Connected care is increasingly about integrating patients with home-based or wearable sensors of all kinds, but until now standards for medical device and personal health device (PHD) interoperability have been somewhat slow to take off, with everyone being left to their own devices. However, US healthcare groups have recently called for more standardisation. Now a timely collaboration between two key players could help bridge the home-to-hospital data divide. 

The PCHA, formerly the Continua Alliance, published the first version of its Continua Design Guidelines (CDG) years ago already. CDG is an interoperability framework for connecting PHD to IT platforms of all kinds. It is supported by major device vendors; but in spite of that, it had major difficulties in recent years to really reach out into the market. Integrating the Healthcare Enterprise (IHE International), on the other hand, has also worked on medical interoperability, but primarily focused on publishing its IHE Technical Profiles for enterprise level data exchange and interoperability within hospitals, health systems, and information exchanges. 

‘A promise to help unlock data and usher in a new era of interoperable solution’

HIMSS Director of Informatics and HIT Standards Amit Trivedi said change was necessary: “Healthcare has long struggled with achieving greater levels of interoperability, however, the situation at the moment is that as an industry, healthcare is poised to benefit from a convergence of new and emerging technologies like the cloud, APIs, wireless, AI, machine learning – coupled with new data standards like FHIR – which promise to help unlock data and usher in a new era of interoperable solution, which enable health information to flow anywhere.” 

Trivedi said PCHA and IHE had similar aims so more collaboration made sense: “Instead of two complementary efforts going on in disparate organizations, we could combine resources and activities to address both home and personal connected health interoperability, as well as enterprise devices. The IHE Patient Care Devices domain will become the Devices domain, which will be comprised of work focused on both enterprise patient devices, as well as personal connected health devices.”

Trivedi believes the Continua/IHE collaboration could make a real difference: “The longer-term significance is that we will have consolidated testing events, technical committee meetings, and will work together to help advance and mature the FHIR® standard with HL7®. IHE and Continua Design Guidelines are standards profiling efforts. That means instead of developing standards from scratch, these initiatives look for industry approved, mature standards that can be used in combination to achieve advanced interoperability to achieve advanced interoperability.”

This collaboration aims to simplify healthcare IT standards by providing one focused initiative to try to drive health IT/device standardisation and profiling, as well as concentrate efforts to make standards and profiles easier for device manufacturers and IT platform providers to understand. As with the implementation of other standards, CDG adoption has been slow in recent years, but it is hoped with PCHA and IHE joining forces, this will change. While PCHA experts will continue to work on the CDG, the CDG will be published as IHE Technical Profiles, and the PCHA will become members of IHE International and sponsor of the Devices technical domain.

Norway: Data exchange for remote monitoring devices in 2020?

Over in Norway, the government encourages the use of international standards but there are no requirements to use the CDG. Marianne Bårtvedt van Os, Senior Advisor at the Direktoratet for e-helse, said they have not yet formulated a medical device interoperability strategy: “The national strategy is not decided yet. As part of the Norwegian program for connected care and health we have since 2018 performed a trial/PoC involving a national hub (based on cloud service) that performs translations between data formats to enable the different connected care solutions to interact with the EHR in the municipalities.”

The interfaces of the connected care solutions are based on HL7 FHIR, while the EHR interfaces are specific to the vendors’ data format, so this is an interim “translation service” that will last until we also have standardized interfaces also on the EHR side. Based on the PoC we will deliver a national recommendation in March 2020. In 2020 we will probably look at including data exchange for remote monitoring devices as well”.

Bårtvedt van Os said the national programme for connected care and health is conducting remote patient-monitoring pilots, involving 600 people in six municipalities over a year: “So far we have seen great effects for patients, for health care professionals and better quality and capacity of service. Personal connected health and care help people feel safer and more secure at home, enable greater self-management, coping with their health condition and life situation. At the same time, we can see an increase in quality and efficiency.”

She said vendors’ solutions were used in pilots as the focus was on the health service, rather than technology: “For the PoC involving the national translating hub for connected care devices, the interfaces of the connected care solutions are based on HL7 FHIR, while the EHR interfaces are specific to the vendors’ data format.”  She added that Norway still has to make a decision about adopting the CDG.

This article was first published in the latest issue of HIMSS Insights. Healthcare IT News and HIMSS Insights are HIMSS Media publications.