Tech

Tech

The Blocking of Health Information Undermines Interoperability and Delivery Reform

20

The secure, appropriate, and efficient sharing of electronic health information is the foundation of an interoperable learning health system—one that uses information and technology to deliver better care, spend health dollars more wisely, and advance the health of everyone.

Today we delivered a new Report to Congress on Health Information Blocking that examines allegations that some health care providers and health IT developers are engaging in “information blocking”—a practice that frustrates this national information sharing goal.

Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Our report examines the known extent of information blocking, provides criteria for identifying and distinguishing it from other barriers to interoperability, and describes steps the federal government and the private sector can take to deter this conduct.

This report is important and comes at a crucial time in the evolution of our nation’s health IT infrastructure. We recently released the Federal Health IT Strategic Plan 2015 – 2020 and the Draft Shared Nationwide Interoperability Roadmap. These documents describe challenges to achieving an interoperable learning health system and chart a course towards unlocking electronic health information so that it flows where and when it matters most for individual consumers, health care providers, and the public health community.

Apple Research Kit is Open Source But Is It “Open”?

7

Screen Shot 2015-03-12 at 8.10.22 AM

For now, the answer is “we don’t know”.

But… the question is very important and worth tracking over the coming months. Let’s not assume that open source will equate to “open”.

What is ResearchKit?

Apple’s press release provided an overview of ResearchKit:

Apple® today announced ResearchKit™, an open source software framework designed for medical and health research, helping doctors and scientists gather data more frequently and more accurately from participants using iPhone® apps. World-class research institutions have already developed apps with ResearchKit for studies on asthma, breast cancer, cardiovascular disease, diabetes and Parkinson’s disease.

…With hundreds of millions of iPhones in use around the world, we saw an opportunity for Apple to have an even greater impact by empowering people to participate in and contribute to medical research,” said Jeff Williams, Apple’s senior vice president of Operations. “ResearchKit gives the scientific community access to a diverse, global population and more ways to collect data than ever before.”

Many members of the research community have had high praise for ResearchKit. For more details and perspectives about ResearchKit, see the list of articles appended at the bottom of this post.

Precision Medicine’s First Test is Blue Button on FHIR

2

flying cadeuciiPresident Obama’s legacy for health information technology is about to see its first test at the hands of a little-known project for access to Medicare beneficiary data. The President’s Precision Medicine Initiative (PMI) database is the big brother of Medicare’s database. Although both databases will be managed by the Government, the PMI one will also have our DNA and as many of our health records as we are willing to move there. How much control will patients have over our data in either of these databases? Federal policy on these databases will impact all of healthcare.
The test is whether either of these databases will limit one’s ability to control and use our own data.

  • Can I have free first-class network access to my own data?
  • Can I send my own data instantly to anywhere I choose?
  • Can I direct my data digitally, without paper forms?

These three questions apply equally to my Medicare data, my data in a private-sector EHR, and my PMI data. Current HIPAA law allows it but will the Government and hospitals actually implement it? The policy for the Medicare database is being implemented as Blue Button on FHIR this summer, and so-far it doesn’t look good.

If our Federal Health Architecture (FHA) will not allow us the maximum control allowed by the law, then how can we expect private-sector healthcare systems to do it? I wrote about the current HIPAA law and how it needs to be changed to make a patient’s first-class access a right, instead of an option, in a previous post.

Matthew Holt Interviews Health Catalyst CEO, Dan Burton

0

One in a series of interviews that should have been posted months ago, but Matthew Holt is just getting to now.

Health Catalyst has emerged to be a dominant player in data warehousing and analytics to support quality (and business) enhancement for huge providers like Kaiser, Partners and Allina, and many more. They’ve also raised over $220m from a stack of noted VCs. Back in February Matthew Holt caught up with CEO, Dan Burton at HIMSS to see what the latest plans for the company were.

Priya Kumar is an Intern at Health 2.0, and a student at George Washington University

The Role of Machine Learning in Making EHRs Worth It

0

Recently, a great op-ed published in The Wall Street Journal called “Turn Off the Computer and Listen to the Patient” brought a critical healthcare issue to the forefront of the national discussion. The physician authors, Caleb Gardner, MD and John Levinson, MD, describe the frustrations physicians experience with poor design, federal incentives, and the “one-size-fits-all rules for medical practice” implemented in today’s electronic medical records (EMRs).

From the start, the counter to any criticism of the EMR was that the collection of digital health data will finally make it possible to discover opportunities to improve the quality of care, prevent error, and steer resources to where they are needed most. This is, after all, the story of nearly every other industry post-digitization.

However, many organizations are learning the hard way that the business intelligence tools that were so successful in helping other industries learn from their quantified and reliable sales, inventory, and finance data can be limited in trying to make sense of healthcare’s unstructured, sparse, and often inaccurate clinical data.

Data warehouses and reporting tools — the foundation for understanding quantified and reliable sales, inventory, and finance data of other industries – are useful for required reporting of process measures for CMS, ACO, AQC, and who knows what mandates are next. However, it should be made clear that these multi-year, multi-million dollar investments are designed to address the concerns of fee-for-service care: what happened, to whom, and when. They will not begin to answer the questions most critical to value-based care: what is likely to happen, to whom, and what should be done about it.

Information Blocking Under Attack: The Challenges Facing EHR Developers and Vendors

6

In March 2017 Milbank Quarterly, researchers Julia Adler-Milstein and Eric Pfeifer found that information blocking — which they define as a set of practices in which “providers or vendors knowingly and unreasonably interfere with the exchange or use of electronic health information in ways that harm policy goals” – occurs frequently, and is motivated by revenue gain and market-share protection.

Among the practices most often cited were deployment of products with limited interoperability (49%) and high fees for health information exchange unrelated to [actual] cost (47%).  Of note: This is the first empirical research identifying and quantifying the specific information blocking practices reported by a group of information exchange experts.

The authors concluded “Information blocking appears to be real and fairly widespread. Policymakers have some existing levers that can be used to curb information blocking and help information flow to where it is needed to improve patient care. However, because information blocking is largely legal today, a strong response will involve new legislation and associated enforcement actions.”

The legal situation regarding the controversial subject of information blocking may have already changed dramatically.  Two important events occurred since this research was undertaken.  First, the strongly bipartisan-backed 21st Century Cures Act was signed into law by President Obama late last year.  The health information technology (HIT) provisions of the law now make it illegal for a vendor or provider to engage in information blocking. Second, the new law provides the nation with a new and comprehensive statutory definition of information blocking:

Why the Market Can’t Solve the EHR Interoperability Problem

2

Screen Shot 2015-04-06 at 7.20.19 PMNiam Yarhagi’s  THCB piece, Congress Can’t Solve the EHR Interoperability Problem (March 21, 2015) raises excellent points with which I mainly agree.  So why write a responding blog?  Because I don’t agree with his solution.

To review:  Dr. Yarhagi discusses a draft congressional bill that calls for the creation of a “Charter Organization” that “shall consist of one member from each of the standard development organizations accredited by the American National Standards Institute and representatives that include healthcare providers, EHR vendors, and health insurers.”

Four agreements:   I agree with Dr. Yarhagi’s conclusion that the proposed charter organization will not succeed; I agree with his prediction that it won’t be able to develop useful interoperability measures (hint: these are the same vendors that have refused to cooperate for the past 30 years); I agree that the ONC or CMS will not decertify an EHR vendor that has over 50% of all American patients and providers; and I agree that there are some medical providers who intentionally refuse to share patient information (because they think it gives them a competitive advantage over their local rivals).

One disagreement:  But I disagree strongly with Dr. Yarhagi’s faith in the market to ensure that healthcare information technology (HIT) vendors will be obliged to “develop sustainable revenue stream through reasonable exchange fees negotiated with the medical providers.”  That is, he asserts that if there were a real market without federal subsidies and requirements that all healthcare providers buy the HIT,  then providers and the HIT vendors would agree on reasonable fees for exchanging patient records.

What to do About Health Care Data Sharing

2

Screen Shot 2016-04-08 at 12.06.36 PM

In my last blog I riffed on prospect theory and how it applies to health care data sharing. In essence, prospect theory suggests two categories:

1. People are extremely unwilling to accept risk when the consequences are unknown (patients avoid sharing data if they don’t know how it will benefit or harm them)

2. People are more willing to accept the risk when the reward is achievable, and the alternative is very harmful (patients with severe illnesses would readily share data when there is a possibility it could save their life or eliminate significant suffering)

Scenario 1, risk adversion, is more common across all constituents including providers, healthy patients and families, political leaders and philanthropists. Generally, the benefits of sharing health care data are foggy and unclear, while the alternatives to keeping the data private are not life threatening.

Accessing & Using APIs from Major EMR Vendors–Some Data at Last!

8

Today I’m happy to release some really unique data about a pressing problem–the ability of small tech vendors to access health data contained in the systems of the major EMR vendors. There’ll be much more discussion of this topic at the Health 2.0 Provider Symposium on Sunday, and much more in the Health 2.0 Fall Annual Conference as a whole.

Information blocking, Siloed data. No real inter-operability. Standards that aren’t standards. In the last few years, the clamor about the problems accessing personal health data has grown as the use of electronic medical records (EMRs) increased post the Federally-funded HITECH program. But at Health 2.0 where we focus on newer health tech startups using SMAC (Social/Sensor; Mobile OS; Cloud; Analytics) technologies, the common complaint we’ve heard has been that the legacy–usually client-server based–EMR vendors won’t let the newer vendors integrate with them.

With support from California Health Care Foundation, earlier this year (2016) Health 2.0 surveyed over 100 small health tech companies to ask their experiences integrating with specific EMR vendors.

The key message: The complaint is true: it’s hard for smaller health tech companies to integrate their solutions with big EMR vendors. Most EMR vendors don’t make it easy. But it’s a false picture to say that it’s all the EMR vendors’ fault, and it’s also true that there is great variety not only between the major EMR vendors but also in the experience of different smaller tech companies dealing with the same EMR vendor. All the data is in the embedded slide set below, with much more commentary below the fold.

A Million Jobs in Healthcare’s Future

1

“The Future is Here. It’s Just Not Evenly Distributed.”

It’s true.

Science fiction writer William Gibson said that right. We simply have to look around enough – now – to find out what the future holds.

The future may never be evenly distributed. But it’s surely becoming the present faster.

What would you do when…

Here are a series of what-would-you-do-when questions to think about. Each of these are a reality today, somewhere.

There’s more medical data than insight

Kaiser Permanente presently manages 30 petabytes of data. Images. Lab tests. EHRs. Patient data. Billing. Registries. Clinical trials. Sooner than later, most medical devices (big and small) will become smart. They will have an IP address like a Fitbit and send data over the cloud.

What would happen when medical data expands to exabytes, zettabytes, and may be even a yottabyte (10^24)?

What it means for jobs: Expect a boom in data-related opportunities. Data scientists. Visualization gurus. Statisticians. Mathematicians who can build predictive models. Anyone who can spot wisdom from information.

Genetic programming becomes the new software gig

People interested in programming are well-suited to become biologists of tomorrow because ATGC (the genomic alphabet) can now be tinkered digitally using tools like CRISPR.

[Read: A programming language for living cells]

If you are a developer, you could join a bio hackerspace or create your own. Explore how programming can make foul-smelling E.coli develop the fragrance of bananas.