Achieving healthcare interoperability

A post by Dr. Taha A. Kass-Hout, Melanie Kaplan, and Pat Combes

As patients navigate the healthcare system, their records should be easily transferable between all organizations to ensure continuity of care. Value-based payment programs and increasing consumerism have driven the need for prompt and complete access to clinical information in healthcare systems around the world.

Similar to how the ATM, now 52-years-old, changed the banking account concept for the industry and consumers, Amazon Web Services (AWS) believes we can help revolutionize medicine.

Instead of moving static, electronic documents (or faxes) like care summaries between healthcare providers, an API can enable electronic health record (EHR) vendors and health systems to communicate in a standardized way with apps and other EHRs. This approach ensures that every entity in the value chain can leverage data that’s in line with regulations securely — improving health quality outcomes, enhancing patient access and engagement, and delivering cost-effective care.

The FHIR Engine

The Fast Healthcare Interoperability Resource (FHIR, pronounced “fire”) open standard has emerged from the nonprofit HL7 organization to act like a lingua franca, providing a universal adaptor for sharing clinically relevant data easily and securely from any EHR or clinical system and allowing software developers to build high-quality applications.

FHIR’s Value

AWS enables customers and partners to build secure, compliant, and scalable solutions for the delivery and exchange of medical information across the healthcare industry. AWS currently provides a reference implementation for serverless implementation of FHIR APIs on AWS and access to over 100 HIPAA-eligible features and services with a wide range of certifications and attestations, covering compliance programs worldwide.

Security is job zero for us. Customers using AWS maintain complete control of their own data, and only they have access to and hold the keys for encryption. Scalability allows healthcare providers to reach more patient records. Wayne Kubick, CTO of HL7 International, says, “…solutions such as AWS can provide much more security, redundancy, and scalability than most on-premises type solutions.”

Change Healthcare announced its clinical data interoperability services on AWS for document retrieval, identity management, and record location. Arien Malec, SVP and member of the HIT Advisory Committee, notes, “Our ability as a country to make dramatic improvements in health and healthcare depends on our ability to deliver improved interoperability and exchange data between settings of care and to the individual. Open standards such as HL7 FHIR and APIs for clinical exchange and administrative automation are critical to this effort.”

Cloudticity helps its customers quickly deploy and manage a healthcare HIPAA-compliant interoperability RESTFul API on Amazon API Gateway. Gerry Miller, CEO, says, “At Cloudticity, we’re proud to help the healthcare industry develop and use open standards, such as FHIR, for easy exchange of information, freeing providers, payers, and patients themselves from the confines of proprietary data formats and systems.”

Cerner’s HealtheIntent population health management platform allows caregivers to communicate and share data between organizations at scale. Ryan Hamilton, SVP, Population Health, says, “Each one of us struggles to manage our health and coordinate the providers in our care teams. Interoperability of healthcare data is key to being able to identify the unique needs of each individual, match them to the right resources in their community, and assist them to share data and coordinate their care, using FHIR via Cerner’s Ignite APIs on Amazon API Gateway.”

Black Pear Software offers a general purpose FHIR integration engine functionality on AWS to automatically share patient data and return clinically coded outcomes to care teams. Dunmail Hodkinson, CTO, explains, “Black Pear uses AWS scalable infrastructure to provide FHIR APIs for a broad range of apps including clinical systems, appointment books, and patient apps. For example, at NHS.”

In a recent DevDays workshop, we demonstrated the use of Amazon Comprehend Medical to extract clinical entities, such as medical conditions from medical notes, and map directly to FHIR resources.

Better Care and Customer Experience

Adopting and scaling open interoperability standards can streamline the structured data exchange needed to improve preventive and value-based care for people, predictions, diagnostics, postmarketing surveillance of medical products (e.g., drug, device), care quality, cost reduction, and clinical research.

Overall, medical and scientific insights and knowledge tied to patient outcomes are enhanced where advanced analytics using machine learning (ML) can be taken advantage of in an accurate, scalable, secure, and timely manner.

Using the Apache MXNet on AWS deep learning API and Amazon SageMaker, Beth Israel Deaconess Medical Center can reach out to patients who might miss appointments at medical clinics and predict operating room cancellations so that care can be delivered in a timely manner, improving the patient experience and health outcomes. In a research project, Amazon and Cerner built an ML model that accurately predicts the onset of congestive heart failure post hospital discharge with 15-months lead time.

GE Healthcare’s Edison, one of the largest artificial intelligence (AI) platforms in healthcare built to connect data from millions of imaging devices, uses Amazon SageMaker. Among its outputs is AIRx, a recently FDA-approved precision diagnostics tool for MR neuroimaging.

Fred Hutchinson Cancer Research Center uses Amazon Comprehend Medical to identify patients for clinical trials who may benefit from specific cancer therapies, reducing the time to process millions of document from hours to seconds. “This is a vital step … to advance lifesaving therapies for patients,” said Matthew Trunnell, CIO.

Looking Ahead

Efforts from the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) for championing an open standard, generated by the user community, will help achieve greater interoperability towards patient access.

At AWS, we enable our customers and partners to promote and scale interoperability for a greater and more efficient access to clinical data by patients and payers. The collective steps outlined here can advance the ability to safely and effectively manage, mitigate, and cure disease on a global level and help restore transparency to the healthcare business and system. We look forward to working together on achieving scalable interoperability using FHIR.