my understanding of FHIR. I’m doing a whole series of posts on EMR and HIPAA around interoperability and the challenges associated with interoperability. You can be sure that FHIR will be a major part of my research and discussion. The above links look like a good place to start.

Please add your thoughts on FHIR in the comments as well.

Healthcare Standards – Opportunities and Challenges Remain for SNOMED CT, RxNorm and LOINC

Posted on October 22, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Brian Levy, MD, Senior Vice President and Chief Medical Officer for Health Language.
Levy Low Res

Health IT standards and interoperability go hand-in-hand. Going forward, the success of the industry’s movement towards greater health information exchange (HIE) will hinge on the successful uptake and adoption of standards that will ensure reliable communication between disparate systems.

Progress is being made in this area through both messaging and coding standards introduced as part of Meaningful Use (MU). Specifically, MU coding standards that draw on such industry-respected clinical vocabularies as RxNorm, SNOMED CT® and LOINC® have the potential to drive more accurate, detailed sharing of patient information to promote better decision-making and patient outcomes.

Effectively deploying and adopting these standards is a huge undertaking with responsibilities falling to both vendors and providers going forward. To survive in future of healthcare, EMR vendors will have to evolve to support current and future industry standards. Providers will also have to grow their knowledge base and become more aware of how standards impact care delivery—instead of simply relying on vendors to pick up the slack.

The ability to “normalize” data to support all of these standards will be critical to advancing interoperability and communication between healthcare providers. With so many federal health IT initiatives competing for resources, the integration and use of terminology management solutions will become an important element to any data normalization strategy.

As providers assess their current needs and vendors move towards more enhanced offerings to align with new standards, the combined effort should produce significant progress towards improved information sharing. In the meantime, many challenges and opportunities exist along the roadmap to full implementation and adoption.

Vendor Readiness

While the EMR vendor market hit $20 billion in 2012, recent surveys suggest that many will not have staying power for Stage 3 MU. And one of the primary reasons, according to a 2013 Black Book Market Research report, is lack of focus on usability. An earlier report also pointed to 2013 as the “year of the great EHR switch,” pointing to provider frustrations that their current EMRs do not address the complex connectivity and sophisticated interface requirements of the evolving regulatory landscape.

Stage 1 MU created an artificial opportunity for many vendors to enter the market through government incentive grants. Because most initial EMR systems were not designed with Stage 2 requirements for HIE standards in mind, many vendors may find that they are not in a position to fund the infrastructure advancements needed to support future interoperability.

For instance, many EMRs support ICD-9 or free text for the development of problem lists. Under Stage 2 MU, problem lists must now be built electronically using SNOMED CT, requiring EMR vendors to develop and put out new releases to support the conversion. In tandem with this requirement, EMRs will also have to be designed to support RxNorm and LOINC.

It’s a time of upheaval and financial investment in the EHR industry, and when the dust settles, healthcare providers will have designated the winners. The end-result will ultimately include those players that can support the long-term goals of industry interoperability movements.

Minimizing Workflow Impacts

In existence since 1965, the SNOMED CT code set has a long track record of success and international respect. A comprehensive hierarchical system that includes mappings to other industry terminology standards, the code set enables computers to understand medical language and act on it by organizing concepts into multiple levels of granularity.

Few would dispute the potential of SNOMED CT to enhance accuracy and address the detail needed to promote enhanced documentation practices, but the expansive nature of the code set is still not exhaustive. Searching and finding the SNOMED concepts to include in Problem lists often requires further expansion of synonyms and colloquial expressions commonly used in clinical practice.  In addition, an accurate SNOMED code may not equate to a billable ICD-10 code, potentially requiring clinicians to conduct multiple searches if EMR workflow is not carefully planned.

The challenge for healthcare organizations is two-fold when it comes to the complicated SNOMED CT conversion process. First, the conversion represents one more complex IT project that healthcare organizations must undertake  amid so many other competing initiatives. Second, the success of implementations will be diminished if clinician workflows are negatively impacted. With EMR documentation practices already requiring more time from a clinician’s day, the situation will only be exacerbated if multiple code searches are required to ensure regulatory compliance for MU and ICD-10.

Terminology conversion tools that leverage provider-friendly language can be a great asset to easing the burden by providing maps between ICD-9 or ICD-10 and SNOMED CT problems. Physicians search for the terms they are accustomed to using in the paper record, and terminology tools convert the terms to the best SNOMED CT and ICD-10 codes behind the scenes.

For example, a clinician may add fracture of femur to a problem list, but ICD-10 requires documentation of whether the fracture was open or closed, the laterality of the fracture and whether the fracture was healing. Provider-friendly terminology tools provide prompts for the additional elements needed and guide clinicians to the most appropriate choices without the need for multiple searches.

Improving Mapping Strategies Internally and Externally

Industry crosswalks and maps exist to help ease the transition to new standards like SNOMED CT, RxNorm and LOINC. While these tools provide a good starting point in most cases, there is simply not a gold standard map that will work for every case.

Consider RxNorm, a naming system that supports semantic interoperability between drug terminologies and pharmacy knowledge base systems. Working in tandem with SNOMED CT to improve accurate capture of patient information from external systems, RxNorm codes are now required as part of the CCD (Continuity of Care Document) and HL7 messages for capture of medication information.

While designing EHRs with the capability to send and receive RxNorm codes is the first step, healthcare providers will still require a method of converting codes from RxNorm to internal medicine systems and drug information and interactions databases like Medi-Span, First Databank, Micromedex and Multum. Another challenge to standardizing medication information is the use of free text. Many healthcare providers receive drug information that is not coded at all, requiring a specific, customized mapping.

LOINC, a universal standard for identifying medical laboratory observations, is particularly challenging in this arena. Because the industry is home to hundreds of local lab systems and thousands of local lab codes, creating a single industry mapping solution is nearly impossible. The process often requires that sophisticated algorithms be built by performing an analysis of individual lab tests that are conducted in a particular hospital.

By leveraging the expertise and sophistication of a terminology management solution, healthcare providers can more easily automate and customize mapping of patient data to standardized terminologies. Otherwise, IT departments must expend valuable staff time to build complex mapping systems to address the myriad of needs associated with an influx of new standards.


The healthcare industry has identified use of a common medical language as a key foundational component to advancing information sharing capabilities. By designating such standards as SNOMED CT, RxNorm and LOINC as MU requirements going forward, the industry is taking a progressive step forward to ensuring clinicians have more efficient access to better patient information.

It’s a critical step in the right direction, but the road to success is complex. Healthcare organizations that draw on the expertise of terminology management solutions will be able to achieve the end-goals of this movement much quicker and with fewer headaches than those trying to implement these complex standards on their own.

Global eHealth Olympics

Posted on August 9, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Blair Butterfield is a senior health IT executive and eHealth expert with over twenty years of global experience in new market and business development, general management, government initiatives, strategic marketing, product strategy and consulting. He is currently president of VitalHealth Software’s North American Division and is the former VP of eHealth International Development for GE Healthcare.

For nearly two weeks, all eyes have been on London as we’ve watched athletes vie for gold in the world’s foremost sports competition. It makes you wonder what would happen if that same competitive nature was applied across other aspects of our national identities—namely healthcare. What if we compared our healthcare system to those of Europe, Asia and the Middle East in terms of areas like integration, communication and population health? How would the U.S. fare?

With the global healthcare system in the midst of a major transition, now is the perfect time to look at how the U.S. compares to other nations, especially with respect to one of the biggest trends we’re seeing worldwide—eHealth. eHealth can be described as the use of information technology to facilitate higher quality, more accessible healthcare at lower costs. As countries across the globe amp up their eHealth programs, they are seeing that the success of these major transformations requires engagement and support by all stakeholders, as well as strategic, controlled governance of eHealth implementation.

While the healthcare industry is experiencing a shift on a global level, the strategies and methods for eHealth initiatives vary at the national level. If we were to look at how different countries compare in the healthcare arena, eHealth Olympic events would include:

  • Standards adoption
  • Terminology and coding adoption
  • Patient consent policies
  • Interoperability infrastructure
  • Prevalence of EHRs
  • National funding for eHealth
  • National governance for eHealth
  • Tolerance  for regional variations
  • Import/export of eHealth best practices

In terms of these events, let’s take a closer look at some of the top medal contenders across the world to see why they have had eHealth success in particular areas:

Standards, Terminology and Coding Adoption

For these events, France and Austria are definite medal contenders. France has employed an incremental eHealth strategy that includes a standards-based architecture at the core, which has allowed vendors to test and adopt standards that address IT and clinical needs in a coherent, proven framework. Austria’s eHealth strategy includes a data sharing architecture that enables data portability and standardization of clinical content. By employing an IHE-XDS sharing architecture, Austria’s system has allowed for seamless data content sharing without disrupting the sharing infrastructure. Also Austria had a very clever “training regimen” that resulted in full adoption of coded data elements by physicians who had initially pushed back against it until they realized the value of coded data.

Interoperability Infrastructure

As England was one of the first countries to invest heavily in eHealth, its early adopter status has allowed the country to improve upon its infrastructure, namely in terms of interoperability. England’s eHealth strategy uses an interoperability “spine” to connect regions of the country. This sharing of health records of documents on the spine has ultimately proved effective by reducing costs and complexity while simplifying data sharing models. It took more than one try to medal, as the first attempt was a failure and resulted in a “back to the drawing board” decision to re-design the infrastructure using newer standards and profiles based on IHE.

National Governance and Funding with Regional Variations

To take the overall gold in eHealth, a key component is a balance of national strategy enforcement and tolerance for regional variations, which is prevalent in the strategies of both Canada and the U.S.  Canada’s federally funded “Canada Health Infoway” has established a national EHR blueprint, while EHR implementation itself is governed at the sub-province level and driven by local priorities, such as funding and regional business drivers. Similarly, the larger health reform legislation in the U.S. wraps around the IT program with a national eHealth funding budget of $30 billion for a wide range of related programs. At the same time, the U.S. recognizes regional variations in IT drivers and business needs as the value propositions to support long-term maintenance of HIEs. In  addition, the national funding of regional extension centers assists providers in complex processes of selecting and implementing healthcare IT systems that are right-sized for their organizations with an adequate training and support infrastructure to ensure successful adoption, modeled on the same lines as the regional agricultural assistance program from decades ago that taught farmers about best practices.

Import/Export of eHealth Best Practices

As previously stated, England’s head start in eHealth investment and adoption has given the country a wealth of learning and best practices that can be shared with other nations looking to employ strategies of their own. Countries like Singapore have been very receptive to this information sharing as its strategy includes global sourcing for expertise and investing in technology to enable interoperability. However, the top-honor for eHealth collaboration may go to Canada as the nation has shown ample willingness to be collaborative with other countries and adopt best practices from around the world. It should also be noted that willingness to learn from other countries’ eHealth strategies is an area where the U.S. has typically fallen short.

In addition to evaluating these eHealth best practices around the globe, it’s important to note fundamental strategies that should be employed in all nations, including: the need to address privacy and security concerns at the onset of the program; ensuring clinician involvement during the entire process; providing ongoing education and training; and employing an incremental adoption strategy.

Though we are seeing eHealth success at varying levels around the world, what is being built today is just the foundation for the future of IT-enabled healthcare delivery systems—no nation has yet realized the vision of patient-centric prevention and disease-management, evidence-based medicine, and ubiquitous provider use of IT. So although countries across the globe are closely competing for eHealth’s top honor, no one country can claim that elusive, exclusive gold. With a vision of connected healthcare, where health information exchange powers population health management, patient activation, clinical decision support, community analytics, collaboration, and information liquidity, competition to win the gold medal in eHealth initiatives should be a huge motivating factor towards improved performance.