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FedHealthIT’s Executive Vice President, Susan Sharer, recently had the opportunity to speak with BookZurman President Brian Book about interoperability, the open source opportunity, and what comes next.

What has Your Impact Been at VA?

VA holds a key thought leadership role in the standards development community and has for a decade, shaping interoperability standards and solutions. As one of the largest Healthcare providers in the world, the Agency has a vested interest in sharing information with the private sector. Roughly 70 percent of Veteran care happens in the community, but all VA get back, in many cases, is the bill. There is a strong need to get Healthcare information back from the community, not only to complete the Veteran record but to be able to drive meaningful analytics around patient information. Being involved in and leading the development of standards for information sharing is key in ensuring we can attain these goals.

With standards becoming more mainstream, a lot of companies are holding themselves out as experts in recent years – but very few have real depth. Our behind-the-scenes work in this niche for many years, and our team with more than a century of expertise, puts us in a space of recognized experts in Healthcare interoperability supported by our unique perspective and past performance.

How does DoD and the Military Health System Fit in?

Although VA and DoD are connected in many ways, they are also separate. From our perspective, compared to the VA, very little Veteran care happens in DoD. When a Veteran transitions from DoD to VA, it’s really a one-time action that could include some care coordination for a period of time. However, the need for interoperability between the VA and DoD is smaller than the need between the VA and the community – so we believe the greater focus should be there.

What Will be the Next Steps?

Through our current work, we have a strategy team working closely with VA. This multinational group of health IT and health standards experts is helping shape the strategy for how VA will move forward in embracing standards. Helping the Agency understand, from a standards perspective, where they can move forward that provides the best investment and opportunity to share information between agencies and in the community is key.

Benefits from Industry

A lot of the conversations I’ve had with the doctors we work with have been around solving problems, and how they rarely look outside for a solution. Healthcare tends to organize and work to solve challenges internally without leveraging lessons learned outside its own community – a dramatically different approach than most industries. When we started in the space, we brought a different perspective, in part because we weren’t influenced by the traditional Healthcare approach to solving problems. Instead, we approach problem solving based on a manufacturing industry background that leverages the knowledge and experience of other industries.

A lot of Healthcare challenges have added layers of needless complexity that make it hard for health IT to deliver solutions to meet clinician expectations. Just one example is patient ID. The Government issued a moratorium on creating a national patient ID, which means we are stuck at a point in which this ID is, at best, about 80 percent effective. That means we have a huge data quality problem and data we have now is so corrupt it won’t be leverageable for machine learning or artificial intelligence.

One thing every doctor’s office has is a credit card machine. Credit card companies have figured out ways to issue numerous individual numbers to one person through multiple credit accounts and to track that individual through their transactions and accounts wherever they are in the world. Why not turn the issue of patient ID to them? It would be one less thing the Healthcare community has to tackle and would be put in the hands of a group that has demonstrated success. Instead, we are seeing the creation of yet another working group.

How do you Work with OSEHRA and Others to Get the Word Out?

We are involved in the community through many organizations including OSEHRA, HL7, HSPC, and OMG. These are the organizations that will likely solve the majority of the interoperability challenges the community has. We actively participate to try to ensure those solutions are not only being accomplished but that people outside of the organizations know the great work they are doing.

Tell us About the Omnibus Care Plan (OCP) and CareNexusTM

Developed by SAMHSA, OCP is a comprehensive approach to care coordination and management. It was built to reimagine how a care plan can improve patient outcomes by facilitating seamless, patient-centered care coordination across multiple care providers.

The Government made a great decision to invest money and time into OCP but, at some point, decided to abandon it. OCP is a fantastic platform that could be leveraged for many things, not the least of which is the opioid crisis, but it will fall to private companies to get the message out about the potential and what can be solved.

Supporting SAMHSA in OCP’s development, we were pleased to help solve a dynamic interoperability challenge for the Healthcare community in a standards-based way. Now, we’re able to take the Government’s vision and bring it to patients by enhancing and commercializing this care coordination platform with CareNexus.

Based on a FHIR-compliant database, CareNexus leverages the foundation of OCP with SMART-on-FHIR in an “app store” capacity for easy scalability and extensibility – allowing disparate programs to share information and applications to add functionality and customization.

With OCP an open source project, and the code custodied with OSEHRA, we were able to add creative enhancements that both Government and the private sector can leverage as a solution for care coordination and care planning.

We made a commitment to leave one major revision of CareNexus in the open source community – giving back so there will always be an open source version of the project we’re working on available.

What Needs to Come Next?

The missing part in the health IT community is meaningful application of the Healthcare standards being created. Without applications of the standards and solutions leveraging them, we will never discover what we don’t know about the gaps in the solutions being developed. Now is the time for more private sector companies to embrace and leverage technology and standards in a way that will allow many of our current issues to be solved in a more expeditious way.

About Brian Book

Brian founded the Healthcare IT consulting firm, BookZurman (BZ) in 1996 – bridging the gap between healthcare and technology through the interpretation, implementation and transformation of healthcare IT standards for a better patient experience. Brian served in the U.S. Army during the Gulf War, and applies his Veteran experience and HIT subject matter expertise to BookZurman’s award-winning work with the U.S. Department of Veterans Affairs (VA).

Brian earned a bachelor’s degree in industrial engineering from Madison University, and applies his cross-industry experience from manufacturing to creating efficiencies in the Healthcare space. He studied project management at Southern Methodist University’s School of Engineering and is a certified Project Management Professional (PMP) and Certified Scrum Master (CSM). Active in the Healthcare IT community, BookZurman holds memberships with HiMSS and OSEHRA.

About BookZurman

BookZurman is a consulting firm that bridges the gap between healthcare and technology for a better patient experience. By leading conversations that connect caregivers and patients, Team BZ is driven to help resolve the challenge of Healthcare interoperability to enhance care through the interpretation, implementation and transformation of timely and integrated data. Team BZ focuses on standards and interoperability, informatics architecture and clinical decision support to empower caregivers to transform the future of Healthcare – one patient at a time.

Founded in 1996, BookZurman began its efforts with Healthcare efficiency PMO support for a portfolio of projects focused on fraud, waste and abuse. Over time, the company evolved into making an impact in the community’s Healthcare standards niche. For almost a decade, BookZurman has worked closely with VA, especially VHA, to shape interoperability standards and solutions and represents the Agency, which is a leader in the standards development community.





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