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Martin Sizemore

Enterprise Architect with specialized skills in Enterprise Application Integration (EAI) and Service Oriented Architecture (SOA). Consultant and a trusted advisor to Chief Executive Officers, COOs, CIOs and senior managers for global multi-national companies and healthcare organizations. Deep industry experience as a consultant in manufacturing, healthcare and financial services industries. Broad knowledge of IBM hardware and software offerings with numerous certifications and recognitions from IBM including On-Demand Computing and SOA Advisor. Experienced with Microsoft general software products and architecture, including Sharepoint and SQL Server. Deep technical skills in system integration, system and software selection, data architecture, data warehousing and infrastructure design including virtualization.

Homepage http://www.perficient.com

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A Blueprint for Managing Drug Shortages

In April 2014, I read a startling article that the United States was importing salt water, saline, from Norway due to a shortage in the United States1. Bags of saline solution are one of the most common items used in modern healthcare and that is why it is amazing that American doctors have been facing a bizarre IV saline shortage that forces the import of heavily, unwieldy bags of salt water from overseas. As a result, hospitals, and especially cancer centers, have been keeping strict inventories of how many bags are on hand and struggling to avoid rationing their use. This turn of events led to a deeper look at the problems caused by drug shortages for healthcare organizations and developing a business intelligence blueprint to help manage shortages more effectively.

A Blueprint for Managing Drug Shortages

The IMS Institute for Healthcare Informatics, in their report Drug Shortages: A closer look at products, suppliers and volume volatility, identified 6 key insights:

  1. The drug shortage problem is highly concentrated to generic injectables or five disease areas including oncology and cardiovascular diseases.
  2. The supply of drugs on the shortages list has been stable or increased overall in the past five years.
  3. There is significant volatility in the suppliers of the drugs, not the total volume supplied.
  4. The recent volatility is a new trend compared to previous years.
  5. The number of suppliers has fluctuated and may be one reason for the volatility.
  6. Some states are feeling the drug shortage more acutely than others.

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Medication Management: 3 Important Safety Tips

One of the hot healthcare topics at health plans this year has been medication therapy management. Hopefully, you have had the drill with your primary care physician of listing the medications that you are taking and discussing the impact of one medication on another for you as a patient. Having said that, I have heard some real horror stories lately of senior citizens taking a long list of daily drugs, then being hospitalized and on discharge given a new set of prescriptions. Confused, the senior citizen ends up taking double doses of some dangerous medications like blood thinners, for example. We are all seeking the least expensive co-payment or cash payment for Medication Management: 3 Important Safety Tipsmedications for a chronic condition, sourcing medications from different pharmacies, and no one is looking at the drug interactions. Health plans that see these pharmacy claims are moving rapidly to address the need for a comprehensive review of medications for an insured individual, especially those people taking eight or more medications.

It isn’t well known that some drugs taken for one chronic condition can make another chronic condition worse in the same patient. Researchers at the Yale School of Medicine and Oregon State University have found that 23% of Medicare patients with multiple chronic conditions were taking at least one prescription medication that could adversely affect a co-existing condition. One clear example is the nearly 4 million older Americans that are being treated for high blood pressure and chronic obstructive pulmonary disease (COPD). Taking a beta-blocker for hypertension could make your COPD worse. Alternatively, taking the COPD drugs can worsen hypertension. Nearly 3 out of 4 older Americans have two or more chronic health conditions and they are often diagnosed and treated by different doctors.

Here are 3 important tips help improve your medication safety as a patient:

  1. Keep a complete list of your medications with you for visiting with all medical personnel, including your dentist. It is important to list the name of the medication, the dose and how frequently you take it. Your list should include vitamins, supplements and over the counter medications that are used on a regular basis.
  2. Talk to the pharmacist when you get refills about potential drug interactions or side effects using your complete list of medications, especially when taking a new medication for the first time. Maybe keep your medication list in Notepad on your smartphone for convenience.
  3. Talk to your general practitioner or family doctor immediately if you believe you have a drug interaction or side effect from a medication. Use your family doctor to coordinate with your other medical specialists to avoid medication issues. Get one quarterback for the team and stick with them!

One final note, it is important to continue to ask your family doctor if you need to continue on a medication periodically and not assume that you will take a medication indefinitely. It is a healthy conversation to review your medication list and see what can be removed or replaced with a newer, more effective drug, for example. Health plans are working hard to avoid their insured members ending up in the emergency room with medication problems and each of us can do our part to be smarter healthcare consumers.

Heartbleed – How we can Reduce the Security Threat in Healthcare

The Heartbleed bug is causing some real heart palpitations in the healthcare community (sorry for the pun), regardless of whether your organization is a health plan, a health provider or both.

ntroducingThat’s according to Phil Lerner, chief information security officer at Beth Israel Deaconess Medical Center, who, on a scale from 1 to 10, ranks the bug a solid “high priority” at 7.5.

“It’s a serious threat for any enterprise, quite frankly, that’s using OpenSSL,” said Lerner. When Lerner and his BIDMC security team first saw Heartbleed, they shifted into gear working closely together to ensure compliance and resolutions. The bug continues to be “top of the food chain” and a chief priority for Lerner. From the looks of it, this appears to be the general consensus across all industries.

(Source: “Insurers, providers try to dodge Heartbleed” by Erin McCann, Healthcare Payer News)

The biggest challenge is that Heartbleed is a silent threat to the security of protected healthcare information (PHI) and, as such, a potential exposure for a HIPAA violation.

Kevin Johnson, chief executive officer of security consulting firm Secure Ideas, called the miscreant Heartbleed a “very serious deal,” as the attack against the bug can go undetected. “If your system is being exploited, the logs and such do not show any maliciousness,” he explained. There are, of course, newly-built detection rules that can now aid vulnerable servers, he pointed out.

As a result, Heartbleed reinforces the need for the encryption of healthcare data both in-flight where there is exposure with OpenSSL and at rest in data storage.  Building multiple layers of protection for PHI must bubble up to the top of the healthcare IT priority list, and Heartbleed is just a warning. (more…)

Population Health: Informatics for Clinical Decision Flow & Costs

At the Fourteenth Population Health Colloquium in Philadelphia, Perficient’s own Lesli Adams, MPA, took the stage with Sanjay Udoshi, MD and Brady Davis to present “Shared Accountability: How Informatics and Data for Clinical Decision Workflow engages Consumers on the Quality/Cost Equation.”  This Mini Summit presentation was sponsored by Oracle Health Sciences and Perficient.   The kick-off of the presentation was fun because it introduced the speakers as a business analyst geek (Lesli), an innovation and strategy guy (Brady) and a doc in the box (Dr. Udoshi). The presentation was targeted at the opportunities for quality improvement and cost control including wellness and chronic disease care gaps.  At the risk of seeming biased, this presentation was one of the more practical, down to earth approaches at this week’s Colloquium event.

Why do I believe that? Well, I felt that many of the attendees at the Colloquium were seeking real how-to knowledge.  Not that the big healthcare organization’s experience in implementing population health management aren’t valuable insights, but there was a lot of buzz about whether population health management can be done in a cost effective manner, and this presentation addressed the type of informatics required to change traditional approaches.  The first step was to outline the process in a slide called Population Health Management 101.  The key concept was moving paper processes for care management to a digital platform to analyze and manage costs, see figure 1.

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Figure 1. Population Health Management 101

 

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Figure 2. Re-engineering Clinical Care

 

The second idea was to re-engineer clinical care to identify and manage care gaps.  The first step is to identify the key populations to be managed, then determine the key Goals for that population, and finally to manage addressing the gaps in care or Action Arms (Figure 2).  Note that different populations have unique goals but subsequently could have common Action Arms.  To address creating the care gaps and related Action Arms, the healthcare organization has to have a strategic vision for these target populations and combine that with the right tactical tools, namely informatics.  The challenge of creating these informatics isn’t simply addressed with technology tools, but requires several key steps including:

  • Structured Data Capture vs Natural Language Processing (NLP)
  • Diagnosis Naming Conventions
  • Establishing the Digital “Gold” Standard”
  • Influencing the Problem List
  • HCCs and Chronic Disease Management
  • Best Practice Alerting and Health Maintenance Modifiers
  • Guideline Based Bundles and Closing Care Gaps

Addressing Care Gaps is very practical advice for healthcare organizations seeking to really manage populations. Creating informatics solutions that support closing preventive, chronic and restorative care gaps will drive health care value for patients and health plans alike.  Creating these informatics requires data mining, process re-engineering and the ability to extract data from modern electronic health record systems.  Building patient-centric plans of care based on this process will need to be supported through proactive outreach as well.  The key is applying technology tools in novel ways to enhance shared decision-making between the clinician and patient.

Lesli Adams outlined what I see as the key factor to population health management: cost management.  The integration of clinical information and financial data is key to cost management and often this data resides in silo’ed or separate software applications.  The ability to manage costs by having standardized pathways, then examine costs at a Patient Level will lead to better decision-making and more cost effective care.  Putting the disciplines in place to examine physician variability against the standardized pathways is the enforcement technique to bring costs under control.  When organizations commit to collecting and cleaning this level of costing information, then profitability reports by service line, DRG and Physician become reliable tools for key decisions about operations.  One of the highlights of the presentation was micro-costing examples to highlight the key decision points for clinicians.

Lesli Adams will be presenting at the Oracle Industry Connect event on Tuesday and Wednesday, March 25-26 in Boston.  For more information on Perficient’s informatics offerings, especially related to Population Health Management, please contact us.

Population Health: Getting the Process Right

It was a privilege to attend the Fourteenth Population Health Colloquium in Philadelphia starting on a snowy St. Patrick’s Day.  One of my favorite sessions on Monday afternoon was led by Terry O’Rourke, MD who postponed his celebration of the holiday to present “Managing Populations: The Role of a Large Health System.”  CHE Trinity as a healthcare organization treats 18 million patients a year and Dr. O’Rourke had a great Snow in Philadelphiaperspective on the challenges of population health management.

Dr. O’Rourke stated that CHE Trinity was one of the largest home care providers in the United States and that their healthcare organization encompassed 86 hospitals and 21,600 physicians.  More importantly, CHE Trinity was participating in 6 bundled payment programs and 29 patient centered medical home programs.  His observation that “All Healthcare is Local, All Healthcare Standards are National” comes from an understanding of the need for clinically integrated networks and the role of data driven decision making in reducing variations in outcomes.  Terry noted that despite hard work on adopting standards that there is still a wide variation in healthcare delivery.  He also noted that the lesser but still significant variation in outcomes across a large healthcare organization was more proof of the resiliency of human body than the careful adoption of standardized procedures.

The key to his presentation was the observation that clinicians need to lead the effort to standardize care, not hospital administrations or others.  CHE Trinity created a unified clinical organization with the help of outside consultants that streamlined many silos within the large organization into a whole unit.  As a result of unifying the clinical organization, Dr.  O’Rourke noted that operating cash flow margins improved to 9.4 – 9.6% across the system.  The second step beyond unification was to improve their reporting to encourage data driven decision-making.  It was interesting to see how the metrics were converted into grades, like school grades, for easy consumption and judging performance.   The different Terry O'Rourke Presentationhospital boards had GPAs ranging from a low of 2.1 to a high of 3.6 on a 4 point scale.  The goal of the data-driven decision support process was to improve the ease of consuming and acting on the information.

To summarize, Dr. O’Rourke said that “good care is cost effective care.”  Clearly, CHE Trinity is focused on bringing a level of consistency in clinical procedures in population health management and improving cash flow margins in the process.  As with most organizational business solutions, the focus on people and process yields the best results with technology playing a supporting role was my observation.  The focus on people, patients, as the central figure in their clinical processes is real population health management.

Can you predict my future? Predictive analytics at #HIMSS14

While my interest is always in the convergence of technology like the Internet of Things and healthcare IT, the role of sensors in managing health and wellness is just exploding. 

“The most popular device functionality in the wearable tech market is heart rate monitoring, with nearly 12 million such devices shipped in 2013. Pedometers and activity trackers accounted for a combined 16 million shipments over the same period.” (According to a report released Thursday by ABI Research)

- Source: New report shows smartwatches and AR glasses have their work cut out.

the role of analytics, especially healthcare analytics, should be to inform, encourage and drive healthcare consumers to improve our behaviors or decisions without being intrusive.

“The role of analytics, especially healthcare analytics, should be to inform, encourage and drive healthcare consumers to improve our behaviors or decisions without being intrusive.”

You can’t turn anywhere without reading about the latest running gadgets, fitness bands, Bluetooth blood pressure cuffs, etc.  In the inevitable rush to wearable computing, one key idea can get lost: what are we doing with all of that data? 

The data produced by these devices and sensors has to be interpreted and turned into information that is actionable.  The fitness band that looks at your goal of 10,000 steps, sees that you are at 8,000 steps right after dinner and encourages you for one final walk around the neighborhood, will ultimately win out over all others.  In order to pull off that trick, we need analytics and, sometimes, predictive analytics.

Just as the sensors are working in the background without us even taking notice, the role of analytics, especially healthcare analytics, should be to inform, encourage and drive healthcare consumers to improve our behaviors or decisions without being intrusive.  The goal of healthcare analytics or informatics should be to create an environment for the healthcare consumer that makes life better, easier and more enjoyable.

An example is when the running app sees your pace slowing down towards the end of a run, then it kicks in a song with a faster pace to help you finish strong.  Today those apps require you to recognize that situation and take action of pressing a button.  It’s all there but it’s not automated.  What we need is that invisible intelligence that recognizes the situation and then takes action to assist us.

The Role of AnalyticsAt HIMSS 2014, we will be seeing this jump in interest in predictive analytics as it applies to healthcare, especially two distinct types of predictive analytics.

  1. One type is the traditional forecasting model of advanced analytics that trends past information to predict future states.
  2. The second type of predictive analytics is statistical models that encompass multiple feeds or variables to predict a future outcome.  This modeling is rapidly moving past the arena of data scientists who create the models and is moving more within the grasp of smart business analysts.  These models can predict your longevity based on multiple factors like your BMI, blood sugar readings for diabetics and other factors from your medical history.

Of course, we want to be able to predict health outcomes, especially when faced with several choices for changing our behaviors or lifestyle.  It will be exciting to see how healthcare application vendors are addressing this important next step in analytics.

The use of predictive analytics could really change the nature of a patient engagement with your doctor.  How will we react when we see the outcome of our current lifestyle?  Will we shut off Netflix bingeing and head to the gym? See you at HIMSS 2014 to find out!  Stop by Perficient’s booth #2035 and tell us what you found out!

himss14_top

 

A Love Letter to Meaningful Use – #HIMSS14

It seems appropriate on Valentine’s Day to write love letters.  This is my letter of adoration to Meaningful Use.  In the past, I have written about how much time and productivity is wasted in the average physician’s office handling phone calls about prescription refills.  My physician’s office has successfully implemented their EMR software, and the patient portal is very, very handy for all of the right reasons.  I could wax poetic about the ease of checking on appointments and reviewing lab results.  The source of my real happiness is the ease of asking for refills and having the ability to route the request to the right pharmacy.  It was love at first click.

A Love Letter toInstead of calling the doctor, waiting on hold to talk to the nurse, fretting about getting the medication name and dosage right for the refill, it was magic.  I signed into the patient portal in a secure fashion, clicked on medication refills, and there was a correct list of my medications!  I selected the ones I needed refilled including a suggested number of days like 30 or 90, selected the pharmacy of my choice and Voila!  Several hours later, I received an email confirmation from the pharmacy that they were processing my order.  Now honestly, I didn’t have to see what went on behind the curtain in the doctor’s office to review my request, but I’m sure they like the elimination of potential communication errors on medications, too.

My doctor has shared with me about the financial burden of casting out his first EMR investment and starting over with a better EMR software.  I have to say that from my point of view, he clearly chose the right one and it actually fulfills the basic tenets of Meaningful Use, particularly from the patient’s point of view.  I plan to share my enthusiasm for the patient portal with him including the secure messaging that allowed me tell him that his changes in my medications worked and improved my quality of life.  This secure messaging was another plus for productivity, and patient satisfaction, because those positive responses got lost in the challenges of telephone communication in the past. (more…)

Identity and the Internet of Things – Lessons for Healthcare

Attending Dreamforce in San Francisco last month, I was reminded of an article I read in All Things Digital about the role of Identity and the Internet of Things.  Apparently Marc Benioff, salesforce.com’s CEO, mentioned during a presentation at the Bank of America Merrill Lynch 2013 Technology Conference,  that Phillips, the electronics company long known for staple consumer products like TVs, cameras and audio equipment, was working on a new toothbrush. The toothbrush under development was not just any ordinary toothbrush but included GPS, Wi-Fi and “realtime” feedback on how a person brushes their teeth.  Voila, no more lying to your dentist – self-quantification will rat you out with your own data.

While the concept of “The Internet of Things” like the high-tech toothbrush isn’t new, salesforce.com’s forward thinking CEO was previewing a new trend — connected devices are becoming inextricably tied to identity.  Just like my registration email at Dreamforce using a barcode to speed check-in and attendance at sessions.  My identity Internet-Of-Thingswas tied to a “thing” in the Internet of Things.  Lots of my personal devices are internet-enabled as well, connecting my identity to how far I walk for exercise, where I travel, what hotels I stay at, etc.  In the world of social, devices like the smartphone, activity tracking wristbands, etc. are creating comprehensive profiles of our “real” behaviors like brushing our teeth.

It doesn’t take a big leap to understand the impact of connecting my identity and devices on managing my health or lifestyle.  You can easily imagine a healthcare plan, like Geico does on cars, offering a discounted health plan in exchange for your comprehensive lifestyle profile, or at least lower deductibles for positive behaviors, including taking your medications on time.  The challenge will be making certain that your identity is truly linked to your proper information in healthcare systems and there are clear safeguards in place.  As the article in All Things Digital states

“And to be clear, trust-based relationships with users means that privacy must be accounted for and the right controls must be in place before businesses start collecting and using this data. With the proper opt-in/out privacy controls in place, identity-defining traits like hometown, religious beliefs, relationships status, likes, activities and social graph can be available to marketers and used to drive hyper-relevant marketing campaigns.”

As the list of connected “things” in our lives grows and uses our identity to tie our behavior profile to our healthcare management, the pressure will be increased for outstanding master data management by healthcare providers and healthcare plans.  It is amazingly difficult for healthcare companies to conquer enterprise-level master patient indexes to resolve your one identity and create a combined view of your medical history.  While your smartphone revolves around your Facebook username and password, Twitter log-ins, etc. to know you, the fragmented healthcare system must piece together that you go by your middle name, use a nickname or don’t really know your actual Social Security Number.

Master Data Management and Identity Management for healthcare is literally a matter of life and death, especially for people with medication allergies, chronic conditions like diabetes and people with medical implants like pacemakers.  Dick Chaney took the extreme step of firewalling his wireless connection on his pacemaker, for example, to block terrorists from attacking him based on his device and identity.  While we enjoy the idea of our exercise wrist band taking to our smart thermostat to cool down the house after a run, we need to understand the broader implication of this degree of connectivity into our own safety as patients.

You may laugh the next time that the hospital asks you your name for the umpteenth time or marks the site of your surgery with a marker, but identity matters in healthcare and as that industry becomes more connected like your devices, make sure that your information is correct, up to date and is “real.”  It could literally save your life.

Are you really listening to your patients?

If the pressure to obtain and implement Customer Relationship Management software by healthcare organizations is any indication, decision makers are recognizing the increasing importance of consumer knowledge in the race to improve patient satisfaction scores.  Indeed, today, patient insights can lead healthcare organizations to their best opportunities for growth and restoration of profitability far more accurately than that marketing presentation in the boardroom.  The increasingly reluctant spending by healthcare consumers needs to be better understood because a healthy healthcare delivery system depends on it.  The challenge is that healthcare consumer interactions are not typically structured information that is easily analyzed to be acted upon, but are increasingly emails, phone conversations, web-based chat support and other unstructured information.

Increasingly, outbound direct mail or telemarketing is simply not getting results for healthcare marketing departments.  The focus needs to shift to creating a great consumer experience on the inbound approach as an alternative. Doesn’t everyone enjoy doing business with a company that is easy to find and obtain what you are looking iStock_DoctorPatientfor?  You don’t have to look far for proof of this idea.  No longer able to differentiate on brand reputation, leading companies instead are focusing on the consumer experience—the all-important feelings that consumers develop about a company and its products or services across all touch points—as the key opportunity to break from their competition and regain lost revenue from programs like hospital value based purchasing. Outside of healthcare, the evidence of this new emphasis is found in the emergence of the “chief consumer officer” (CCO) role across the Fortune 1000 community.  Companies such as United Airlines, Samsung and Chrysler have all implemented chief consumer officers as part of their executive suites.  Should healthcare plans and providers consider this key competitive move too?

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Google Decides to Take on Oil of Olay

Calico

 

 

 

 

Google is tackling anti-aging with their new healthcare initiative called Calico.  It remains to be seen if it is a threat to anti-aging creams or will increase their potential customers.  But seriously, Calico is being led by the former Genetech CEO and current Apple Chairman, Arthur D. Levinson and this new healthcare project will leverage Google’s massive cloud and data centers to help facilitate research on disease and aging.  Google already had an investment in 23andMe, and, as a result, has access to a fast growing genomic database that could be used for research into increasing longevity and disease.  Personally, I like these “big bet” investments with a great long term goal by companies like IBM and Google.  Today, we are seeing significant gains in analyzing unstructured information and natural language processing in healthcare, thanks to IBM building Watson to play Jeopardy.  Hopefully, Google’s investment in Calico can bring about innovation in personalized medicine by deep analysis of a person’s genome versus their medical history.  Focusing on an individual’s genetic make-up, it’s impact on aging and the prevention of possible disease is exactly the premise of Eric Topol’s book called The Creative Destruction of Medicine and a bold step in the right direction.

 

Hopefully, Google can use its worldwide reach, like they did with Street Maps, to examine key populations that have longevity today and the combination of their genetics, lifestyles and geography to bring quality of life and wellness to more people.   Google’s investment in Calico could create new “Blue Zones” where a people in demographic or geographic area of the world live measurably longer lives.  Taking guidance from Dan Buettner’s book, “The Blue Zones: Lessons for Living Longer from people who live the longest,” I would suggest that Google begin analyzing the men in Sardinia’s Nuoro province for their genomic lessons.  Studying these centenarians as benchmarks for these rest of us living long lives is a great place for Calico to begin.  Just my two cents worth . . .

 

The Coming “Big Data” Storm

As a technologist raised in Kansas as a child, I am used to examining the horizon for changes in the weather.  We could watch the large thunderstorms build up during the heat of the day into 40,000 foot monsters full of hail and tornadoes.  I was reading an Ars Technica article on how pervasive computing and cloud will change the nature of IT recently, and the article pointed out the coming “big data” storm.  The article argues that like the heat of a Midwestern day growing and driving the thunderstorm, key technologies have reached a tipping point to create the perfect “big data” storm.

Just like storms, big data includes three big trends of volume, velocity and variety.  Data sets were predicted to reach 1 petabyte (1 million gigabytes) and without recent advances in hardware and software, especially virtualization and cloud storage, would be unmanageable in terms of volume.  Velocity is especially evident in healthcare data stormwhere near real-time information is not just a goal but becoming a requirement.  Velocity demands very fast processing to analyze data, potentially aggregate it, and visualize results.  Variety of data is a challenge in healthcare as well, with new and unstructured forms like video, text and sensor readings. The proliferation of medical devices and sensors alone can create data that literally overwhelm the typical healthcare organization’s ability to analyze and take action based on the information, thus creating a dangerous storm.

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It is time for Interoperability to catch fire! (FHIR® that is)

One of my healthcare consulting friends once said that interoperability was difficult because healthcare was interactional, not transactional.  The interactive nature of the healthcare organization and the patient foretells the complexity of integrating and sharing information that is so critical to reducing costs, increasing patient safety and streamlining productivity.  The challenge is inertia – we have so many healthcare applications and integration engines that are stuck on the older HL7 version 2.x as the means of implementing interoperability.  The uptake of the proposed HL7 version 3.0 has been very, very slow due to support from the EMR vendors that are focused on bigger problems like Meaningful Use or ICD-10 support.  In response, HL7 is hoping to set interoperability on fire with a new approach called FHIR® – Fast Health FHIRInteroperable Resources – it is a next generation standards framework created by HL7. FHIR combines the best features of HL7’s Version 2, Version 3 and CDA® product lines while leveraging the latest web standards and making sure that easy implementations are a top priority.

The key to the fast implementation speed of FHIR® is flexibility!  FHIR solutions are built from a set of modular components called “Resources.”  These resources can easily be assembled into working systems that solve real world clinical and administrative problems quickly and with a minimal amount of development, sometimes only one day. FHIR is designed to meet modern integration demands in a wide variety of contexts – social media on mobile phones, cloud communications, EHR-based data sharing, server communication in large institutional healthcare providers, and many other scenarios.

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