Tech

Tech

The Blocking of Health Information Undermines Interoperability and Delivery Reform

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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.

HxRefactored: Exclusive Interview with Alan Joseph Williams, Code For America

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Health 2.0 Co-Founder, Matthew Holt recently interviewed Alan Joseph Williams, Product Designer and User Researcher at Code for America’s Health Lab, which develops digital services for Californians eligible for or enrolled in social services like SNAP and Medicaid. Alan will be presenting at the HxRefactored Conference April 1-2 in Boston, MA.

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The Healthcare Data Sharing Conundrum

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flying cadeuciiPeople are more likely to avoid loss than to seek gains. HIPAA creates a framework where it rewards risk adverse behavior for data sharing even when data sharing would ultimately be beneficial to the enterprise, the mission, and the patients. This is a general issue at the heart of making progress in healthcare regarding data sharing and interoperability. I have some new thoughts on how to bridge this divide.

Recently I read the book ‘Thinking, Fast and Slow’ by the Nobel Prize winning economist Daniel Kahneman. This book discusses the concept of Prospect Theory. In reading through it I could see a hint of why our industry has so much trouble trying to share medical records and in general has trouble sharing almost anything among trading partners and competitors. If you haven’t read about Prospect Theory, the following tests provide some of the basics into how humans make decisions about risk.

Decision 1: Which do you choose? Get $900 for sure OR 90% chance to get $1,000

Decision 2: Which do you choose? Lose $900 for sure OR 90% chance to lose $1,000″[i]

The common answer to #1 is to take the $900. The common answer to #2 is to take the 90% chance to avoid the loss. As a result, we take risks to avoid danger but avoid risks when we see certain rewards. This behavior is relevant to data sharing and access to PHI and can be instructive on how people will approach risk.

Interview with Aptus Health at HIMSS

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

Previously known as Physicians Interactive, Aptus Health rebranded itself after acquiring several companies including MedHelp, Quantia & Univadis, and now focuses on both physicians and consumers globally and domestically. At HIMSS back in February, Matthew met with Teri Condon, VP of Strategy and Development at Aptus Health, previously with IMS Health and PharMetrics, and Michael Bodenstab, Vice President of Healthcare Solutions at MedHelp, to talk about where the company stands today and what their platform offers.

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

Whether They Like It Or Not, The GOP Must Repair Obamacare

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It’s very possible that the pejorative “Obamacare” could become the even more pejorative “Trumpcare” in a very short period of time. That is because Trump’s and the GOP’s promise to repeal Obamacare — the Affordable Care Act (ACA) — has already hit a snag called reality.

Reports are now circulating that the much-promised repeal of the health care law (60 plus House and Senate votes since 2010) won’t take effect until at least 2019, after the mid-term elections. The excuse is that it’ll take that long to figure out an alternative and get it into place. But congressional calendars and political expedience have nothing to do with the health care market. And without action early in 2017, the health insurance exchanges could collapse in 2018 or sooner — leaving millions without insurance, millions more without protections from pre-existing conditions, and possibly millions more cursing Trumpcare. The only constructive solution is to repair the ACA before, ironically, repealing it and then replacing it with a brand new, untested experiment in 2019.

Is Health Privacy a Human Right?

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Health privacy sits at an uncomfortable junction between three interests: individual human rights, public / population health, and private business interests. There’s no obvious reason for these three interests to be misaligned but a lot of pain and money are involved so either politics or competition are typically in the picture.

Health privacy is a subset of the human right to privacy, what Supreme Court Justice Brandeis called “the right to be left alone”. But privacy has never been defined, and is seldom enforced, in health care because of the competing interests of society to manage populations, and a $100 Billion industry in data brokerage that’s hidden from public view. Big Healthcare business seeks our trust on the one hand while doing their best to manipulate prices on the other.

Plans For the Quality Payment Program in 2017: Pick Your Track

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Screen Shot 2016-07-07 at 2.30.28 PMAs the baby boom generation ages, 10,000 people enter the Medicare program each day. Facing that demand, it is essential that Medicare continues to support physicians in delivering high-quality patient care. This includes increasing its focus on patient outcomes and reducing the obstacles that make it harder for physicians to practice good care.

The bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) offers the opportunity to advance these goals and put Medicare on surer footing. Among other policies, it repeals the Sustainable Growth Rate formula and its annual payment cliffs, streamlines the existing patchwork of Medicare reporting programs, and provides opportunities for physicians and other clinicians to earn more by focusing on quality patient care. We are referring to these provisions of MACRA collectively as the Quality Payment Program.

We received feedback on our April proposal for implementing the Quality Payment Program, both in writing and as we talked to thousands of physicians and other clinicians across the country. Universally, the clinician community wants a system that begins and ends with what’s right for the patient. We heard from physicians and other clinicians on how technology can help with patient care and how excessive reporting can distract from patient care; how new programs like medical homes can be encouraged; and the unique issues facing small and rural non-hospital-based physicians. We will address these areas and the many other comments we received when we release the final rule by November 1, 2016.

How Technology is Driving the Next Wave of Telemedicine

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Ryan BecklandThe growth in business cases for new models of healthcare delivery and integration of digital health technology is reaching the point of convergence — creating powerful synergies where there was once only data silos and skepticism.

We have not quite achieved this synergy yet, but opportunities emerging in 2015 will move the industry much closer to the long-awaited initiatives in connected, value-based care.

Individuals are constantly hyper-connected to a variety of technology networks and devices. Wearables will continue to enter the market, but their features and focus will go well beyond fitness. Even the devices entering the market now are more sophisticated than ever before. Some are now equipped with tools like muscle activity tracking, EEG, breath monitoring, and UV light measurement.

It will be fascinating to watch how consumer electronics, wearables, and clinical devices continue to merge and take new forms. Some particularly interesting examples will be in the categories of digital tattoos, implantable devices, and smart lenses.

As the adoption of wearables continues to grow, we will continue to see more value placed on accessing digital health data by healthcare and wellness organizations. This will be especially important as healthcare shifts towards value-based models of care. The need to gain access to the actionable data on connected devices will only grow as innovation creates more complex technologies in the market.

The Thing About the IoT

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In the coming years, the number of devices around the world connected to the Internet of Things (IoT) will grow rapidly. Sensors located in buildings, vehicles, appliances, and clothing will create enormous quantities of data for consumers, corporations, and governments to analyze. Maximizing the benefits of IoT will require thoughtful policies. Given that IoT policy cuts across many disciplines and levels of government, who should coordinate the development of new IoT platforms? How will we secure billions of connected devices from cyberattacks? Who will have access to the data created by these devices? Below, Brookings scholars contribute their individual perspectives on the policy challenges and opportunities associated with the Internet of Things.

The Internet of Things will be Everywhere

Humans are lovable creatures, but prone to inefficiency, ineffectiveness, and distraction. They like to do other things when they are driving such as listening to music, talking on the phone, texting, or checking email. Judging from the frequency of accidents though, many individuals believe they are more effective at multi-tasking than is actually the case.

The reality of these all too human traits is encouraging a movement from communication between computers to communication between machines. Driverless cars soon will appear on the highways in large numbers, and not just as a demonstration project. Remote monitoring devices will transmit vital signs to health providers, who then can let people know if their blood pressure has spiked or heart rhythm has shifted in a dangerous direction. Sensors in appliances will let individuals know when they are running low on milk, bread, or cereal. Thermostats will adjust their energy settings to the times when people actually are in the house, thereby saving substantial amounts of money while also protecting natural resources.

With the coming rise of a 5G network, the Internet of Things will unleash high-speed devices and a fully connected society. Advanced digital devices will enable a wide range of new applications from energy and transportation to home security and healthcare. They will help humans manage the annoyances of daily lives such as traffic jams, not being able to find parking places, or keeping track of physical fitness. The widespread adoption of smart appliances, smart energy grids, resource management tools, and health sensors will improve how people connect with one another and their electronic devices. But they also will raise serious security, privacy, and policy issues.

A Fail For Activity Trackers: The I Told You So’s vs Need More Datas

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Perhaps the normally measured physician-economist Aaron Carroll best captured the reaction and sentiments of the healthcare community in response to a recent JAMA article demonstrating that subjects in a weight reduction study using activity trackers lost significantly less weight than those in the control group:

“I TOLD YOU SO!!!!!!” (Emphasis in original.)

These results were cheered for several key reasons.

First, many in healthcare are irritated by the idea of simplistic technical fixes for complex medical (and social) (and cultural) (and economic) problems–like obesity.

Second, as Carroll has pointed out, exercise is healthy for many reasons, but weight loss is probably not one of them; changing your diet seems to matter a lot more.

However, it’s important to critically evaluate research even (especially) when it seems to produce an ego-syntonic conclusion–a conclusion with which we so strongly agree.

My initial reaction to the result was that perhaps it reflects an example of the concept of “moral licensing” that Malcolm Gladwell discusses so thoughtfully on his Revisionist History podcast–i.e., when you deliberately act morally in one context, you may be more likely to act less morally in another context, having already demonstrated to yourself your moral bona fides.