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ONC & CMS Proposed Rules | Part 2: Interoperability

Mar 15, 2019• 1

By DAVE LEVIN MD

The Office of the National Coordinator (ONC) and the Centers for Medicare and Medicaid (CMS) have proposed final rules on interoperability, data blocking and other activities as part of implementing the 21^st Century Cures Act. In this series, we will explore the ideas behind the rules, why they are necessary and the expected impact. Given that these are complex and controversial topics open to interpretation, we invite readers to respond with their own ideas, corrections and opinions. You can find Part 1 of the series here.

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In 2016, Congress enacted the 21^st Century Cures Act with specific goals to “advance interoperability and support the access, exchange and use of electronic health information.” The purpose was to spur innovation and competition in health IT while ensuring patients and providers have ready access to the information and applications they need.

The free flow of data and the ability for applications to connect and exchange it “without special effort” are central to and supported by a combination of rules proposed by ONC and CMS. These rules address both technical requirements and expected behaviors. In this article, we look at specific technical and behavioral requirements for interoperability. Future articles will examine data blocking and other behavioral issues.

Compatible “Plugs and Sockets”

The proposed rules explicitly mandate the adoption and use of application programming interface (API) technology (or a successor) for a simple reason: APIs have achieved powerful, scalable and efficient interoperability across much of the digital economy. Put simply, APIs provide compatible “plugs and sockets” that make it easy for different applications to connect, exchange data and collaborate. They are an essential foundation for building the next generation of health IT applications. (Note: readers who want to go deeper into APIs can do so at the API Learning Center).

APIs are versatile and flexible. This makes them powerful but can also lead to wide variations in how they work. Therefore, ONC is proposing that certified health IT applications use a specific API based on the Fast Healthcare Interoperability Resources (FHIR) specification. FHIR is a consensus standard developed and maintained by the standards development organization (SDO) Health Level–7 (HL7). Mandating the use of the FHIR standard API helps to ensure a foundational compatibility and basic interoperability. This gives API technology suppliers (like EHR vendors) a clear set of standards to follow in order to fulfill the API requirement. It also ensures “consumers” of that API (like hospitals and health IT developers), have consistency when integrating applications.

Health Care Must Open More Doors to Mental Health Patients

Mar 14, 2019• 2

By ARPAN WAGHRAY, MD and BENJAMIN F. MILLER, PsyD

If someone we love has a physical ailment, we can list a variety of places for them to seek care: a clinician’s office, a pharmacy, an urgent care clinic, a school health clinic, an emergency department — the list goes on.

And, in every case, we would feel confident the clinicians in those places would know how to handle the case — or at least know where to send the patient if they need more intensive or specialized care.

But, sadly, the same isn’t true for a loved one with a mental health or substance misuse need, even thought mental health problems are more prevalent than many physical conditions.

As deaths of despair from drug or alcohol misuse or suicide continue to rise, we need a comprehensive, coordinated “no wrong door” approach that fully integrates mental health into the health care system and beyond. We need to transform our clinical practice, creating more options for care and putting mental health and substance use patients’ best interests first. Policy and payment reform must happen to make this new vision of care possible.

Health in 2 Point 00, Episode 73 | Mergers, Medicaid, & Money

Mar 13, 2019

Today on Health in 2 Point 00, Jess and I power through a whopping six questions. In this episode, Jess asks me about the merger between Cambia Health Solutions and Blue Cross NC, Alex Azar getting grilled by Rep. Joe Kennedy on Medicaid work requirements, Omada Health adding connected blood pressure and glucose monitors, 23andMe’s new Type 2 Diabetes predisposition test, and raises by Akili Interactive and MAP Health Management. —Matthew Holt

Come Together.Health, Right Now…Over Me

Mar 13, 2019

By JESSICA DaMASSA, WTF HEALTH

At HIMSS19, the year-old ‘Digital Health Collaborative’ announced its relaunch as ‘Together.Health.’ More than just a feel-good name, the new moniker is indicative of how the organization is literally trying to help the health innovation world ‘get its #%&! together.’

“We’re building a hub-and-spoke model,” says Stephen Konya of the US Office of the National Coordinator for Health IT (ONC).

He and Nick Dougherty of MassChallenge Health Tech are founding co-chairs for Together.Health and the pair have managed to build a roster of more than 40 different partners – including almost every digital health accelerator and incubator in the country. Add into the mix some of the biggest health innovation investors in the biz, the usual healthcare incumbents, and a number of different government organizations and economic development groups with local, regional, and federal reach and one begins to clearly see how Together.Health is filling a void for ‘spokes’ that were definitely missing the connecting power of a ‘hub.’

But, what’s the real value of all this together-ness? According to Konya and Dougherty, faster uptake for innovation in healthcare.

For example, the organization’s first project is the development of a standard Business Associates Agreement (BAA) for startups and health systems to use to streamline the onerous paperwork process required before piloting or deploying new solutions. This is a process that currently takes 9-12 months and varies by health system. Together.Health thinks they can shorten that timeframe to 2-3 months just by getting the right people into the room and agreeing to keep 80% of the questions in the assessment in a standard format. The idea is meant to help prevent startups from ‘running out of runway’ (and their health system champions from simply ‘running away’ in frustration), while everyone waits for the necessary paperwork to make its way through Legal.

The pragmatism doesn’t stop there. Listen in to my interview with Stephen Konya to hear about the two other challenges Together.Health is taking on this year: putting together a common curriculum for health accelerator programs and mapping the US Health Innovation Ecosystem.

Want to get a jump on learning what’s happening in some of those health innovation pockets in the US? I had the opportunity to interview 10 ecosystem leaders at the Together.Health Spring Summit at HIMSS and the variety of conversations (and concerns) they share is pretty remarkable.

You can check out the whole Together.Health playlist here, or wait for a few of my favs (and their dishy gossip!) to make an appearance here on THCB over the next week.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.

Health Care Price Tags Won’t Find You the Best Doctor

Mar 12, 2019• 14

By MICHAEL L. MILLENSON

Say you want to know which baseball players provide the most value for the big dollars they’re being paid. A Google search quickly yields analytics. But suppose your primary care physician just diagnosed you with cancer. What will a search for a “high value” cancer doctor tell you?

Not much.

Public concern over bloated and unintelligible medical bills has prompted pushback ranging from an exposé by a satirical TV show to a government edict that hospitals list their prices online. But despite widespread agreement about the importance of high-value care, information about the clinical outcomes of individual physicians, which can put cost into perspective, is scarce. Even when information about quality of care is available, it’s often unreliable, outdated, or limited in scope.

For those who are sick and scared, posting health care price tags isn’t good enough. The glaring information gap about the quality of care must be eliminated.

“When people are comparison shopping, knowing the price of something is not enough,” notes Eric Schneider, a primary care physician and senior vice president of policy and research at the Commonwealth Fund. “People want to know the quality of the goods and services they’re buying.”

Reducing Burnout and Increasing Efficiency with Telepsychiatry

Mar 11, 2019• 1

Radiologist Entrepreneurs

Mar 8, 2019• 1

By SAURABH JHA MD

What motivates the radiologist entrepreneur? In this episode of Radiology Firing Line Podcast, we talk to Kathryn Pearson Peyton MD, chief medical officer of Mammosphere.

Saurabh Jha is a contributing editor to THCB and host of Radiology Firing Line Podcast of the Journal of American College of Radiology, sponsored by Healthcare Administrative Partner.

Standing Rock Two Years Later: Public Health Lessons and the Physician’s Responsibility

Mar 7, 2019• 11

By PHUOC LE MD

A close look at disease and suffering would lead most of us to the same conclusion: our natural environment is inextricably linked to our health. When the Army Corps of Engineers approved the construction of the Dakota Access Pipeline (DAPL) in July 2016, thousands of water protectors from across the world gathered in protest. Through staunch, organized resistance, indigenous activists and their non-indigenous allies refuted the proposed pipeline, which now shuttles over 500,000 barrels of oil per day through the Standing Rock Sioux’s sole water supply and most coveted burial grounds.

In December 2016, I joined the thousands at Standing Rock to briefly bear witness to their commitment to protecting the health and well-being of future generations. Eager to assist, I provided medical care to these heroes, many of whom had given up their jobs, quit school, or come out of retirement in solidarity with the water protectors. Their determination and strength became even more inspirational when a blizzard brought -40° F in its wake, trapping everyone inside the camp for several days.

Photo Courtesy of Phuoc Le, MD

After battling corporate juggernauts, state governments, and fossil fuel lobbyists for months, the Standing Rock Sioux Tribe and their allies neared victory when the Obama administration denied a permit required for the pipeline’s completion. Just a couple of months later, however, President Trump authorized its advancement and on February 23^rd, 2017, the U.S. National Guard evicted the final Standing Rock protestors from the Oceti Sakowin camp. Last week marks the two-year anniversary of that eviction.

Health in 2 Point 00, Episode 72 | Haven, Scott Gottlieb, & Crossover Health

Mar 7, 2019

On Episode 72 of Health in 2 Point 00, Jess and I give you a run down of the latest in health tech. At long last, the joint health care venture between Amazon, Berkshire Hathaway and J.P. Morgan has a name: Haven. In other news, Scott Gottlieb has decided to leave the FDA; we’ll just have to see what happens with the next FDA Commissioner. On the behavioral health front, AbleTo has acquired Joyable, a mental health coaching app. Finally, Crossover Health, which provides medical services to large employers like Facebook, acquired Sherpaa, a text messaging-based service—we’re seeing virtual services combining with a physical space more and more. And as mentioned, you can catch my talk from the 2017 HIC conference in Australia on how SMACK Health and Karl Marx will change health care here. —Matthew Holt

Health Innovation in Detroit | Paul Riser, Tech Town Detroit

Mar 6, 2019

By JESSICA DAMASSA, WTF HEALTH

What’s happening in health tech in Detroit? Paul Riser from the Tech Town accelerator says med device innovation and digital health applications are the area’s ‘sweet spots’ thanks to the area’s talent pool of auto industry engineers and R&D experts. Another unique opportunity for healthcare innovation that capitalizes on the Motor City’s proximity to Ontario? Easy access to emerging cannabis & CBD startups taking advantage of Canada’s legalization laws. Listen in to find out more…

Filmed at the Together.Health Spring Summit at HIMSS 2019 in Orlando, Florida, February 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.