ONC

Today is the kick-off of the vendor-fest that is HIMSS. Late last week on THCB, ONC director Karen De Salvo and Policy lead Jodi Daniel slammed the EMR vendors for putting up barriers to interoperability. Last year I had my own experience with that topic and I thought it would be timely to write it up. (I’ll also be in the Surescripts booth talking about it at 3.45 Monday)

I want to put this essay in the context of my day job as co-chairman of Health 2.0, where I look at and showcase new technologies in health. We have a three part definition for what we call Health 2.0. First, they must be adaptable technologies in health care, where one technology plugs into another easily using accessible APIs without a lot of rework and data moves between them. Second, we think a lot about the user experience, and over eight years we’ve been seeing tools with better and better user experiences–especially on the phone, iPad, and other screens. Finally, we think about using data to drive decisions and using data from all those devices to change and help us make decisions.

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This is the Cal Pacific Medical Center up in San Francisco. The purple arrow on the left points to the door of the emergency entrance.

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Cal Pacific is at the end of that big red arrow on the next photo. On that map there’s also a blue line which is my effort to add some social commentary. To the top left of that blue line in San Francisco is where the rich people live, and on the bottom right is where the poor people live. Cal Pacific is right in the middle of the rich side of town, and it’s where San Francisco’s yuppies go to have their babies.
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Last year, on August 26, 2014 at about 1 am to be precise, I drove into this entrance rather fast. My wife was next to me and within an hour, we were upstairs and out came Aero. He’s named Aero because his big sister was reading a book about Frankie the Frog who wanted to fly and he was very aerodynamic. So when said, “What should we call your little brother?” She said, “I want to call him Aerodynamic.” We said, “OK, if he comes out fast we’ll call him the aerodynamic flying baby.” So he’s called Aero for short.

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Thus began the Quest for Intra-Aero-Bili-ty –a title I hope will grow on you. The Bili part will become obvious in a paragraph or two.

Something had changed since we had been at Cal Pacific three years earlier for the birth of Coco, our first child.

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If you look carefully at the top of Amanda’s head, there’s now a computer system. Like most big provider systems, Sutter–Cal Pacific’s parent company–has installed Epic and it’s in every room or on a COW (cart on wheels). Essentially we have spent the last few years putting EMRs in all hospitals. This is the result of the $24+ billion the US taxpayer (well, the Chinese taxpayer to be more accurate) has spent since the 2010 rollout of the HITECH act. Continue reading “In Search of Intra-Aero-Bili-ty”

flying cadeuciiLast Friday ONC (the Office of the National Coordinator for Health IT) released a long-awaited Report On Health Information Blocking. The ONC blog capsulizes the report:

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.

We were struck with two major reactions to the ONC Info Blocking Report:

  • It’s a solid double: it does a credible job of recognizing that the major problems of interoperability and blocking are not technical or due to a lack of standards, but rather due to business practices and business models. The report also proposes a baseline of potential solutions.
  • It’s not a home run: the report misses the opportunity to describe a comprehensive approach to combat information blocking. Continue reading “ONC Report on Health Information Blocking: A Solid Double, But NOT a Home Run”

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.

Continue reading “The Blocking of Health Information Undermines Interoperability and Delivery Reform”

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.

Continue reading “Learning From Our Interoperability Failures”

Niam YaraghiRep. Mike Burgess (R-Texas) has released a draft bill entitled “ensuring interoperability of qualified electronic health records” in which interoperable (Electronic Health Records) EHRs are defined as those that do not block sending and receiving data to and from other EHRs and provide users with complete access to the captured medical data. The draft bill proposes that detailed methods to assess interoperability be defined by a “Charter Organization.” According to the draft bill, this Charter Organization 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. To keep its certification after January 2018, an EHR vendor should comply with the definitions of the Charter Organization, publish API’s to enable data exchange with other EHRs and attest and demonstrate that it has not willfully interrupted data exchange with other EHRs. The draft bill suggests that the Inspector General of HHS shall have the authority to investigate both EHR vendors and medical providers with regards to claims that they have interrupted interoperability.

The proposed Charter Organization will not be successful.

Continue reading “Congress Can’t Solve the EHR Interoperability Problem”

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.

Continue reading “What Can Meaningful Use Learn From Healthcare.gov?”

Aron SeibYou have the choice to get your health information anywhere and any way you want –according to the Office of Civil Rights with some limitations. Today, more and more uses of health information are being presented to consumers as innovators recognize our demand for health related applications. Unfortunately, there is a dilemma. Over the past ten years a lot of things have changed – more and more providers are using technology to improve how they deliver care and, once that care is delivered, how they share information with other caregivers that see the patient. Sadly, other things are still pretty much as they were in the 19th Century, including how patients get access to information about themselves held by their provider.

The release of the National Association for Trusted Exchange’s (NATE) Blue Button for Consumers (NBB4C) Trust Bundle is aimed at simplifying interoperability between the healthcare delivery system and the consumer, enabling you to decide how to use your health information.

NATE is an association focused on enabling trusted exchange among organizations and individuals with differing regulatory environments and exchange preferences. With beginnings back in 2012, NATE emerged from a pilot project supported by the Office of the National Coordinator for Health Information Technology (ONC). NATE was incorporated as a not-for-profit organization on May 1, 2012 in the District of Columbia. NATE has been operating Trust Bundles in production since November 2012 and recently took over administration of the Blue Button Consumer Trust Bundles.  Working with a broad set of stakeholders through multiple task forces, crowdsourcing and a call for public comment, NATE announced the first release of NATE’s Blue Button for Consumers (NBB4C) Trust Bundle February 4th at the ONC’s Annual meeting. Continue reading “NATE: Making Choices Easier”

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ONC Issues Draft HIT Interoperability Road Map

The ONC releases a draft of its 10-year nationwide interoperability road map, which includes a focus on helping the majority of providers across the care continuum and consumers achieve basic interoperability of health data over the next three years. The ONC also released a draft of its Interoperability Standards Advisory, which includes an assessment of the best available standards and implementation specifications for clinical health information interoperability.

Public comment for the draft Roadmap closes April 3, 2015; comment period for the Standards Advisory closes May 1, 2015.

Meaningful Use Reporting Relief         

CMS proposes rule changes for the EHR incentive program, including a reduction in the 2015 reporting period from one year to 90 days. An additional change would re-align the reporting period to match the calendar year, giving hospitals more time to incorporate 2014 Edition software into their workflows and better align with other CMS quality objectives. CMS will consider additional program modifications to reduce complexity and lessen providers’ reporting burdens.

CMS noted that the proposed rule changes are separate from the upcoming Stage 3 proposed rule that should be be released in March that is expected to limit the scope of the Stage 3 requirements for MU in 2017 and beyond.

Providers, vendors, and professional organizations are breathing a collective sigh of relief over the CMS announcement.  The proposed changes aren’t too surprising, given low Stage 2 attestation numbers and overwhelming provider dissatisfaction with the MU program.

New Valued-based Payment Goals to Drive HIT Adoption

HHS sets a goal for 30 percent of Medicare payments to be link to value-based performance through alternative payment models, such as ACOs, by 2016 and 50 percent by 2018. In addition, HS wants 85 percent of traditional Medicare payments tied to quality by 2016 and 90 percent 2018.

Achieving those objectives will require technology that supports quality-based payments versus the traditional fee-for-service model, so both vendors and providers will need to make aggressive moves to deploy the appropriate tracking and reporting tools. No doubt this will be one of the hotter topics at the HIMSS conference in April.

Continue reading “HIT Newser: A Meaningful Sigh of Relief”

An Epic Loss for Cerner and GE

flying cadeuciiMayo Clinic announces it will replace its existing Cerner and GE systems with Epic’s EHR and RCM system.

The prestigious Mayo Clinic name and clinical reputation make the win especially sweet for Epic, which is in the running for the DoD’s $11 billion EHR contract. Analysts estimate that Mayo will pay Epic “hundreds of millions” over the next several years.

Google Glass Confusion

Earlier this month Google announced the end of its Glass Explorer program and sales of its existing version of Glass. Many mainstream publications carried “Glass is Dead” headlines, which is certain attention-grabbing, though not entirely true.

Individual consumers had the option to pay $1,500 to purchase Google Glass through the now-defunct Glass Explorer program. Enterprise businesses, such as HIT vendors Augmedix and Pristine, are still able to buy the existing version of Glass through Google’s Glass at Work program. In other words, if you’re interested in using Google Glass in a healthcare setting, that option is still available through a Glass at Work partner.

Meanwhile, Google says it is working future versions of its Glass product – though no one is saying when the next release will be. Continue reading “HIT Newser: An Epic Loss for Cerner & GE + Google Glass Confusion”

Jacob RiderI started my blog over 15 years ago.  Yes – it’s been less active in recent years, and as I reflect on why I’ve been less active – only part of the reason is that I was working for a publicly traded company from 2008-2011 .. and a federal agency from 2011 – 2014.  Both of these organizations have reasons to control the messages of their employees.  I needed to be cautious about what I blogged.  So I didn’t blog publicly very much. 

But since November, I’ve had no excuse.  And yet nothing much flowed from these fingertips.  

It should have.  Back in the day – THCB and Docnotes – and a handful of other sites offered bookmarks and observations on health care delivery, the convergence of health care and IT, and random observations.  These days – there is a tidal wave of these things on the Internet. I sometimes question whether MY contributions are of any value now that there is so much out there.  I remember when Dave Winer toyed with killing his blog.  He didn’t.  Nor should I.  This post celebrates the not-killing of my new blog, and the beginning of the NEXT 15 years of my public observations.

Here goes ..

Continue reading “My World in 2015″

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