Tag: ONC

Information Blocking–Gropper & Peel Weigh in

Jun 25, 2018• 5

By ADRIAN GROPPER & DEBORAH PEEL

Today is the last day for public comments on the proposed CMS regulations regarding Medicare hospital inpatient prospective payment systems (IPPS). While there are several changes proposed, the one that’s raised lots of attention has been the idea that access to Medicare may be denied to those providers guilty of information blocking. Here are the comments submitted by Gropper & Peel from Patients Privacy Rights— Matthew Holt

Executive Summary of PPR Comments on Information Blocking

Information blocking is a multi-faceted problem that has proved resistant to over a decade of regulatory and market-based intervention. As Dr. Rucker said on June 19, “Health care providers and technology developers may have powerful economic incentives not to share electronic health information and to slow progress towards greater data liquidity.” Because it involves technology standards controlled by industry incumbents, solving this problem cannot be done by regulation alone. It will require the coordinated application of the “power of the purse” held by CMS, VA, and NIH.

PPR believes that the 21st Century Cures Act and HIPAA provide sufficient authority to solve interoperability on a meaningful scale as long as we avoid framing the problem in ways that have already been shown to fail such as “patient matching” and “trust federations”. These wicked problems are an institutional framing of the interoperability issue. The new, patient-centered framing is now being championed by CMS Administrator Verma and ONC Coordinator Rucker is a welcome path forward and a foundation to build upon.

To help understand the detailed comments below, consider the Application Programming Interface (API) policy and technology options according to two dimensions:

API Content and Security	Institution is Accountable	Patient is Accountable
API Security and Privacy	Broad, prior consent Patient matching Institutional federation Provider-directed interop Compliance mindset	Directed authorization Known to the practice Individual credentials Patient-directed interop Privacy mindset
API Content / Data Model	Designated record set FHIR Patient-restricted data De-identified data Bulk (multi-patient) data	Designated record set FHIR Sensitive data Social determinants Wearables and monitors

This table highlights the features and benefits of interoperability based on institutional or individual accountability. This is not an either-or choice. The main point of our comments is that a patient-centered vision by HHS must put patient accountability on an equal footing with institutional accountability and ensure that Open APIs are accessible to patient-directed interoperability “without special effort” first, even as we continue to struggle with wicked problems of national-scale patient matching and national-scale trust federations.

Here are our detailed comments inline with the CMS questions in bold:Continue reading…

A Patient Experience-Based View of the TEFCA

Jan 18, 2018• 5

By ADRIAN GROPPER

Let’s give the Office of the National Coordinator (ONC) credit for trying. In what’s arguably the first significant piece of policymaking, the newly Republican HHS issued a draft Trusted Exchange Framework and Common Agreement (TEFCA) that aims to implement the massively bipartisan 21st Century Cures act mandate to end information blocking. Are they succeeding?

Why should you care? After almost a decade and many tens of $billions spent on health information technology, neither physicians nor patients have access to a longitudinal health record, transparency of quality or cost, access to independent decision support, or even the ability to know what their out-of-pocket cost is going to be. After eight years of regulation, precious little benefit has trickled-down to patients and physicians. This post looks at the TEFCA proposal from the patient experience perspective.

The patient perspective matters because, under HIPAA, patients do not have choice about how our data is accessed or used. This has led to information blocking as hospitals and EHR vendors slow-walk the ability of patients to direct data to information services we choose. Patients lost the “right of consent” in 2002. This puts a regulation-shy administration in a quandary: How do they regulate to implement Cures, when current HIPAA and HITECH-era regulations give all of the power to provider institutions bent on locking-in patients as key to value-based compensation?

A New Pothole on the Health Interoperability Superhighway

Aug 15, 2017• 10

By ADRIAN GROPPER, MD

On July 24, the new administration kicked off their version of interoperability work with a public meeting of the incumbent trust brokers. They invited the usual suspects Carequality, CARIN Alliance, CommonWell, Digital Bridge, DirectTrust, eHealth Exchange, NATE, and SHIEC with the goal of driving for an understanding of how these groups will work with each other to solve information blocking and longitudinal health records as mandated by the 21st Century Cures Act.

Of the 8 would-be trust brokers, some go back to 2008 but only one is contemporary to the 21stCC act: The CARIN Alliance. The growing list of trust brokers over our decade of digital health tracks with the growing frustration of physicians, patients, and Congress over information blocking, but is there causation beyond just correlation?

A recent talk by ONC’s Don Rucker reports:

One way to get data to move is open APIs, which the 21st Century Cures Act mandates by tasking EHR vendors to open up patient data “without special effort, through the use of application programming interfaces.”

ONC’s Interoperability Plan: a Day Late and $19bn Short

Oct 20, 2015• 1

By TOM GIANNULLI, MD

Earlier this month, the Office of the National Coordinator for Health Information Technology released an update to Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap. The roadmap was first announced back in January, and the changes shared this month aren’t significant.

Ultimately, it calls for all healthcare providers nationwide to be able to send and receive electronic clinical information by the end of 2017.

This is a good plan on the surface, although it comes six years and millions of dollars late, and like other programs it may be more cumbersome that it first seems. Essentially, there are three facets:

1) Data standards to format and request/receive data

2) Incentives (again!)

3) Governance

Despite the intention to move data across the Union, each state will have the right to create its own unique rules on how to manage the exchange of information. This is a problem as we have seen before in the simple Case of e-prescription routing. A few states make it almost impossible to send e-scripts and layer on their own special form of bureaucracy. This inhibits the ultimate goal of reducing costs and errors and increasing Efficiency at the expense of both providers and patients.

Is Obamacare working? Where’s the data?

Sep 8, 2015• 1

By FRED and ALMA TROTTER

As President Obama’s healthcare reform unfolds in the last years of his administration, critics and supporters alike are looking for objective data. Meaningful Use is a funding program designed to create health IT systems that, when used in combination, are capable of reporting objective data about the healthcare system as a whole. But the program is floundering. The digital systems created by Meaningful Use are mostly incompatible, and it is unclear whether they will be able to provide the needed insights to evaluate Obamacare.

Recent data releases from HHS, however, have made it possible to objectively evaluate the overall performance of Meaningful Use itself. In turn we can better evaluate whether the Meaningful Use program is providing the needed structure to Obamacare. This article seeks to make the current state of the Meaningful Use program clear. Subsequent articles will consider what the newly released data implies about Meaningful Use specifically, and about Obamacare generally.

Health DataPalooza 2015: The Download

Jun 10, 2015• 2

By STEVE FINDLAY

Health Datapalooza once again lived up to its reputation as the liveliest and most eclectic health IT confabs of the year. Energetic and sleek young entrepreneurs mingled with government bureaucrats, academic types, consultants, current and former ONCers, a smattering of providers, app developers, data geeks, and patient advocates at this year’s conference, held in Washington D.C. June 1 to 3 with about 2,000 in attendance.

Although the speeches, app demonstrations, and panel sessions broke little new ground, that’s not the point. The point is to maintain the excitement, optimism and commitment, to update the vision, showcase the creativity, and extol the virtues and power of data-driven care improvement. Perhaps not as the solution to all the health system’s woes, but a fair share of them.

I didn’t discern a dominant theme, but amid the ra-ra and fun there was a good amount of hand-wringing around these issues:

1. Failure to engage the vast majority of consumers/patients in their own care—with data, medical records and Yelp reviews in hand. Some two-thirds of providers attesting to stage 2 meaningful use reported that not a single patient had requested their data or records. Continue reading…

ONC Awards $300K in Funding to 6 Digital Health Pilot Projects!

May 4, 2015• 1

By ADAM WONG

The Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) today announced the six winners of the inaugural ONC Market R&D Pilot Challenge. The six winners will live-test new health information technology (health IT) applications in health care settings administered by their challenge partners.

The winning innovator-health care organization teams will each receive $50,000 to fund their pilot programs which will become operational in August are:

ClinicalBox and Lowell General Hospital
CreateIT Healthcare Solutions and MHP Salud
Gecko Health Innovations and Boston Children’s Hospital
Optima Integrated Health and University of California, San Francisco, Cardiology Division
physIQ and Henry Ford Health System
Vital Care Telehealth Services and Dominican Sisters Family Health Service

The ONC Market R&D Challenge launched on October 20, 2014 with the goal of finding early stage health care startups from across the country and connecting them with health care organizations and stakeholders with whom they could potentially run a pilot program to test the application.

Three in-person matchmaking events were held in January, 2015, focused on connecting health care organizations with innovator companies looking to pilot test their products. Almost 500 organizations expressed interest in finding partners through the matchmaking program. More than 300 in-person meetings were held in New York, New York; San Francisco, California; and Washington, D.C., with many more conducted virtually. These “speed-dating” events allowed startups to meet face-to-face with health care organizations to identify common interests and goals. ONC and the organizer of these meetings, Health 2.0, intended for the events to have additional benefits, including facilitating the exchange of ideas that might lead to new partnerships and relationships.

To be eligible to serve as a host, organizations were required to operate in clinical, public health and community, or consumer health environments while also serving enough consumers or patients to conduct a pilot study. The innovators had to be an early-stage health information technology company with less than $10 million in venture capital funding and a readily available technology solution.

HIT: Where We Stand and Where We Go From Here

Apr 27, 2015• 3

By KAREN DeSALVO

This post is adapted from DeSalvo’s talk at the annual meeting of the Health and Information Management Systems Society in Chicago last week.

I am optimistic about the bright future we have to leverage health information technology to enable better health for everyone in this country.

One year ago, we called upon the health IT community to move beyond adoption and focus on interoperability, on unlocking the data, so it can be put to the many important uses demanded by consumers, doctors, hospitals, payers, and others who are part of the learning health system.

ONC spent the year listening to the health IT community to understand the challenges and opportunities and developing strategic roadmaps to guide our way. Our goal was to evolve to be best able to lead where appropriate, and partner wherever possible, as we all shift the national strategic focus towards interoperability. I hope you all have felt that shift.

In Search of Intra-Aero-Bili-ty

Apr 12, 2015• 4

By MATTHEW HOLT

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.

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.

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.

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.

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.

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…

ONC Report on Health Information Blocking: A Solid Double, But NOT a Home Run

Apr 12, 2015• 3

By VINCE KURAITIS and DAVID C. KIBBE, MD

Last 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…