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Tag: HHS

Calling All Health Innovators: Health Data Palooza

This week the Health 2.0 team will be at Health Innovation Week DC, and the biggest event there will be the Health Data Initiative Forum. One day, 50 demos, mixing more government and private data than you can imagine. We’ve been helping at the periphery of the Health data Initiative and we’ll be be having a special session talking more about the Health 2.0 Challenge, including our upcoming work running Challenges for ONC. We’re incredibly excited and enthusiastic, but no one is as enthusiastic as Todd Park! Here’s the CTO of HHS telling you about his brainchild, Health Data Palooza–Matthew Holt

Almost exactly one year ago, we launched a vital new HHS Open Government effort: The Health Data Initiative (HDI). The Initiative was publicly launched by HHS Secretary Kathleen Sebelius, Deputy Secretary Bill Corr, Institute of Medicine (IoM) President Harvey Fineberg, and White House CTO Aneesh Chopra at a forum held at the National Academy of Sciences.

The Health Data Initiative is an incredibly exciting public-private collaboration that is encouraging innovators to utilize data made publicly available by HHS and others to help fuel applications and services that can help improve health and health care. Over the past year HHS has been working very hard to make our data ever more accessible to the public – both publishing brand new data and making more of our existing data machine-readable, downloadable, accessible via application programming interfaces (APIs), free, and vastly easier to find. We’ve launched major new data and information websites (the HealthData.gov community, the Health Indicators Warehouse; and HealthCare.gov).

Equally importantly, we’ve been energetically publicizing our data, through challenges, code-a-thons, and many sessions with innovators of all kinds – educating folks around the country about what data we’ve made available and its potential to help power health  improvement. Innovators from across America are taking our data and are using it to build and power an amazing and rapidly growing array of applications in creative and powerful ways to help advance health. This movement has included entrepreneurs and change makers from all sectors: startups, major businesses, nonprofits, public health, health care delivery system, federal and local government, and academia.

On June 9th, 2011 at the National Institutes of Health, in partnership with the IoM, we will be holding our 2nd Annual Health Data Initiative Forum (or, as I like to call it, our second annual Health Data Palooza!). Continue reading…

Outrage is Easy. Solutions are Hard.

The inspector general of HHS reported this week that nearly half of the anti-psychotic drugs fed to the demented elderly in nursing homes are inappropriately prescribed. That’s about one in fourteen nursing home residents.

Forget about cost, which is over a quarter billion dollars a year. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, the HHS I.G. wrote in his letter to Senators Charles Grassley (R-Ia.) and Herb Kohl (D-Wis.), who asked for the report.

Why is this happening? First, the medication patterns of the frail elderly are not monitored by the Centers for Medicare and Medicaid Services, which is afraid of a backlash from Capitol Hill where doctors and nursing home operators fiercely lobby to protect the hallowed doctor-patient relationship. The drug industry has also, in some cases, paid kickbacks to the pharmacy operators in nursing homes.

But at the root of the issue are the doctors who are faced with caring for these patients. Even though clinical trials have shown the drugs are likely to result in earlier deaths for some of these elderly patients, doctors prescribe them to reduce agitation, as Daniel Carlat, a practicing psychiatrist and purveyor of non-industry-funded continuing medical education, told the New York Times. “Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” he said.

As someone who watched his father’s decline with dementia over a ten year period (usually from a distance), I can attest that shortening one’s lifespan is not the crucial issue, especially in the last few years when the personality in the shell of the human being that has survived the loss of cognition has largely disappeared. The first question is whether the anti-psychotics are effective in reducing the outbursts associated with severe dementia, and whether those benefits outweigh the side effects (catatonia?). The second question is whether families have been adequately informed about the risks and benefits of this approach. That the drug companies deploy their marketing arms to stoke sales in this situation is outrageous. But even eliminating their right to do so wouldn’t solve the underlying problem.

Accountable Care Organizations and Antitrust

There’s a new PSA test in health care.  Hopefully it will prove more reliable than that other one.

In conjunction with the unveiling of the long-awaited ACO regulation by HHS, the FTC and Department of Justice issued a Joint Policy Statement setting forth their standards for conducting an expedited (90-day) antitrust review of applicants for ACO certification.  The agencies explained that they will evaluate applicants’ market power based on the ACO’s share of services in each participant’s Primary Service Area (PSA) defined as the “lowest number of contiguous postal zip codes” from which the hospital or physician draws at least 75 percent of its patients for its services.   The Statement summarized the antitrust implications of ACOs formed by hospitals or physician groups with large market shares in their markets:

ACOs with high PSA shares may pose a higher risk of being anticompetitive and also may reduce quality, innovation, and choice for both Medicare and commercial patients. High PSA shares may reduce the ability of competing ACOs to form, and could allow an ACO to raise prices charged to commercial health plans above competitive levels.

The antitrust enforcers were properly concerned with the risk that ACOs could become a vehicle for increasing or entrenching provider market power.  Studies by academics, health policy experts and state governments have documented the impact of provider concentration on insurance premiums. Moreover, a post-reform merger wave may have increased the number of hospital and specialty physician markets and many areas are already served by dominant local providers.  Inasmuch as the success of the ACO concept depends on its ability to spur delivery system change, the predictable intransigence of monopolistic providers presents an important issue. In this regard, it is heartening that the extended (and apparently controversial) regulation drafting process produced a result that promises to constrain the growth and exercise of market power.Continue reading…

Beating up on ONC, mostly unjustified

Earlier this week there was a curious little hearing at Pete Stark’s committee. Much of the Q & A—mind you post the announcement of the final meaningful use rules—was (apparently, as I can’t find the transcript) a beating up on the poor folks at ONC for reducing the barriers towards meaningful use. Here’s Jonathan Hare of upstart privacy/identity/network vendor Resilient explaining that things are not tough enough.

While Jonathan is having a bit of fun here (and, oh by the way, he does actually have a solution for the inadequacies of current HIEs which we’ll be showing you more about in the world of Health 2.0), some of this and the other stuff the ONC folks had to deal with was a little tough. They got a fair amount of abuse from the committee.

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Interview: Blumenthal talks meaningful use

Absolutely hot off the recorder, here’s my interview with David Blumenthal, the Obama administration’s National Coordinator for Health IT.

David and I discuss patient communication, why the percentages of certain criteria were reduced, and how to get the two Reginas on Oprah. Well, he didn’t have many ideas about that! …

David Blumenthal on Meaningful Use, 13 July 2010

Meaningful use, and cats & dogs

More than a year or so of squabbling is (sort of) over and today HHS announced its criteria for the first phase of meaningful use. Essentially the 25 criteria for qualifying for “meaningful use” (in other words who qualifies for the money) have been changed to 15 with a further 5 from a menu of 10. The details are here, and it looks like most of the percentages needed to qualify have been relaxed but not eliminated. The Dogs have clearly had a minor victory in that there are patient communication requirements in both the mandatory and optional criteria.

The most impressive part of the announcement (you can see it here) which included HHS Sec Sebelius, CMS head Berwick (not wearing his Che Guevara T Shirt) & ONC Director Blumenthal, was the two Reginas. First, Surgeon General Regina Benjamin explained how thrice her clinic was destroyed by nature, and how the second time she realized that while she had thought she couldn’t afford electronic records for her patients, she then realized that she couldn’t afford not to have them.

The other Regina was our friend Regina Holiday who made (to me) a surprise appearance and told the 73 Cents story in a heartfelt and powerful way. She’s really become the poster child for why access to health data matters to ordinary people, and we need to get her from the world of webinars, Health 2.0 Conferences and HHS announcements onto Oprah and the 6 O’Clock News right now.

And I’ll be suggesting that when I interview David Blumenthal in a little under 30 minutes.

And here's the 3mins audio of Regina Holiday at MU announcement

The Health 2.0 Developer Challenge–It’s On!

Today is the formal kick-off of the Health 2.0 Developer Challenge. The challenge was first announced by Federal CTO Aneesh Chopra on June 2 at the Community Health Data Initiative (CHDI) meeting, and it’s partly a continuation of the great work done within CHDI, and partly an expansion of the code-a-thon/developer camp effort to the whole Health 2.0 community. The challenge is supported by HHS. It’s being run by the Health 2.0 Conference, with partners O’Reilly, Internet2, Sunlight Labs, Healthtap & the Health 2.0 Accelerator.

Anyone can submit a challenge or join a team to solve a challenge. But the goal is to get the health care and developer communities working on building new innovative applications in rapid-fire time.

The Challenge has two parts: online and offline. The online challenge process officially begins today—there are four challenges up already and we have several others in the queue, but we’re looking for more!

  • Whyville challenges game developers to build tools for their arcade to help kids understand and apply health data. The kids will vote on the winner!
  • Move your apps; a challenge to develop an app for the Android platform that helps users burn calories, brought to you by Snaptic & Hopelab
  • Practice Fusion‘s Real Time Patient-Driven Data Challenge invites developers to build applications that connect to the Practice Fusion EMR platform.
  • The Szollosi Healthcare Innovation Program wants to see whether a lightweight EMR can be built with blog and wiki software.
  • And……Your challenge here!!

Here’s the link to the challenges page

Teams will be working on challenges over the course of the summer. Selected winners from the challenges will be showcased at the Fall Health 2.0 Conference, and we’ll be building an online community of challengers and teams in the coming weeks.

Continue reading…

The Primary Care Workforce: Help is on the Way

The best electronic health record on the planet isn’t going to help anybody unless a physician uses it. The HITECH incentive scheme should enhance the woefully poor EHR uptake rates among US providers, as should innovative vendor business models that remove cost-barriers which have prevented many from getting in the game.

But there’s an even more fundamental issue, which is a looming manpower shortage among the ranks of US primary care physicians, a topic we’ve covered numerous times, most recently here. There simply aren’t enough physicians to use those EHRs!

Communities across the nation have long suffered from a lack of PCPs. The problem is expected to worsen as baby boomers age and the number of medical students who enter primary care continues to drop. If nothing is done to change current trends, the Association of American Medical Colleges estimates our country will be short 21,000 and PCPs in 2015 and a whopping 47,000 in 2025.

Now, finally, something is being done. And while it may not be enough, it certainly points us in the right direction. More importantly, it sets a precedent for future interventions by the federal government.

This Wednesday, Department of Health and Human Services Secretary Kathleen Sebelius announced $250 million worth of new investments designed to support the training and development of more than 16,000 new primary care providers over the next five years. The investments were mandated by the Affordable Care Act, that controversial health care bill signed into law by President Obama in March.

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Why Rush Vendor Certification of EHR Technologies?

A surprise move by ONC/HHS indicates the wheels may be falling off health IT reform at about the same rate they’ve fallen off Democrats’ broader health reforms.

David Blumenthal and his staff have unveiled two separate plans to test and certify EHR technology products and services. We don’t think this is a good idea. We’ve supported the purpose and spirit of the ARRA/HITECH incentive programs, and believe ONC’s/HHS’ re-definition of EHR technology puts it on a trajectory to improve the quality and efficiency of health care in the U.S. But this recently-announced two-stage EHR technology certification plan bears all the marks of a hastily drawn up blueprint that, if rushed into production, could easily collapse of its own bureaucratic weight.

The new Proposed Rule puts vendors through the wringer, twice. As defined by ONC, vendors with “complete EHRs” and those with “EHR modules” will have to find an “ONC-approved testing and certification body” (ONC-ATCB) that will take them through a “temporary certification program” from now until end of 2011. Then in 2012, under a “permanent certification program,” they’ll have to switch over to a National Voluntary Laboratory Accreditation Program (NVLAP)-accredited testing body for testing, after which they must seek an “ONC-approved certification body” (ONC-ACB, not to be confused with ONC-ATCB) that can provide certification. The ONC-ATCB will be accredited by ONC, but the ONC-ACBs will be accredited by an “ONC-approved accreditor” (ONC-AA).Continue reading…

Finally, A Reasonable Plan for Certification of EHR Technologies

A caution to readers: This post is about methods for certifying Electronic Health Record (EHR) technologies used by physicians, medical practices, and hospitals who hope to qualify for federal incentive payments under the so-called HITECH portion of the American Recovery and Reinvestment Act (ARRA). It may not be as critical as the larger health care reform effort or as entertaining as Sarah Palin, but it WILL matter to hundreds of thousands of physicians, influencing how difficult or easily those in small and medium size practices acquire health IT. And indirectly for the foreseeable future, it could affect millions of American patients, their ability to securely access their medical records, and the safety, quality, and the cost of  medical care.

Three weeks ago, on July 14-15, 2009, the ONC’s Health IT Policy Committee held hearings in DC to review and consider changes to CCHIT’s current certification process. The Policy Committee is one of two panels formed to advise the new National Coordinator for Health IT, David Blumenthal. In a session that was a model of open-mindedness and balance, the Committee heard from all perspectives: vendors, standards organizations, physician groups, and many others.

And then, on July 16, they released their final recommendations on what is now referred to as “HHS Certification.” The effects of their recommendations – these are available online and should be read in their entirety to grasp their extent – are potentially monumental, and could very positively change health IT for the foreseeable future.

At the heart of these hearings was the issue of who will define the certification criteria and who will evaluate vendors’ products. Among many others, we have voiced concerns that the Certification Commission for Health Information Technology (CCHIT), the body currently contracted by HHS to perform EHR certification, has been partial to traditional health IT vendors in defining the certification criteria, and in the ways certification is carried out, and thereby able to inhibit innovation in this industry sector. Despite its leaders’ claims that the certification process has been developed using an open framework, CCHT’s obvious ties to the old guard IT vendors have created an overwhelming appearance of conflict of interest. That appearance has not been refuted by CCHIT’s resistance to and delays in implementing interoperability standards, or by its focus on features and functions over safety, security, and standards compliance.

In the hearings that led to the recommendations, longtime IT watchers were treated to some extraordinary commentary, much of which dramatically undermined CCHIT’s position.

“HHS Certification means that a system is able to achieve government requirements for security, privacy, and interoperability, and that the system would enable the Meaningful Use results that the government expects…HHS Certification is not intended to be viewed as a ‘seal of approval’ or an indication of the benefits of one system over another.”

In other words, as the definition of Meaningful Use is now tied to specific quality and safety improvements and cost savings that result from health IT — among them e-Prescribing, quality and cost reporting, data exchange for care coordination, and patient access to summary health data — HHS Certification will closely follow. Rather than pertain to an EHR’s long list of features and functions, some of which have nothing to do with Meaningful Use, certification will be focused on each IT system’s ability to enable practices and hospitals to collect, store, and exchange health data securely.

Who Determines the Certification Criteria

The Office of the National Coordinator – not CCHIT – would determine certification criteria, which “should be limited to the minimum set of criteria that are necessary to: (a) meet the functional requirements of the statute, and (b) achieve the Meaningful Use Objectives.” As regulator, funder for this project, and a major purchaser of health services, the government, not users or vendors, will now determine HHS’ Certification criteria.

A New Emphasis on Interoperability

“Criteria on functions/features should be high level; however, criteria on interoperability should be more explicit.” That is, functions/features criteria will be broadly defined, but there will be a greater focus in the future on the specifics associated with bringing about straightforward data exchange.

Multiple Certifying Organizations

ONC would develop an accreditation process and select an organization to accredit certifying organizations, then allow multiple organizations to perform certification testing. In other words, the Committee recommended that CCHIT’s monopoly end.

Third Party Validation

The “Validation” process would be redefined to prove that an EHR technology properly implemented and used by physician or hospital can perform the requirements of Meaningful Use. Self-attestation, along with reporting and audits performed by a Third Party, could be used to monitor the validation program.

Broader Interpretation of HHS Certification

HHS Certification would be broadly interpreted to include open source, modular, and non-vendor EHR and PHR technologies and their components.

These bold, forward-thinking proposals from the HIT Policy Committee have not been accepted yet. But in our opinion they should be. These measures would encourage new technologies to enter the market for physician medical practices seeking EHR technology, and wrest control away from the legacy health IT vendors that have maintained barriers and delayed adoption, so you can be sure that the old guard players are doing everything possible to have them rejected.

But these are hugely progressive steps in the right direction, toward allowing HIT to enable improvements in care and cost efficiencies that would be in the best interests of users and the public at large. If implemented, the changes recommended by the HIT Policy Committee would create greater choice, more standardization, lower price, less interruption of the practices — as well as a check from CMS or Medicaid each year to help smooth the implementation, starting in 2011.

David C. Kibbe MD MBA is a Family Physician and Senior Advisor to the American Academy of Family Physicians who consults on health care professional and consumer technologies. Brian Klepper PhD is a health care market analyst. Their collected collaborative columns may be found here.

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