< + > MeldRx Is Making Healthcare App Development and FHIR Data Access Easy

When someone wants to create a healthcare app, they often think that getting the data they need to make their app work will be easy.  They assume that there must be some easy EHR API they can tap into that will provide them with the data access they need.  Or maybe they hear about this new more modern FHIR standard that will give them access to that data.  Once they dive into the details associated with accessing health data from the EHR, they realize there is a whole lot more to it than most expect.

This is at least part of the problem that Darena Solutions saw when they talked with healthcare application developers.  These developers wanted to spend time on their application versus spending time figuring out the hundreds of flavors of FHIR implementations and APIs that are required to get data from the hundreds of EHRs and health IT solutions on the market.  Darena Solutions had been working for years providing important interoperability and MIPS solutions to the market when they realized that they could help solve this problem for developers and thus MeldRx was born.

To better understand the newly launched MeldRx product, I sat down to chat with Patrick Schiess, President & CISO at Darena Solutions.  In the video interview below, Schiess shares how the solution works and the problems it solves for developers.  He also shares some insights into the various healthcare standards available and why MeldRx started with FHIR, but how they can support a number of other standards as well (Side Note: Darena Solutions was one of the first implementers of BlueButton 2.0 for HHS and also the first to get certified for the Cures Act for implementing FHIR APIs, so they have a long history in health data standards and sharing).

Schiess also shared the wide variety of potential users he sees for this product.  Healthcare app developers who want access to FHIR data from EHRs are one of the top user-bases, but Schiess also sees how this can be a great solution for research organizations and can even be useful to EHR vendors themselves.  EHR vendors have enough things to manage that it makes sense to outsource the hard work of supporting FHIR to a company with specific FHIR expertise across all EHRs.

I also asked Schiess why a developer wouldn’t just connect to the EHR directly.  Plus, he shares how many FHIR data sources MeldRx can connect, how they approach connecting to multiple data sources, and how they think about linking the data.  Schiess noted how most systems only support read access and not write access.  MeldRx offers a unique data vault feature to customers that allows developers to read and write back to their FHIR data store.  Finally, he shares a little bit about the MeldRx community they’re launching that helps developers navigate the various aspects of FHIR and SMART on FHIR.  This community is a space where developers can ask and answer questions.

Check out the video below to learn more about the newly launched MeldRx and how it can help developers access FHIR APIs more easily.  For a hands-on experience with MeldRx, visit Darena Solutions at HLTH23 (booth #5826).

Learn more about MeldRx: https://meldrx.com/

Learn more about Darena Solutions: https://www.darenasolutions.com/

Listen and subscribe to the Healthcare IT Today Interviews Podcast to hear all the latest insights from experts in healthcare IT.

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Darena Solutions is a proud sponsor of Healthcare Scene.

< + > Future Proofing Healthcare Automation

The following is a guest article by Niall O’Connor, Chief Technology Officer at Cohere Health

Constructing a Responsible AI Framework for Prior Authorization

The American healthcare system is on the precipice of a critically necessary digital transformation. Anyone who has experience with healthcare, even just as a consumer, knows technology and change are needed. A recent report found that 89% of healthcare organizations are still using fax machines and 39% are using pagers. It’s time to future-proof healthcare automation, and I’m not the only one suggesting that now is the time for a digital transformation in healthcare.

Gartner projects expenditure on enterprise IT within the healthcare and life sciences sector to expand by 9.1% during 2023, reaching $240.5 billion. Healthcare leaders are allocating additional funds towards IT services and software, with anticipated yearly growth rates of 11.9% and 13.1%, respectively. Most recently, health industry investors have focused more on artificial intelligence (AI).

As industry leaders have eased into adopting AI solutions and machine learning techniques to expedite the provision of high-quality care and optimize administrative workflows, an enormous opportunity to improve prior authorization processes has surfaced. The process of obtaining prior authorization to evaluate the medical necessity of treatments has plagued healthcare professionals and patients for years. In short, due to their complex nature, inappropriate prior authorization denials contribute to delays in patient care and increased administrative burdens for physicians and their staff. Healthcare leaders have thus set their sights on AI to address the deficiencies within a system characterized by outdated and overly complex prior authorization approval procedures.

While cutting-edge AI tools offer significant potential for enhancing operational efficiency, streamlining processes, and improving patient outcomes, it is crucial that AI-driven technology is utilized responsibly and well-regulated. To gain insight into effective regulation, one must first understand the key ways to establish guardrails around AI’s role in the prior authorization approval process, and what details and actions to consider when leveraging automation.

Creating the Foundation for Responsible AI 

The efficacy of AI hinges on the quality of input data, necessitating an acknowledgment of its inherent limitations to ensure responsible utilization. Addressing these concerns and adhering to four critical considerations for fostering responsible AI transformation have the ability to deliver high-quality, value-based care and enhance patient outcomes.

• Accountability: Responsible use of AI entails a robust collaboration between clinical experts and software engineers, ensuring that the creation, assessment, and refinement of AI models are guided by deep, evidence-based clinical practices.
• Inclusiveness & Equity: AI models with specific health plan policies uphold consistent standards, prevent erroneous care denials, and maintain equity for vulnerable patient populations whose care would otherwise be affected by social determinants.
• Privacy & Security: Safeguarding sensitive patient information requires clinical oversight, and technology must be designed to support that. AI models for prior authorization requests should exclude patient identifiers, relying solely on essential treatment data such as type, date of care, and diagnosis.
• Transparency: Decisions driven by AI must be rooted in clinical data, and transparent practices are vital in minimizing the risk of AI models recommending unjustified prior authorization denials.

Building the Case for AI Accountability 

One in three doctors report adverse patient events stemming from prior authorization issues and delays. Failing to proactively address the potential for negative outcomes, such as algorithmic bias, is unwise and could exacerbate today’s legacy prior authorization concerns. 

In response, the American Medical Association (AMA) has been advocating for increased regulatory supervision of artificial intelligence’s application in assessing prior authorization requests. This oversight includes evaluating whether health plans adhere to a comprehensive and equitable process and mandating human examination of patient records before deciding to deny care. This is one of the major steps to mitigate the risks associated with leaning too heavily on technology rather than utilizing it as a support tool.

One misconception about leveraging AI in the prior authorization process is that the technology makes the final decision; however, AI does not and should never be used to automatically deny authorization requests–or cause delays in patients receiving the care they need. Accountability is the foundation of responsible AI: it stresses that clinical expertise must not only govern the prior authorization processes in real-time but also be integral to AI model development from the outset. 

One example of this overreliance on AI was uncovered in 2022 during an investigation into the use of AI-based technology for the prior authorization review process. Over a period of two months, investigators found that more than 300,000 pre-approved claims were denied by doctors, and did not adequately review the AI-generated denial recommendations.

These fears have prompted growing apprehension about excessive reliance on AI and inadequate clinical oversight. Again, AI’s primary role should be to expedite positive health outcomes and guide providers toward the best treatment options. Physicians cannot rely solely on AI to make final decisions on prior authorization requests without actively scrutinizing the data. We must ensure intelligent decision-making is conducted responsibly and with accuracy. By championing responsible AI alongside advanced clinical innovation and oversight, the healthcare industry is charting a course toward a more patient-centric, precise, and equitable healthcare system.

About Niall O’Connor

Currently, Niall serves as the Chief Technology Officer for Cohere Health. Prior to joining Cohere, Niall acted as Chief Technology Officer for Genospace, a cloud-based software company focused on delivering personalized medicine. Niall was a member of the founding team at Genospace, which was acquired by Sarah Cannon, the Cancer Institute of HCA. Niall also held software engineering positions at Dana-Farber Cancer Institute and Fidelity Investments. 

< + > Featured Health IT Job: Rural Health Clinic Transition Project Manager

We like to regularly feature a healthcare IT job that might be of interest to readers. Today, we’re featuring the Rural Health Clinic Transition Project Manager position that was recently posted on Healthcare IT Central. This position was posted by Stoltenberg Consulting Inc. and is a hybrid position located in the Midwest.

Here’s a description of the position:

Now seeking a Project Manager for a client engagement in the Midwest, who can lead the organization’s physician practices/clinics in their transition over to Rural Health Clinic (RHC) designation. This is a full-time hybrid role for a 6-month duration, with possibility of extension.

Desired Skills/Expertise

• Experience leading the creation of multiple Rural Health Clinics from scratch
• Experience transitioning multiple physician offices over to a Rural Health Clinic program
• Epic Ambulatory experience and/or certification
• Ability to drive the entire RHC transition both operationally and technically
• Thorough understanding or RHC compliance requirements

Looks like a great opportunity for those with experience in being a project manager! If this looks like a position that would interest you, check out the full details for the job and how to apply.

As always, you can search our Health IT job board for a variety of jobs from leading companies in the industry. You can also register for free and post your resume where recruiters search for job candidates regularly.

< + > AstraZeneca expands AI lung screening to public hospitals in Malaysia

It has partnered with Institut Kanser Negara to promote the adoption of AI-based lung screening in public health.

< + > Advocate Health, Mount Sinai, among 10 big health systems in Transcarent provider network

The goal of the new nationwide ecosystem is to simplify patient access through virtual care pathways that work in tandem with local delivery, enabling higher quality and cost efficiencies for providers, says CEO Glen Tullman.

< + > How virtual care can help ease the rural mental health crisis

The overall provider shortage, combined with other unique factors, means rural residents have the odds stacked against them when it comes to seeking mental and behavioral healthcare. But one expert says telehealth can make a big difference.

< + > Not All Prescription Management and Clinical Decision Support Are Created Equal

When I first discovered Synapse Medicine, I was fascinated by the depth of work they had done to handle prescriptions and clinical decision support in their system.  Since their system was and is being broadly used in France, they were able to see and work on all the problems associated with medication management and discover the solutions that worked across a wide swath of patients and environments.  Needless to say, there’s more to prescription management and medication decision support than you would expect at first glance.

This is why I was excited to sit down with Clement Goehrs, MD-PhD, CEO & Co-Founder Synapse Medicine, to learn more about these topics and Synapse Medicine’s progress bringing these solutions to the US market and other countries.  We kick off our discussion around prescription safety and Goehrs offers a nice framework for thinking about prescription safety including two macro trends that are making medication management more challenging: Changing Demographics (Older Population) and Advancement in Treatment Options.

I also ask Goehrs why EHR vendors and other digital health software vendors haven’t solved this problem already.  They all have some sort of medication management and clinical decision support and so why isn’t this enough?  This is an important question since I’m quite sure most hospitals and health systems think their EHR vendor is taking care of this.  In response to the question, Goehrs suggests that many doctors aren’t actually using the clinical decision support that’s in place and I add that some are annoyed by it.  Then, he offers the three major challenges that a useful clinical decision support system has to overcome: Information Not Relevant to That Patient, Poor UI, and Lack of Personalized Recommendations. He then shares what Synapse Medicine has done to address these three challenges.

Goehrs then dives into how an EHR vendor or other digital health company could integrate Synapse Medicine into their product, what that integration would look like, and how easy it is to integrate.  Plus, I ask him to share how he ensures a good user experience when a company decides to integrate with them.

Since prescription safety has such an impact, Goehrs also shares with us some stories he’s heard from his customers of where good clinical decision support has improved the lives of patients.  Finally, we ask him to share what he sees as the emerging trends in clinical decision support.

If you’re interested in what else can be done to address prescription safety and high quality clinical decision support, check out our interview with Synapse Medicine below.  Also, if you’ll be at the HLTH conference in Las Vegas, you can find them at Booth #5931 to learn more in person.

Learn more about Synapse Medicine: https://synapse-medicine.com/

Listen and subscribe to the Healthcare IT Today Interviews Podcast to hear all the latest insights from experts in healthcare IT.

And for an exclusive look at our top stories, subscribe to our newsletter.

Tell us what you think. Contact us here or on Twitter at @hcitoday. And if you’re interested in advertising with us, check out our various advertising packages and request our Media Kit.

 Synapse Medicine is a proud sponsor of Healthcare Scene.