June 3rd was the kick-off for an amazing Challenge – the Blue Button Patient CoDesign Challenge. Developers everywhere are being invited by the Office of the National Coordinator to develop apps and other tools to use patient data, acquired via the Blue Button. You might be thinking: why is that so amazing? Because the entire Challenge has been designed to actively involve the ultimate users of the tool – patients. Imagine that!
Here are the details:
From now until June 11th, patients (which includes almost all of us) are invited to go to Health Tech Hatch to post their ideas about how they want to see their data used to create tools that they can use themselves or with their doctors. There are already over 50 ideas already posted, which include:
- Please help my wife manage our children’s immunizations
- A tool that simplifies the management of chronic multiple conditions,
- Make my prescription management stink less (my favorite)
An unfathomably complex entity such as a health system grows over time like a city. Right now, communications and data usage in the US healthcare system is a bit like a medieval town, with new streets and squares popping up in unpredictable places and no clear paths between them. Growth in health information has accelerated tremendously over the past few years with the popularity of big data generally, and we are still erecting structures wherever seems convenient, without building codes.
In some cities, as growth reaches the breaking point, commissioners step in. Neighborhoods are razed, conduits are laid in the ground for electricity and plumbing, and magnificent new palaces take the place of the old slums. But our health infomation system lacks its Baron Haussmann. The only force that could seize that role–the Office ofthe National Coordinator–has been slow to impose order, even as it funds the creation of open standards. Today, however, we celebrate growth and imagine a future of ordered data.
The health data forum that started today (Health Datapalooza IV) celebrated all the achievements across government and industry in creating, using, and sharing health data.
Useful data, but not always usable
I came here asking two essential questions of people I met: “What data sources do you find most useful now?” and “What data is missing that you wish you had?” The answer to first can be found at a wonderful Health Data All-Stars site maintained by the Health Data Consortium,which is running the palooza.
The choices on this site include a lot of data from the Department of Health and Human Services, also available on their ground-breaking HealthData.gov site, but also a number of data sets from other places. The advantage of the All-Stars site is that it features just a few (fifty) sites that got high marks from a survey conducted among a wide range of data users, including government agencies, research facilities, and health care advocates. Continue reading…
Those of us who have spent years arguing in favor of standards based health information exchange (HIE) have just had a few good months. The federal government has asked IT vendors and providers what it can do to advance health information sharing across organizations. This has drawn new attention to “interoperable” health IT systems and the quality and economy of care delivered to Medicare and Medicaid beneficiaries.
In late March, the Office of the National Coordinator for Health IT (ONC) awarded cooperative agreement grants to two non-profit trade groups working to certify and credential electronic health records (EHRs) and health exchange service providers whose products are capable of secure data sharing — that is, of “talking to one another.” (Disclosure: I am the President and CEO of one of these alliances, DirectTrust.) The tone of the conversation has definitely changed.
My sense, though, is that most people still don’t have a firm grasp on the issues. They remain uncertain or confused about what interoperable health information exchange really means to providers and patients, how it can be achieved, the barriers that remain to be overcome, and who is making the decisions about these matters. So this seems like a good time for both an update and a refresher of sorts on the nature of health information exchange, and to explain why this is not a good time to reduce spending on health IT in America.
Let’s start with what is probably the most important thing to understand: we are very, very close to national deployment of a relatively simple standard, known as Direct, that enables secure Internet transport of health information between people, organizations, and software. Direct exchange permits users of any EHR to send and receive messages and files from any users ofany other EHRs, regardless of operating system or vendor. In fact, Direct facilitates secure messaging, with attachments, to and from anyone with Internet access. It makes EHRs interoperable with one another, but also facilitates secure communication with providers and patients using Internet devices of almost any kind.
It’s a busy time in Washington, DC. June 3 marks the Datapalooza and begins a week of cheering and reflection on the success of federal initiatives designed to improve health while reducing cost. This year, the big claim is “information following patients” – a combination of federal Stage 2 Meaningful Use regulations, federal Health Information Exchange guidelines and federal open pricing data policies. We’re surely beyond 1,000 pages of federal initiatives around health data and the policy fog seems to be getting thicker every day. The Independent Purchase Decision Support Test is my beacon for whether we’re headed in the right direction.
Here’s a quote from the Meaningful Use Implementation Guidelines to Assure Security and Interoperability just released by ONC:
“In effect, HISPs are creating “islands of automation using a common standard.” This will hamper information following patients where they seek care―including across organizational and vendor boundaries―to support care coordination and Meaningful Use Stage 2 requirements.”
How will “information following patients” improve health while reducing cost?
It all depends on where the patient goes to get what. Not surprisingly, federal Accountable Care Organizations and related accountable quality contracts with private payers are exactly about where the patient goes too. The difference between these health reform innovations and the old managed care approach is supposed to be the patient’s ability to choose where to go for a healthcare service. Will Stage 2 and the new federal health information exchange implementation guidelines actually lead to effective patient engagement or is it time to “reboot” the HITECH incentives as some have suggested?
The Independent Purchase Decision Support Test cuts through the techno-jargon and paternalistic framing and goes straight to the heart of the policies that influence the physician-patient decisions to drive health care quality and cost. This the essence of patient engagement and the place where the money in healthcare is actually spent.
President Obama has released his 2014 budget proposal, which includes $80.1 billion in spending for theDepartment of Health and Human Services (HHS), an increase of $3.9 billion. The proposed budget for The Office of the National Coordinator for Health IT (ONC) would increase its $61 million budget to $78 million, a 28% increase. The plan also includes a $1 million fee for electronic health record vendors that would almost certainly be passed along to users of the systems.
“In addition to the expanding marketplace and corresponding increase in workload for ONC, much of the work to date has been funded using Recovery Act funds scheduled to expire at the end of FY 2013. Consequently, a new revenue source is necessary to ensure that ONC can continue to fully administer the Certification Program as well as invest resources to improve its efficiency,” the ONC explains in the budget proposal appendix.
In particular, the fee could be used to fund:
- Development of implementation guides and other forms of technical assistance for incorporating standards and specifications into products
- Development of health IT testing tools that are used by developers, testing laboratories and certification bodies
- Development of consensus standards, specifications and policy documents related to health IT certification criteria
- Administration of the ONC Health IT Certification Program and maintenance of the Certified Health IT Product List
- Post-market surveillance, field testing and monitoring of certified products to ensure they are meeting applicable performance metrics in the clinical environment
It’s called Blue Button+ and it works by giving physicians and patients the power to drive change.
The US deficit is driven primarily by healthcare pricing and unwarranted care. Social Security and Medicare cuts contemplated by the Obama administration will hurt the most vulnerable while doing little to address the fundamental issue of excessive institutional pricing and utilization leverage. Bending the cost curve requires both changing physicians incentives and providing them with the tools. This post is about technology that can actually bend the cost curve by letting the doctor refer, and the patient seek care, anywhere.
The bedrock of institutional pricing leverage is institutional control of information technology. Our lack of price and quality transparency and the frustrating lack of interoperability are not an accident. They are the carefully engineered result of a bargain between the highly consolidated electronic health records (EHR) industry and their powerful institutional customers that control regional pricing. Pricing leverage comes from vendor and institutional lock-in. Region by region, decades of institutional consolidation, tax-advantaged, employer-paid insurance and political sophistication have made the costliest providers the most powerful.
In November 2012, the digital team at HealthEd embarked on a challenge to redesign the face of personal health records. That effort has been rewarded with a first-place win in the category of Best Lab Summaries. And another HealthEd entry was cited as a finalist that “inspired the judges and challenged the status quo.”
About the Health Design Challenge
The Office of the National Coordinator of Health Information Technology and the Department of Veterans Affairs issued a challenge to designers throughout the United States: imagine how personal health records could be improved for clarity, readability, and visual appeal. Given HealthEd’s mission to create better outcomes in personal wellness, the team embraced the Health Design Challenge with typical enthusiasm.
The Health Design Challenge was more than an exercise in graphic design, however. Entrants were required to demonstrate expert knowledge of clinical systems and to render information of relevance for both millennials and senior citizens. The judges wanted more than pretty pictures—participants had to know their stuff.Continue reading…
Today I’m speaking at the ONC annual meeting as part of panel discussing interoperability.
For years, patients, providers and payers have complained that EHRs “do not talk to each other.”
By 2014, I expect this issue to disappear.
Do I expect that every state and territory will have a robust, sustainable healthcare information exchange by 2014? No
Do I expect that every provider will be connected to a Nationwide Health Information Network by 2014? No
Do I expect that a single vendor will create a centrally hosted method to share data by 2014 just as Sabre did for the airline industry in the 1960’s? No
What I expect is that Meaningful Use Stage 2 will provide the technology, policy, and incentives to make interoperability real.
Stage 2 requires that providers demonstrate, in production, the exchange of clinical care summaries for 10% of their patient encounters during the reporting period. The application and infrastructure investment necessary to support 10% is not much different than 100%. The 10% requirement will bring most professionals and hospitals to the tipping point where information exchange will be implemented at scale, rapidly accelerating data liquidity.
Over the past several weeks, many of us at the Office of the National Coordinator for Health Information Technology (ONC), Agency for Healthcare Research and Quality (AHRQ), and Food and Drug Administration have been evaluating the submissions for the Reporting Patient Safety Events Challenge. Team 90, consisting of KBCore (created by CRG Medical, Inc.) and iHealthExchange, was selected the winner of the challenge—and the recipient of the $50,000 prize—because the company’s patient safety reporting system best fit the criteria of the challenge to find and reduce the risks associated with patient care. Right now, finding risks through the reporting of adverse events is slow because paper-based systems may be hard to read and require transmission by fax machines. By modernizing the patient safety reporting system through the use of computer-based applications we can better shed light on medical errors and augment the discovery of new patient safety hazards more timely and efficiently.
Reporting Patient Safety Events Challenge Submissions
The Challenge submissions were evaluated on a variety of criteria to determine which would potentially improve reporting of adverse events the most. The applications were required to make it easier to file an adverse event report using AHRQ’s Common Formats while allowing for:
- The inclusion of additional information during the initial submission and from a follow-up investigation;
- Import of relevant electronic health record or personal health record information, including screenshots; and
- Ability to submit reports to various entities including PSOs, FDA, and other health oversight organizations.
IDinc and Shands Healthcare finished in second place, while third place went to MidasPlus. They will receive $15,000 and $5,000, respectively.
In a time of EHR naysayers, mean-spirited election year politics, and press misinterpretation (ONC and CMS do not intend to relax patient engagement provisions), it’s important that we all send a unified message about our progress on the national priorities we’ve developed by consensus.
1. Query-based exchange – every country in the world that I’ve advised (Japan, China, New Zealand, Scotland/UK, Norway, Sweden, Canada, and Singapore) has started with push-based exchange,replacing paper and fax machines with standards-based technology and policy. Once “push” is done and builds confidence with stakeholders, “pull” or query-response exchange is the obvious next step. Although there are gaps to be filled, we can and should make progress on this next phase of exchange. The naysayers need to realize that there is a process for advancing interoperability and we’ll all working as fast as we can. Query-based exchange will be built on top of the foundation created by Meaningful Use Stage 1 and 2.
2. Billing – although several reports have linked EHRs to billing fraud/abuse and the recent OIG survey seeks to explore the connection between EHR implementation and increased reimbursement, the real issue is that EHRs, when implemented properly, can enhance clinical documentation. The work of the next two years as we prepare for ICD-10 is to embrace emerging natural language processing technologies and structured data entry to create highly reproducible/auditable clinical documentation that supports the billing process. Meaningful Use Stage 1 and 2 have added content and vocabulary standards that will ensure future documentation is much more codified.
3. Safety – some have argued that electronic health records introduce new errors and safety concerns. Although it is true that bad software implemented badly can cause harm, the vast majority of certified EHR technology enhances workflow and reduces error. Meaningful Use Stage 1 and 2 enhance medication accuracy and create a foundation for improved decision support. The HealtheDecisions initiative will bring us guidelines/protocols that add substantial safety to today’s EHRs.