Events and News

Developers on FHIR Challenge takes place THIS Saturday

posted Mar 13, 2018, 9:19 PM by Linda McKay



Saturday 17th March - full details below...

Autumn News - March 2018

posted Mar 4, 2018, 4:56 PM by Linda McKay   [ updated Mar 4, 2018, 4:58 PM ]


HL7 New Zealand – Autumn 2018 Update:


Since our last message at Xmas, we hope that you all enjoyed a good break and managed to enjoy or record summer temperatures.  It’s been a very busy start to 2018 for both Health Level Seven International (HL7®) and our local affiliate HL7NZ, starting with the January Working Group meeting in New Orleans. A Full Report  is available on our Web Site – suffice to say here that preparations for Release 4 of the HL7® FHIR® specification in October of this year are still well on track and the number of implementations of this ground-breaking standard is growing exponentially.


The HL7NZ Executive Board met recently and agreed a strategy based on ‘practical interoperability’ for the coming financial year. This includes confirmation of an exciting Event Calendar for the remainder of 2018, commencing with…

HL7NZ in Collaboration with The University of Auckland, announce the…


2018 “Developers on FHIR” Challenge

For those wishing to learn or demonstrate practical solutions development skills, using the ‘game-changing’ HL7® FHIR® standard, this event is underway and finishes with a full-day at the University of Auckland on Saturday 17th March. You will also get to rub shoulders with FHIR experts and others working in this field. Prizes will be awarded for the top three submissions as judged by health sectors leaders!  If you are an application architect, usability designer, developer or clinician working in the Health and Disability Sector - or a student with an active interest in digital healthcare - this event is for you!  Click here to REGISTER and gain more information – it is not too late to enter and participate. For regular updates go to…HL7NZ FHIR Chat Site


Further 2018 Event Plans (save the dates):


Monday 18th June – 9:00 am to 5:00 pm

Novotel, Auckland Airport

HL7® FHIR® and SNOMED CT® Implementation Showcase


An opportunity for developers of digital healthcare applications, based on HL7® FHIR® and/or SNOMED CT®, to present their work and discuss their experiences in implementing the key interoperability standards underpinning the NZ Digital Healthcare Strategy.


Tuesday 20th November – 9:00 am to 5:00 pm (pre-HiNZ 2018 Conference Workshop)

TSB Arena / Shed 6, Queens Wharf, Wellington

HL7® New Zealand FHIR® Connectathon


New Zealand’s first ‘official’ HL7® FHIR® Connectathon will be an interactive event in which participants can test their FHIR implementations, parts of the specification itself, or simply learn more about the most important new standard in healthcare information interoperability. The hands-on nature of the event encourages attendees to pass data, via APIs, between client applications and FHIR servers, plus utilise cloud-based testing services. The Connectathon will be divided into ‘streams’ that will focus on specific topics of interest to the NZ Sector, such as patient access & case management, terminology and health pathways.


If you would like to see particular topics/issues discussed at these events please contact us and if you are not already a member see we welcome your involvement.

Season's Greetings from HL7NZ

posted Dec 13, 2017, 2:43 AM by Ray Murakami

At the end of my first full calendar year as HL7NZ Chairman, it’s time to reflect on a productive year for our Affiliate and look forward to the coming months. Hopefully, the fulfilment of our key goal of greatly increased outreach and engagement with the health and disability sector, including more regular updates, means that this final seasonal message can focus on providing some broader perspectives on 2017.

A key component of this strategy has been building membership and new partnerships with NZHIT and HINZ, the later providing our first-ever booth at their highly-successful 2017 Conference in Rotorua. I firmly believe that the combined resources and capabilities of our organisations can provide invaluable support to the designers and developers of digital health solutions.

In particular, we hope to continue to work on removing roadblocks, both technical and tactical, on the path to achieving heath data interoperability. Like another less worthy road, this is ‘paved with good intentions’, but also serious obstacles, notably data silos, that need to be eliminated if the greater objectives of a patient-centric health strategy are to be achieved. For example, in common with other users of patient portal products, it frustrates me that I cannot access this information, via an API, in the health and wellness monitoring application of my choice.

This not to say that the air of optimism that I expressed at the corresponding time last year has dissipated, rather that our progress has been slower than anticipated. In my annual report to the HL7NZ Board, I attributed this to the fractured nature of our health and disability sector, a period of governance changes and the ‘not invented here syndrome’. However, these are the headwinds against which we must sail and one must never underestimate the challenges of change management in our sector.

One increasingly bright light is the number of industry partners now exposing APIs based on HL7® FHIR® in open, ‘sandbox’ environments. One of these platforms will be used as one of the key components of our first 2018 event – the “Developers on FHIR” challenge – in partnership with The University of Auckland. This begins with a Webinar on December 19 and culminates on 17th March 2018 in a full day, hands-on event with submitted solutions judged by health sector leaders.

On the international front, next year will be a seminal one for HL7 as we prepare for Release 4 of FHIR - the first to contain normative content - and it would be wonderful to see as many HL7NZ members as possible contributing to this ground-breaking product. One only has to spend a short time on digital health and networking web sites to realise that FHIR has now been implemented by all of the major digital health software and cloud platform providers. Opportunities to participate in such a significant project are rare indeed!

Although FHIR has taken the world by storm, and is now HL7’s ‘primary standard’, that does not mean that we are withdrawing, or ignoring, our others standards. It is estimated that version 2 messaging will have a long usage tail and we will be engaging with the sector to gain consensus on migrating to what is likely to be the ‘final release’ of this product.

Finally, I’d like to extend sincere thanks to all of our members and benefactors (notably the Technology & Digital Services Team at the Ministry of Health) for their support in the past year and I hope that you and your families all enjoy a well-earned Christmas and New Year break. I look forward to continuing to work together with you all to progress interoperability in 2018.

Peter Jordan, Chairman HL7 New Zealand

    2018 “Developers on FHIR” Challenge

    posted Oct 26, 2017, 1:18 AM by Ray Murakami   [ updated Mar 12, 2018, 1:59 AM ]

    HL7 New Zealand in Collaboration with The University of Auckland
    Announce the 2018 “Developers on FHIR” Challenge 

    ! It’s Not Too Late to Participate in the Developers on FHIR Challenge Event – 09.00 – 4.30 March 17th, 2018 !

    This must attend, all-day event is the culmination of the HL7NZ Developer on FHIR Challenge 2018 and will take place at the Tamaki Campus of the University of Auckland

    This is where you will present your solution to the judging panel. The top three submissions are eligible for prizes!

    FHIR masterclass on 17th March. At the beginning of the day, Dr David Hay, one of the founding developers of FHIR and an international expert on it, will be giving a masterclass on how to use FHIR. This is your opportunity to learn the basics of FHIR and ask questions. Read more about the Challenge here >>

    Register Now by clicking here >> http://


    We have finalized three judges and I’m excited to tell you about them.
    Dr David Hay is New Zealand’s leading expert on the HL7® FHIR® standard. He was originally a GP who became interested in interoperability and subsequently became one of the founding developers of FHIR. He is also a member of the HL7 International FHIR Management Group.
    Dr John Fountain is the Medical Toxicologist of the National Poisons Centre. He has a particular interest in entrepreneurship and creating new solutions. He is an expert in the risks associated with medical care that result in adverse events.
    Peter Marks is the Manager of Architecture and Standards at the Ministry of Health. He brings international experience in architecture services, business development, and the development of technologies and their implementation to his role as judge.

    Register for the Event 

    To attend the event, make a submission, and be eligible for prizes, you must formally register and accept the terms and conditions of participation. 

    Many of you have completed the form to express interest in participation, you now need to complete the formal registration form. Click here to register >> Developers on FHIR Event Registration Form

    All-day Event Agenda and Instructions

    Here’s the agenda for the day:
    • Welcome and “state of the nation” with FHIR
      --- 30 minutes
    • Development session 1 (Teams code solutions)
      --- 2.5 hours
    • Review 1 – Feedback, learning and need help
      --- 30 minutes
    • Lunch and Networking
    • Development Session 2 (Teams code solutions)
      --- 2 hours
    • Break
    • Solution Pitch
      --- 1.5 hours
    • Judges Report and Feedback
      --- 30 minutes
    • Close 
    Click here for more details of the March 17th Event, including instructions and location >> Participant Instructions

    Team Connections                                                                                                                          

    A number of people have expressed interest in being connected to others to form teams. To help this process we have created an online sheet with the contact details of those seeking to connect with others.
    The online sheet enables you to update your entry to describe your skills, which if you edit and complete will help others identify how you can help them. If you are not listed and want to be included, please add your details to the bottom of the list.
    You can access this online resource here >> Developers on FHIR Participants Seeking to Join Teams
    It’s over to you to use this resource to connect with others!

    Event Briefing

    For further details on the event, its objectives, making a submission, judging criteria, etc see the linked documents below

    Suggested Next Steps

    There are some next step action points to call-out:
    • Summary of Requirements for a Submission – slides 2 – 4 of the deck provide a succinct summary of the requirements for submission. If you have questions or require clarification, please contact us (
    • Planning a Submission and Forming Teams – we encourage you to begin planning the solution you would like to develop and submit. Working in teams will help significantly, so think about who you can collaborate with. Click here to link with others >> Developers on FHIR Participants Seeking to Join Teams
    • Availability of Resources – HL7 NZ through our sponsor, Microsoft, is making available a range of resources, including a FHIR server, to support development. The Briefing Presentation includes these links 
    • Discussion Group – We have established a topic on Zulip for participants to ask questions, make comments and connect with others. Click here >> to join Zulip FHIR Chat
    • Need More Information – Go online to see the briefing document, slide deck and other resources (
    • Have Questions - Need more information or have questions you want answered, email us at
    • Encourage Others to Participate – Go online and register as a participant

    (Past updates)

    Invitation to Join the Event Kick-off Teleconference – 12 pm Tuesday February 13th, 2018

    Instructions for Joining the briefing Webinar at 12 pm on Tuesday February 13th 2018 NZDT
    1. The meeting is using Skype for Business
    2. Use the attached meeting invite to save this event in your calendar (It’s from Martin Entwistle HL7NZ Board Member)
    3. Use this link to access the meeting >> Join HL7NZ Developers on FHIR Challenge Briefing (
    4. You will be asked to download the Skype for Business app (if it possible to select the option to join via a web browser)
    5. All participants should join as a guest (even if you have an existing Skype for Business or Microsoft Account)
    6. Read the attached Event Briefing to get further background and prepare questions to raise with the event organisers in the Webinar
    You can schedule this session in your calendar by clicking on this link >> Teleconference Invite

    If you have not yet signed up, please complete our online registration form to register your interest in participation in the Developers on FHIR Challenge

    Follow-up to Briefing Webinar for Participants - December 19, 2017

    A successful briefing session for participants in the Developers on FHIR Challenge 2018 was help on December 19, 2017. This page provides information on next steps action points, the Webinar slide-deck and the latest version of the Briefing for Participants document:

    There are some next step action points to call-out:
    • Summary of Requirements for a Submission – slides 2 – 4 of the deck provide a succinct summary of the requirements for submission. If you have questions or require clarification, please contact us (

    • Planning a Submission and Forming Teams – we encourage you to begin planning the solution you would like to develop and submit. Working in teams will help significantly, so think about who you can collaborate with

    • Availability of Resources – HL7 NZ through our sponsor, Microsoft, will be making available a range of resources, including a FHIR server, to support development. Watch for more news on these, but we anticipate them being available for free to participants registered for the challenge before the end of January 2018

    • Discussion Group – We have established a topic on Zulip for participants to ask questions, make comments and connect with others (

    • Plan for the Next Check-in Webinar – The next event in the Challenge series with be a check-in Webinar in early February 2018 . Watch for confirmation of the date!

    • Need More Information – Go online to see the briefing document, slide deck and other resources (

    • Have Questions - Need more information or have questions you want answered, email us at

    • Encourage Others to Participate – Go online and register as a participant (

    • Save the date for the Challenge Event - University of Auckland, March 17, 2018

    Want to take part on a fun challenge to create cool apps that directly impact patient care?

    Interested to learn how to use the new HL7® Fast Healthcare Interoperability Resources (FHIR®) standard that is taking the world of healthcare information exchange by storm?

    This challenge runs from December 2017 to March 2018 and ends in a full day, hands-on event with submitted solutions judged by health sector leaders. Prizes will be awarded for the top three submissions!

    If you are an application architect, usability designer, developer or clinician working in the Health and Disability Sector or a student with an active interest in digital healthcare, then this event is for you!


    The Board of HL7 New Zealand (HL7NZ), in collaboration with The University of Auckland, is organising “Developers on FHIR” as a fun challenge to create new tools and apps that can directly impact patient care using the new HL7® Fast Healthcare Interoperability Resources (FHIR®) standard that is taking the world of healthcare information exchange by storm.

    The proposed “Developers on FHIR” challenge will run from December 2017 to March 2018, culminating in a full day, hands-on face-to face event, hosted by The University of Auckland on Saturday March 17th, 2018, and is being generously supported by Microsoft.

    Event Details

    Participants will work in teams to develop a client application that utilises a FHIR based-API to tackle a current and important issue directly relating to patient care, the support of clinical care or person-managed health and wellness.

    This Challenge will end with a demonstration of the solutions produced to be judged by health sector leaders. We propose to award prizes for the top three submissions! 

    Who Should Participate

    If you are an application architect, usability designer, developer or clinician working in the Health and Disability Sector or a student with an active interest in digital healthcare, then this event is for you!

    Please complete our online registration form to register your interest in participation in the Developers on FHIR Challenge.

    More Information 

    Need more information or have questions you want answered, email us at

    AGM Monday 6th November 2017, Auckland

    posted Oct 9, 2017, 8:45 PM by Linda McKay   [ updated Nov 6, 2017, 5:00 PM ]

    The 2017 Annual General Meeting was held at the offices of Sysmex NZ, 386 Manukau Road, Auckland  on Monday 6th November at 4 pm. All previous Board Members were re-elected along with two new Members - David Moorhouse (Pegasus Health) and John Carter (Healthlink). At the first meeting of the new Board, held directly afterwards, the following officers were unanimously re-elected: Peter Jordan (Chairman), Peter Sergent (Vice Chairman), Edwin Ng (Treasurer), Linda McKay (Secretary). 

    HL7NZ Seminar at HINZ 2017 – NZ Clinicians on FHIR

    posted Aug 20, 2017, 1:10 PM by Linda McKay   [ updated Nov 6, 2017, 5:20 PM ]

    This all-day event was held as part of the HINZ annual conference on Tuesday 31 October in Rotorua, and was aimed at people with only a minimal (or no) understanding of the new HL7® FHIR® (Fast Healthcare Interoperability Resources) standard to help them understand what FHIR is, how it fits in the context of sharing health information, and what are the advantages it will bring to those in the business of delivering (and receiving) healthcare in New Zealand - and overseas! The major presenter was HL7 New Zealand Chair Emeritus, Dr David Hay – member of the FHIR Management Group and author of the ClinFHIR tool used at Clinicians on FHIR events around the globe.



    Cybersecurity in Health - Tuesday 1st August

    posted Jul 18, 2017, 1:51 PM by Linda McKay

    Cyber security: Some IT people think it is a business problem, some business people think it's an IT problem. Any board Chairperson will tell you that when you've been hit, it's a problem for both!

    This workshop is specifically designed to bridge the gap between IT and Business to manage the risk of cyber security.

    At this important event you will:

    • Meet key government and private sector experts
    • Hear best practice and ask questions to get immediate advice
    • Find out what has changed in the policy area and upskill yourself

    The safety of your organisation and its clients depends on it.

      Programme includes:

      • Who is trying to hack you?
      • What the future and new technologies will bring
      • You've been hacked! Recovery and remediation
      • What does an Incident Response Plan look like?

      You will hear about the latest Government policies and tactics, developing an incident response plan, practical case studies, AI/machine learning, blockchain, cloud, mobile devices, IoT, and the pros/cons of outsourcing and insurance.

      Plus there will be lots of audience interaction - so you can ask questions and get expert answers.


      • Peter Plowman, Senior Manager Cyber Crime, Kiwibank
      • Hector Rodriguez, Worldwide Health Chief Information Security Officer, Microsoft
      • Richard Harrison, Chief Information Security Officer, healthAlliance
      • Chris Blackford, Department of Internal Affairs
      • Ted Christiansen, Ministry of Health
      • Hayley Power, Senior Engagement Advisor, CERT
      • Heather Ward, Principal Advisor, National Cyber Policy Office
      • Graeme Neilson, CISO & Head of Research, Red Shield
      • Dr Alan Litchfield, Director, Service and Cloud Computing Research Lab, AUT
      • Rick Ferguson, Cylance
      • Sean Au, Founder,
      • Mandy Simpson, CEO, Cyber Toa
      • Mike Gollop, Chief Technology Officer, Conporto Health
      • Dr Karolyn Kerr, Consulting Advisor, Conporto Health
      • Liz Schoff, Director, Pleione Consulting
      • Boris Wilkitzki, Managing Director, Computer and Network Solutions
      • Steve Walsham, Crombie Lockwood Insurance
      • Tim Sewell, Security Manager, Computer Concepts
      • PLUS more speakers to be announced soon...

      Download preliminary programme

      Register online now.

      IHIC 2017 - Athens, Greece

      posted May 30, 2017, 2:15 PM by Linda McKay   [ updated May 30, 2017, 2:16 PM ]

      The deadline for submitting scientific full papers or practice reports to IHIC 2017 in Athens is getting closer.
      Paper submission deadline has been extended to Sunday, June 11th.


      HL7: On the Path to Interoperability

      posted Apr 27, 2017, 7:07 PM by Linda McKay

      By attending this webinar, you'll learn what steps healthcare providers are taking in building optimized HL7 application environments.

      Highlights Include:

      • Overview of HL7 standards

      • The HL7 role in health data interoperability

        What you'll learn

        HL7 is growing as a wide-ranging solution to the requirement for improved interoperability. But merely conforming to HL7 specifications is not enough to deliver superior ITperformance. This webinar will provide an update through insights into the Standards and explore the steps that healthcare providers are taking in building optimized HL7 application environments.

        After an insightful update and examination of HL7 from a standards perspective, this educational session will discuss strategies that are working in service assurance.  Strategies that will be discussed include building bridges with other departments and assessing business needs.  Attendees will learn how HL7 can be leveraged for optimized IT service assurance.  

        During this webinar, you’ll learn:

      • Overview of HL7 standards

      • The role of HL7 toward achieving health data interoperability

      • How they differ and where they're used

      • Insight into how HL7 is evolving, particularly with the rapid adoption of HL7 FHIR Restful services

      • How to leverage HL7 to uncover the full context of IT service anomalies across multiple layers which may be contributing to slow application response times and poor user experience in transmitting health information.  That is, health information such as administrative and clinical data between hospital information systems could include:

        • Reduce time to pinpoint source of interoperability issues

        • Troubleshoot network slowdowns rapidly

        • Improve analysis of HL7 interoperability services

        • Decrease analysis time of message sender and receiver issues

      • Learn about the benefits of leveraging IT service assurance technology to achieve benefits for HL7 in healthcare environments:

        • Quickly and Efficiently Triage Service Degradations for HL7 and Other Healthcare Applications

        • Assure High Quality Patient-care User Experience

        • Improve IT Team Collaboration

        • Reduce Monitoring and Vendor Management Complexities and Costs

          READ MORE

      News and Views from HIMSS 2017

      posted Apr 23, 2017, 6:17 PM by Linda McKay

      News and Views from HIMSS 2017

      Produced by Martin Entwistle

      Board Member HL7 New Zealand



      This paper provides a personal view of highlights from the Health Information Management Systems Society Conference (HIMSS) 2017, which took place in Orlando Florida February 19-23, 2017.


      Despite the uncertainties over future directions for healthcare in the US, resulting from the new administration, there was significant buzz in several areas of strategic importance with significant potential impact on health systems development in the near to medium term.


      The following are the themes that appear to be of particular importance, and with relevance to the New Zealand health sector. The list is not comprehensive, other themes that have importance to those working in more narrow or specialized fields are not included:


      • Consumerization of patient care and customer experience

      • AI and cognitive computing

      • Advancing value-based care

      • Population health, connected health and patient engagement

      • Improving interoperability between the connected health world and EHR systems

      • Cloud computing and security for the digital healthcare enterprise


      Consumerization of Patient Care and Customer Experience


      Over the last 5 years there has been an accelerating awareness of a significant social change in the way people seek to engage with and consume traditional healthcare services. The organization Health 2.0 has been leading discussion on this through its conferences and workshops, initially with an emphasis on the disruptive potential of new market entrants with a consumer products and services and more recently increasing interest from mainstream healthcare providers, insurers and vendors. At this Conference the importance of addressing consumerism in healthcare was explicit, with the many and wide-ranging implications being presented and discussed.


      Consumerization is about the changing role of consumers (patients) from being a reactive recipient of care to playing a more proactive role in being in control of how they manage their own health, seeking services that focus on wellness rather than just sick-care, being better informed about the choices available and demanding services that better fit their day-to-day lives rather than for the convenience of the health system itself.


      This was a common theme throughout the conference. Providers are accepting that this is no longer a future-state concept, but a major dimension of future healthcare delivery that needs to be taken seriously and addressed as a priority. A number of presenters observed that failure to address this deep-seated need by patients represents a major threat if not tackled, with patients moving to alternate providers or accessing services outside mainstream healthcare that do address their needs.


      The implications for health systems development are significant, as the systems and services required to meet these needs are very different from those currently available, and the detailed requirements are still not well defined. Relevant solutions include; customer relationship management systems to profile and engage with individuals even when not sick, devices and apps to support behavior change and wellness, big data analytics to help anticipate needs and intervene preemptively, remote managed care including telemedicine and video visits. Of critical importance is not just the functionality these new systems provide, but the experience they generate. Reference models for success are closer to Amazon, Facebook and Salesforce than they are to the health systems currently in place.


      AI and Cognitive Computing


      Artificial Intelligence (AI) is not new to healthcare. In the 1980s and ‘90s AI was the focus of significant research and development efforts. At that time, AI solutions were built around fuzzy logic, and neural networks used to develop predictive learning systems. There were some interesting results but they did not have sufficient accuracy to become widely adopted. As a result, AI has been on the sidelines for some years.


      But no longer! AI is once again a hot topic. Solutions are again focused on predictive analytics, but with methods developed through big-data mining systems that have been evolving over the last 5 – 7 years, and resulting in solutions very different than before. They include the application of machine learning, reasoning, natural language processing, data mining, human-computer interaction to deliver advanced analytics.


      There are many companies big and small active in the area offering both broad and narrow solutions. Among the big companies, and while still on the cutting edge, IBM, Google and Microsoft are taking a major role in leading the way forward. However, IBM-Watson was definitely the most prominent of these at HIMSS 2017.


      AI systems are undoubtedly complex and historically their use for the development of solutions has been in the hands of experts in the area. Once of the new developments presented at the Conference is the availability of AI analytics tools as cloud-based services. This has the potential to widely expand their use as it puts the tools in the hands of a wider range of developers to build these into their solutions.


      Encouragingly, much of the energy is going into practical uses of these solutions to ensure these have wide-scale value in the real world and directly impact patient care and the outcomes achieved. One of the challenges experienced historically was that the underlying fuzzy methods were not easily understandable, so the outputs were viewed with some skepticism, particularly by doctors. With this new wave of solutions ease of use and believability are significant areas of focus. Indeed, a whole new area of technology is being created, “cognitive computing”.


      Cognitive computing systems depend on various aspects of artificial intelligence (AI) to acquire knowledge from the massive amount of data fed into to them. Outputs focus on getting the right information to the right user at the right time and in an impactful format so that rapid decision making without further information processing can be achieved. Uses include matching the patient to specific tailored interventions. For example using genetic data inputs to identify optimal clinical interventions for that patient. Natural Language processing can mine intelligence from unstructured clinical notes and link that information from other clinical inputs to identify patients with specific but hard to identify risks, eg depression.


      Some companies are ‘betting the bank” on the future importance of cognitive computing. Ginni Rometty, IBM chief executive, in a key-note presentation said that cognitive computing technologies could usher in a golden era for personalized and precision medicine. “We’re in a moment when we can actually transform pieces of healthcare. It’s within our power”. “This era that will play out in front of us can change the world for the better.”


      Advancing Value-based Care


      In the US, value-based care is seen as critical to addressing rising health care costs, clinical inefficiency and duplication of services. In value-based models, doctors and hospitals are paid for helping keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way. This contrasts with the traditional fee-for-service approach, where payments are made on the basis of services provided irrespective of the outcomes achieved.


      Under “Obamacare” the US government strongly signaled a major shift to value based care by enacting MACRA (Medicare Access & CHIP Reauthorization Act), that would cut physicians base salaries and put more emphasis on incenting quality outcomes. MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or MIPS.


      Presentations at the Conference outlined that in the recent past, four models have evolved for the delivery of value-based care:


      Accountable care organization (ACO) - Accountable care organizations are alliances of doctors, hospitals and other health care providers that deliver and coordinate care for their patients and are paid based on their success at improving overall quality, cost and patient satisfaction with their health care experience. In an ACO, providers are responsible for improving the quality of patient care and health outcomes, at equal or lower costs, through better coordination and preventive care.


      Patient-centered medical home (PCMH) - In a PCMH, a primary care doctor leads a clinical team that oversees the care of each patient in a practice, and is focused on providing enhanced care coordination across the health care system. Financial incentives are based on performance on specific quality measures. When practices do well on quality and efficiency measures, they share in the savings they create. While still fee-for-service, this entry-level value-based model encourages quality and efficiency.


      Bundled payments - In a bundled payment model, a single payment is made to doctors or health care facilities (or jointly to both) for all services associated with an episode-of-care, such as a hip or knee replacement. “Bundled payment rates” are determined based on the costs expected for a particular treatment, as well as costs for any preventable complications that may arise.


      President Trump’s promise to repeal and replace the Affordable Care Act (ACA) which underpins “Obamacare” is what is leading to much uncertainty over the future of value-based care. Nonetheless, there was a general consensus at the Conference that the shift to value-based care and that quality payment programs very similar to those developed under MACRA, will continue.


      However, the transition from fee-for-service to pay-for-value payment models is one of the greatest challenges the U.S. healthcare system faces. Management of value-based services is data intensive and requires new business processes and workflows. Few provider organizations have the necessary end-to-end clinical, financial and administrative systems in place and there were a significant number of vendors offering such solutions as well as the advisory services for implementation and management.


      Population Health, Connected Health and Patient Engagement


      Population health management (PHM) is one of the fastest-growing segments in U.S. healthcare systems development. It was reported at the Conference that the majority of $8 billion in US digital health investments during 2016 went to support complex PHM initiatives. At the same time PHM solutions are a major area for development by existing vendors large and small.


      One of the interesting battles being played out, is whether advanced PHM solutions should be delivered as core capabilities of EHR systems or through specialized applications. In addition to EHR vendors Epic, Cerner, Allscripts and AthenaHealth providing solutions to their existing customers, the following vendors were identified among others as being well established in the provision of solutions and services; Optum, Philips Wellcentive, Caradigm, Lightbeam, Deloitte, Health Catalyst, Enli, Premier, i2i, Medicity, Lumeris, Best Doctor, Medecision, ZeOmega, Influence, Humana Transcend Insights, Conduent (Xerox), Cognizant Trizetto, Orion Health.


      To give some idea of the challenges for systems development, six diverse functional components were presented as being necessary to deliver the full-scope of required PHM capabilities:


      • Data collection aggregation, storage and patient registries

      • Connectivity and identification of gaps in care

      • Big data stratification and risk segmentation/cost metrics

      • Patient engagement and external data acquisition

      • Care team coordination and management

      • Outcomes measurement, reporting and analytics


      As advanced solutions increasingly need to make use of some of the more complex computing capabilities previously identified in this paper, in particular patient engagement, cognitive computing and AI, it is going to be hard for any vendor to provide solutions that meet all these needs and it will be especially hard for EHR vendors to keep up with the pace of development. This suggests that future solutions will be created through seamless integration of systems capabilities from multiple vendors.


      Improving Interoperability Between the Connected Health World and EHR Systems


      Digital and personal connected health was the subject of its own 2 day forum at the Conference, accompanied by a booth in the exhibition hall providing a series of case studies and demonstrations by over 50 companies active in the area.


      Connected health embraces a number of technology domains broadly encompassed by the Internet of Things (IoT); medical and consumer devices for remote patient monitoring, mHealth apps for collection and display of data as well as direct interaction with users, advanced data mining, interpretation and presentation capabilities. New devices, wearable sensors and mobile apps now track fitness, behaviours and many important clinical measures, with the promise of even more complex and interesting metrics becoming available in the near future. It is a dynamic and expansive market, exploding with opportunity.


      The resulting patient-generated health data (PGHD) is available to be flowed into EHRs to help improve engagement, adherence and clinical outcomes; individuals are connecting with providers through portals and apps to manage chronic conditions, and telemedicine is enabling a growing number of virtual visits. Functionality including gamification adopted from the consumer space is being leveraged to drive both sustained engagement and positive behavior change.


      Connected Health already has the potential to improve care delivery across the healthcare continuum, with the promise of adding even greater value in the future. However, as more healthcare providers and plans embrace these technologies, they’re running into interoperability, regulatory, and cultural challenges. Case studies, best practices, and panel discussions, presented at the Conference outlined tools, technologies and strategies designed to address these challenges. A number of presenters called out that Connected Health represents a fundamental change in the way we provide healthcare services that require new systems, delivery models and workflows, and even more importantly a fundamental cultural shift to the total approach to service delivery prevention and remote engagement at large scale with the people for whom health systems are responsible.


      A closely related theme is that EHR interoperability continues to be a barrier to progress, and is general and pervasive. Many of the EHR vendors presented work they are doing to overcome these barriers; openAPIs, adoption of interfacing standards (eg FHIR) and use of webapps, but progress is not as fast as many would like. This issue is a particular challenge to the seamless delivery of connected health capabilities into the clinical workflow which are is critical to adoption and use. In parallel, there is significant work underway to simplify EHR integration and facilitate sophisticated data exchange between organizations. FHIR was covered in many presentations and received significant interest for its potential to assist with this particular challenge.


      Cloud Computing and Security for the Digital Healthcare Enterprise


      Cloud computing and security in the digital healthcare enterprise, which for health systems development are closely linked, were also major themes at the Conference.


      A move to healthcare solutions that have been formally developed and deployed to leverage cloud computing capabilities has significant potential, but to date, healthcare world-wide has been slow to embrace these opportunities. There are a number of reasons; most healthcare providers have significant investment in on-prem deployments of their all-critical clinical systems including EHRs, migration appears potentially costly and to have significant risks even if the end results would have economic and business advantages, but probably the most significant barrier has been the perceived security risks.


      The issue is around ensuring complete protection of electronic personal health information (ePHI), and the proven solutions available to healthcare IT teams that still rely on tried and tested, locally deployed security measures, eg network and endpoint security tools.


      But the tides of change can no longer be held back and the healthcare industry is increasingly adopting the cloud, with health systems realizing the significant cost savings of contracting their data-center operations. This opens up important questions having to do with data being held in compliance with HIPAA-HITECH; whether ePHI is being encrypted and, if so, where the keys reside and how organizations can port their data from one cloud provider to another if needed.


      The other hot topic in this space is medical device security and there were a number of educational sessions dedicated to this topic. Groups like the Medical Device Security Information Sharing Council (MDSISC) and NH-ISAC are focusing much-needed attention on medical device security, and there is growing momentum for security to be incorporated at the point of manufacture as opposed to being an afterthought.




      In summary, this was one of the most interesting and invigorating HIMSS Conferences I’ve attended. While healthcare world-wide face very significant challenges, it seems that the health system development space finally has a range of truly exciting and in many ways disruptive solutions with very real potential to address these challenges. These systems are not only novel in concept, but can facilitate totally new business processes that if well implemented can provide the very different healthcare experience that is it now clear many individuals are seeking. Our ability to address this need  will materially impact the future care of healthcare, leading to a world very different that we know today.


      HIMMSS Conference 2017

      1-10 of 63