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Keas Opens API for Health 2.0 Developer Challenge!

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Keas_logo-one1 The fifth challenge for the Health 2.0 Developer Challenge has just been announced. Keas, the health and wellness data-driven platform, has opened up their API and a development environment to anyone who wants to author a "social Care Plan." In a fun play on a "Challenge to design a Challenge," teams will have access to tools and a robust engine to test new ideas that incorporate social motivation in health and behavior change through the sharing of health data and health results.

The winning team gets to discuss their work over dinner with Web 2.0 pioneer CEO Adam Bosworth, $3,000 cash prize, and the opportunity to feature the winning app at the Health 2.0 Conference in October. To find out more and sign up to compete, see the Keas' Challenge here.

Big Day in HIT

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By DAVID HARTZBANDDavid Hartzbrand

Today was a big day in health care information technology (HIT). There are so many acronyms in HIT that I probably should publish a list, not today though. The Office of the National Coordinator of HIT (ONC) of the Department of Health and Human Services (HHS) issued its final rule on meaningful use criteria. As we know, these are the requirements that ‘providers’ (mainly physicians) have to meet to receive incentive payments from the Centers for Medicare & Medicaid Services (CMS) for the use of electronic health records (EHR) and other specific information technology (such as electronic ordering, electronic prescribing & exchanging of health information). The incentive payments start as early as this year for Medicaid providers, the rub is that after 2015, if you haven’t qualified, you will receive smaller Medicare or Medicaid payments (you can only qualify for one). These criteria were first published early last year & have been in comment periods or under revision ever since.

Despite this long period of evolution (over 2000 comments were evaluated), the question for providers continues to be “Is it worth it to me or my practice to even try to qualify?” The incentives are supposed to be based on the cost to acquire & adopt the necessary technology, but the total incentive (paid over as much as five years) is well under $100K for Medicaid providers. This may be close to the actual cost of the technology, but that does not take into account the disruption in practice caused by training, workflow changes & differences in usage caused by the technology. Providers who have been used to talking to their patients (even in the small amounts of time that modern clinical workflows allow) must now also do data entry (into the EHR) & spend part of their time filling out electronic order & prescription forms. This disrupts the clinical visit for both the provider & the patient. I have had not a few people (it’s people who are patients after all) tell me that they refuse to allow their doctor to enter data & consult “the computer” during their visit. They feel it’s disrespectful, regardless of how productive it may potentially be.

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New and Improved Meaningful Use

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By MARGALIT GUR-ARIE
HHS_ONC

The long anticipated final rule on Meaningful Use was unveiled yesterday with much pomp and circumstance in a rather unusual ceremony which, interestingly, also marked the first public appearance of Dr. Berwick as CMS Administrator. The Final Rule is contained in an 846 page document. Accompanying the CMS ruling is the 228 pages final EHR certification rule issued simultaneously by ONC. Fortunately for all of us scrambling to figure out what has changed, Dr. Blumenthal released a synopsis in NEJM (recommended). Already many articles and dissertations have appeared and indubitably many, many more will be written in the next few days and weeks analyzing every change and every nuance of the new, and now binding, Meaningful Use. For those who don’t care much about nuances, preferring a bigger and lower resolution picture, here are the major changes to the old version of Meaningful Use.

The Good

  • By far the biggest relaxation was to divide the original 25 measures (23 for hospitals) into two groups – 15 mandatory measures and 10 optional measures of which only 5 need to be fulfilled, per provider choice. This is in effect a 20% reduction of the Meaningful Use burden.
  • They added back a requirement for hospitals to record advanced directives. It is listed in the optional group, which means that some hospitals could choose not to implement it, but one must be grateful for having it back on the list.Continue reading…

What Could Don Do?

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By PAUL LEVY
Picture 3

What is the important thing Don Berwick could do as head of CMS to improve quality and reduce the cost of health care?  Let’s face it, as head of a humongous agency, it is hard to make changes.  You have to pick your battles carefully, for every cause has a constituency and an opponent.  Gridlock is a fact of life in Washington, DC:  The system is designed for that result.

Let’s just say, though, that you had a chance to adopt one innovative regulation or proposal, one where even opponents would have little moral ground on which to get traction.

Here’s mine:

Announce that you are going to create a website in which each hospital is invited to input two or three real-time metrics with regard to reducing harm. Let’s start with central line infections.  There is a common definition provided by the CDC.  Many hospitals keep track of their rate of infection.

Provide a password-protected template and give each hospital CEO (yes,
CEO!) the opportunity to send in his or her hospital’s quarterly figure
for the world to see.  Set up the web page so the accumulated sequence
of numbers is translated in a trend line, so anyone can watch a given
hospital’s progress over time.

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Op Ed: Dr. No to Run CMS

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By JOHN GOODMAN, PhDPicture 2

Let’s do a thought experiment. Suppose you were a U.S. Senator and the President’s nominee to head CMS appeared at his confirmation hearing:

  • Wearing a Che Guevera t-shirt, sporting the image of a psychopath who apparently enjoyed killing people, or
  • Fondly clutching a copy of Quotations from Chairman Mao, written by a man who presided over the genocidal murder of more people than any other person in the history of the world.

When I was at Columbia University, my fellow students did these sorts of things. I soon learned they were not evil. They simply could not think clearly about moral issues involving collectivism. I view Don Berwick in much the same way.

President Obama took advantage of a short Congressional recess to appoint him to run Medicare and Medicaid without even a hearing. Although the President blamed Republicans, even some Democrats were unhappy with his snubbing of normal Senate prerogatives — something Obama criticized George Bush for doing with the appointment of John Bolton as UN Ambassador.

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PPACA: The Individual Mandate

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By ROGER COLLIER

Roger Collier The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act. Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of $695 or 2.5 percent of income.

The rationale is straightforward: without a mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing coverage, and potentially creating an “insurance death spiral” as the higher premiums lead to increasing numbers simply dropping their coverage. (This last part is basically what we have today, but will be magnified by PPACA’s ban on preexisting condition exclusions.)

The individual mandate was preferred for obvious reasons over the alternative of a general tax offset by credits for premiums paid. Democratic lawmakers had no wish to be blamed for imposition of a new tax—no matter how reasonable the arguments in its favor. In fact, as President Obama made clear in an ABC television interview “I absolutely reject that notion [that the penalty is a tax].”

The individual mandate has now become the centerpiece in Republicans’ legal fight against reform. Suits challenging PPACA have been filed by the attorneys general of twenty states (with the first, in Virginia, already being argued), with the constitutionality of the mandate a key issue in every case.

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KP Innovation Workshop

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Logo At the Sidney R. Garfield Innovation Center, Kaiser Permanente's patients, doctors, nurses, architects and engineers use elements of human-centered design to improve and to innovate physical spaces, technologies and clinical operations in a unique, “movie-set”-style warehouse. Many of these innovations have been spread throughout Kaiser Permanente as well as to organizations nationally and internationally.  

As a result, an inaugural workshop has been developed workshop to share the Kaiser Permanente methodology and some best practices. On August 3rd and 4th, a variety of health care providers, biotech and pharmaceutical companies, policy researchers, architects and more will get together in a hands-on session to explore and experience first-hand how Kaiser Permanente understands it’s users’ needs and ideate and prototype new processes, spaces and technologies. Participants will work in the same space where Kaiser Permanente employees and patients conduct deep-dives and collaborate on new idea generation.

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ONC announces HITECH amendments to HIPAA privacy, security and enforcement rules

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By DAVID HARLOW

David HarlowThe federales announced a new set of HIPAA regulations today (to be published in the Federal Register on July 14) in a press conference featuring Kathleen Sebelius (HHS Secretary), Georgina Verdugo (HHS OCR Director) and David Blumenthal (ONC Director).  The HIPAA changes are essentially mandated by the HITECH Act.  From the HHS presser:

The proposed rule announced today would strengthen and expand enforcement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Enforcement Rules by:

  • expanding individuals’ rights to access their information and to restrict certain types of disclosures of protected health information to health plans;
  • requiring business associates of HIPAA-covered entities to be under most of the same rules as the covered entities;
  • setting new limitations on the use and disclosure of protected health information for marketing and fundraising; and
  • prohibiting the sale of protected health information without patient authorization.

Two new websites were announced as well.  One is a beefed-up version of the HIPAA data breach notification wall of shame, and the other is a new HHS privacy website directed at the general public, now up at hhs.gov/healthprivacy.

This website, a joint statement from ONC and OCR posted today, and the tenor of the federales’ remarks today indicate a deep concern about public perceptions concerning privacy and security of protected health information — sort of a “what if we throw a party and nobody comes?” vibe.Continue reading…

Maybe Being Wrong is Better and More Human than Being Right

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By KENT BOTTLES, MD

St. Augustine: “Fallor ergo sum”

When I was in charge of the medical residency programs in Grand Rapids, Michigan, David Leach introduced me to the expanded Dreyfus Model of how physicians can progress from beginners to masters.  I was always struck by how master physicians freely admitted their mistakes and used them as a teaching tool.  As a young surgical and cytopathologist, my sanity was saved more than once by University of California San Francisco’s Dr. Theodore R. Miller, a true master of cytology, being willing to share with me some of his mistakes.  I do not honestly think I could have survived in diagnostic pathology without his guidance and wisdom.  Years later, I still remember Dr. Miller showing me a breast fine needle aspiration biopsy slide of fat necrosis that mimicked ductal carcinoma and a case of wrongly diagnosed pancreatic cancer that turned out to be inflammatory atypia.

Mistakes and errors are on my mind because I just finished reading some extraordinary works.

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Why Obama Made the Right Call on Berwick

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By BOB WACHTER, MD Wachter

The recess appointment of Don Berwick to lead CMS can be seen as a cynical act of political opportunism, sidestepping the Congressional approval process using a tactic worthy of Machiavelli, or Karl Rove. Or it can be viewed as a pragmatic decision by Obama to avoid a lengthy and exasperating re-litigation of the healthcare reform debate.

Death Panels. Been there, done that. So I’m going with Choice #2.

The right side of the blogosphere has erupted, painting Berwick as an effete academic who would have withered under the Klieg lights and piercing questions of the likes of John Ensign and Jim Bunning. Those of us who know Don have no doubt that he would have more than held his own in debating the lessons of England’s healthcare system and the necessity of clear-headed rationing choices. Don is serious, hyper-articulate and intellectually nimble; in a real debate with members of the Senate Finance Committee, all my money would have been on him.Continue reading…

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