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.

What Can Meaningful Use Learn From Healthcare.gov?

18

Fred's HeadThe US has spent several billion dollars on medical records, as part of the HITECH program. The goal of that spend was simple: portable medical records for patients. On our current path, we will have medical records, but without that magic word: “portable.” Ironically, the reason for this is identical to the root-cause of the problems with healthcare.gov

The root-cause of the initial failure of healthcare.gov was a lack of accountability and empowerment. There was no one person who was in charge of the operation, and those who were presumed to be in charge did not have the skill-set or political clout needed to make decisions about the project.

The result was the healthcare.gov train wreck. Thankfully, healthcare.gov was turned around.

That turn-around was the result of decisively fixing these exact issues.

Accountability restored, disaster averted.

You would think that the Obama administration and HHS would have learned the “accountability with empowerment” lesson well, if not for IT projects generally, then at least for projects involving Health IT.

Yet we are repeating this mistake with Meaningful Use. For those who are living in a cave with regards to healthcare reform, Meaningful Use is a set of standards designed to ensure that the money that the federal government spends on Electronic Healthcare Records (EHRs) for doctors results in clinically productive outcomes.

Quality v. Quantity

4

A few weeks ago, the medical community received unexpected good news from the government about a “simplification of quality measures:”

Strictly speaking, and contrary to what Mr. Slavitt’s tweet would lead us to believe, the agreement to the new rules was primarily between commercial insurers and CMS, the Center for Medicare and Medicaid Services. Physicians were not actually party to the deal.

Nevertheless, doctors were expected to greet the news with cheers. As Rich Duszak reported, Adam Slavitt, acting administrator for CMS, also declared that “patients and care providers deserve a uniform approach to measure [sic] quality.”

Indeed, we all deserve uniform quality measures. Equality in quality!

The Patient and the Snake Oil Salesman

52

Screen Shot 2016-06-28 at 12.17.51 PM

On June 11, 2016, James Madara, MD., addressed the American Medical Association’s Annual Meeting with some wonderful hyperbole. Dr. Madara is the CEO of the AMA, and he likely felt some pressure to rally the troops (a/k/a physicians) and show that the AMA is advocating for their “side.” And it got attention, with articles trumpeting that Dr. Madara called digital products “modern-day ‘snake oil’.” He indeed did.

We do need to give Dr. Madara a little leeway here.  The role of the AMA is to represent physicians, and he’s the CEO.  That being said, consider for the moment that one of the major points Dr. Madara made was to tout how the AMA’s predecessors over 100 years ago outed snake oil for the fraud it was, thereby protecting the consuming public.  While it was a while ago, the AMA should be rightly proud of that accomplishment.

However, what Dr. Madara did at the June AMA meeting, entertaining as it was, does not deserve equal accolades.

What Does the Recent Election Mean For Predictive Analytics In Healthcare?

5

The outcome of the recent election caught many people, and many forecasters, by surprise. How could their predictions have missed the mark so significantly? Granted, there were a number of people who predicted the outcome more accurately, but many of those who used data models to analyze the likely outcome are left now with head-scratching and postmortem analysis in order to improve their methods.

In their book Superforecasting, The Art and Science of Prediction, authors Philip Telock and Dan Gardner describe a subset of people who, on average, are significantly more accurate in their ability to predict upcoming events. “What makes them so good is less what they are than what they do—the hard work of research, the careful thought and self-criticism, the gathering and synthesizing of other perspectives, the granular judgments and relentless updating.”

What does this mean for healthcare? I’m not talking about the impact of the new presidency on health policy and healthcare delivery (that’s another discussion) – I’m talking about whether predictive analytics is really all that accurate in the first place. Where does it fail?

Learning From Our Interoperability Failures

13

flying cadeuciiCurrently, when healthcare data moves in this country it does it using fax machines and patient sneaker-nets. Automated digital interoperability is still in its earliest stages, mostly it has a history of being actively resisted by both the EHR vendors and large healthcare providers. We, as an industry, should be doing better, and our failure to do so is felt everyday by patients across the country.

The ONC-defined difference between EHRs and EMRs is that EHRs are interoperable. Yet, as I have said before, we have spent almost a billions of dollars and generally gotten EMRs instead of EHRs.

Comments were due Apr 3 for the ONC Interoperability Roadmap for 2015-2020. This was specifically separated out from the overall ONC Health IT Strategic Plan for which comments have closed.

Both of these plans ignore the lessons in execution from the previous strategic plan for health IT from ONC. The current Interoperability Roadmap mentions the “NwHIN” (Nationwide Health Information Network) for instance, and only covers what it accomplished, which are mostly policy successes like the DURSA (Data Use and Reciprocal Support Agreement). NwHIN was supposed to be a network of networks that connected every provider in the country… why hasn’t that happened?

ONC has forgotten what the actual ambition was in 2010. It was not to create cool policy documents. The plan 5 years ago was to have the “interoperability problem” solved in 5 years. The plan 5 years before that was probably to solve the problem in 5 years. Apparently, our policy makers look at interoperability and say “wow this is a big problem, we need at least 5 years to solve it”. Without any sense of ironic awareness that this is what they have been saying for decades, even before Kolodner was the ONC.

Torture the Data Until it Confesses

9

flying cadeuciiDid you ever hear the old joke where the boss says floggings will continue until morale improves? Torturing the data until results improve…or the data confesses…is not uncommon. Which is a pity.

In my career I’ve worked with companies with over 100k covered lives the claim costs of which could swing widely, from year to year, all because of a few extra transplants, big neonatal ICU cases, ventricular assist cases, etc.

Here are just a few of the huge single case claims I’ve observed in recent years:

  • $3.5M    cancer case
  • $6M       neonatal intensive care
  • $8M       hemophilia case
  • $1.4M    organ transplant
  • $1M       ventricular assist device

This is not a complaint. After all this is what health insurance should be about, huge unbudgetable health events.

All plans have one organ transplant every 10k life years or so, most of which will cost about $1M over 6 years. A plan with 1k covered lives will have such an expense on the average of every 10 years. Of course the company may have none for 15 years and two in the 16th year. The same goes for $500k+ ventricular assist device surgeries.

My Ideal EHR

19

flying cadeuciiGive me technology which improves my life and that of my patients, or give me death.  Medical records must be informative, efficient, and flexible; like the physicians they serve.  For me, a medical record does not contain just a collection of problem lists, prescribed medications, and immunizations; it is a noteworthy account of the health care provided to another human being over a lifetime.

Recently, I attended a baby shower of a patient who is now an adult.  (I am a pediatrician.) I brought her medical chart wrapped with a satin bow as one of her gifts.  I was her physician for many years; my father had taken care of both her and her mother as children.  Her growth, development, immunizations, and illnesses were all recorded; but so were 25 years of life experiences, trials, triumphs, and tribulations.  The back section contains drawings she had given me, newspaper articles of her achievements, graduation announcements, and her wedding invitation.  Obviously, medical records register growth parameters, vital signs, and sick visits; but they also encompass my relationship with my patients.

What 32 Million Tweets Tell Us About Health & the Twitterverse

0

How can we gauge whether America is prioritizing health and well-being? Since public attitudes toward health-related topics are widely shared on social media, we gazed into the mirror that is Twitter and tried to answer that question by sifting through 32 million health-related tweets, one of the largest social media samples ever collected for health research.

Posts and conversations on Twitter have the potential to shed light on the public’s views about a seemingly endless array of health-related topics—obesity, exercise and fitness, safe sex, alcohol use, medication adherence and mental health. Accordingly, researchers have turned to social media to better understand these topics.

Is There a Business Case For Patient Engagement?

9

Screen Shot 2015-03-04 at 4.23.13 PMIn the past, the AMA published an article questioning the merits of patient portals — the primary tool for engaging patients. Rob Tennant, senior policy adviser with the MGMA-ACMPE, the entity formed by the merger of the Medical Group Management Association and the American College of Medical Practice Executives raised the fundamental issue: “The business case just hasn’t been made.” I’ll attempt to make it.

Perhaps the best evidence of the business case is when industry visionaries/organizations/leaders such as HIMSS (the professional association for healthIT), Aetna and Kaiser Permanente have made significant investments in patient engagement.

I’ve excerpted a couple sections of Pam Dolan’s article on the topic to set context and then I will address the business case. The patient portal benefits assume that it’s more than a simplistic silo’ed patient portal tethered to an EHR since they are broadly available. [Disclosure: My company, Avado, is one many patient engagement companies.]

This is why I would call it the patient portal & relationship management system or simply patient relationship management system to distinguish it from traditional limited patient portals.