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The Election and Healthcare IT

Tomorrow the Presidential election process comes to an end and the advertising will finally stop.   We’ll all be relieved.   I especially look forward to a quiet dinner at home without robotic election-related calls.

What about healthcare IT?  Will differences in the Obama and Romney platforms impact the momentum of Meaningful Use?

Here’s what I believe.

The Obama Healthcare IT platform builds on what we’ve created over the past few years.   It will continue to leverage the federal advisory committees (Policy and Standards) to engage a wide array of stakeholders.   It will persist the progression to Meaningful Use Stage 3 and possibly future stages.   It will embrace certification now the temporary certification process has been replaced with a permanent one.   It will support the initiatives of the Standards and Interoperability framework (S&I), although the end of stimulus funds from ARRA means that ONC will move some of the S&I initiatives to private/public partnerships.  It will support the current leadership at ONC – Farzad and his delegates such as Steve Posnack, Doug Fridsma, and Judy Murphy.

The Romney Healthcare IT platform notes that Healthcare IT is an issue which has broad bipartisan support.   No one argues that a foundation of healthcare IT implemented properly is essential for accountable care organizations.   Quality, safety, and efficiency  all benefit from the process enhancement afforded by healthcare IT.    Michael Leavitt, former Secretary of HHS and chair of the American Health Information Community (AHIC) will lead the Romney transition team and Leavitt has years of experience with healthcare IT issues from the early days of ONC.     As Governor of Massachusetts, Romney supported the early EHR rollout efforts of the Massachusetts eHealth Collaborative.

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Nationwide Health Information Network Comes of Age

The Nationwide Health Information Network Exchange (NwHIN Exchange, or just Exchange) has been operating as an ONC program since 2007. For the past three years, a rapidly growing community of public and private organizations (Exchange Participants) has been routinely sharing information in production. That community now represents thousands of providers and millions of patients. Healtheway is new a non-profit, public-private partnership that will operationally support the eHealth Exchange (formerly referred to as the NwHIN Exchange).

On August 1, 2012, the Exchange Coordinating Committee appointed three representatives to serve on the Healtheway Board of Directors, including: Michael Matthews (CEO, MedVirginia), Paul Matthews (CTO, OCHIN) and Jan Root (CEO, Utah Health Information Network). These individuals, along with Healtheway’s Interim Executive Director, Mariann Yeager, will serve as the initial board of directors for the non-profit. The remaining Healtheway board seats will be filled by up to nine elected Healtheway members. The company launched its Member Program in August 2012, with elections for the member board seats expected in the Fall 2012.

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The EHR “Final Rule” (Finally)

Six months to the day after the Centers for Medicare and Medicaid Services (CMS) released the “preliminary rules” for Meaningful Use, the final rules are in.  For clinicians and policymakers who want to see Electronic Health Records (EHRs) play a key role in driving improvements in the healthcare system, there’s a lot to like here.

For the Office of the National Coordinator (ONC), the agency that oversees the federal health information technology incentive program, the Meaningful Use rules are a balancing act. On one hand, ONC wants to get as many clinicians and hospitals on board with simply adopting EHRs (and thus, the need to set a low bar). On the other hand, they want to ensure that once people start using EHRs, they are using them in a “meaningful” way to drive improvements in care (and thus, the need to set a high bar).  I think ONC got that balance just about right.

Let me begin with a little background.  In 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act, setting aside about $30 billion for incentives for ambulatory care providers and acute-care hospitals to adopt and “meaningfully use” EHRs.  Congress specified that the executive branch would define Meaningful Use (MU) and would do so in three stages.  The first stage was finalized in 2010 and its goals were simple – start getting doctors and hospitals on board with the use of EHRs.  By most metrics, stage 1 was quite successful.  The proportion of doctors and hospitals using EHRs jumped in 2011, and all signs suggested continued progress in 2012.  Through July 2012, approximately 117,000 eligible professionals and 3,600 hospitals have received some sort of incentive payment.

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Finally, Quality We Really Care About

Patient-centered care and patient engagement have become central to the vision of a high value health delivery system. The delivery system is evolving from a fee-for-service transactional payment model to a value-based purchasing model using outcome data and quality improvement and attainment. The Centers of Medicare and Medicaid Services (CMS) and private payers have spurred delivery redesign of networks that focuses on a set of clinical quality measures and patient care experiences along with efficiency measures.

However, the questions we ultimately really care are: “Did I get better? Am I healthier?”

With the advent of Facebook, PatientsLikeMe® and Avado, consumers and patients are sharing their healthcare experiences openly with their support system and strangers with similar illnesses. Our delivery system has yet to leverage the power of patient/consumer reported data in feeding back to care deliverers in the quality improvement cycle.

Clinical quality measures have traditionally consisted of process or surrogate measures and centered on providers and hospitals. As we move toward a system based on value, the measurement system must shift as well. Part of this movement will be utilizing outcomes directly reported from patients and their caretakers and incorporating these outcomes into quality improvement initiatives and payment models. The widespread adoption of standardized and validated patient-reported outcomes measures (PROMs) would accelerate the development of a patient-centered health system. However, new standards; patient-friendly, digitally-enabled instruments; secure portals; and more research will be required to facilitate adoption.

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What The Emergence of an EMR Giant Means For the Future of Healthcare Innovation

(Note: the following commentary was co-authored with Tory Wolff, a founding partner of Recon Strategy, a healthcare strategy consulting firm in Boston; Tory and I gratefully acknowledge the insightful feedback provided by Jay Chyung of Recon Strategy.)

Medicine has been notoriously slow to embrace the electronic medical record (EMR), but, spurred by tax incentives and the prospect of cost and outcomes accountability, the use of electronic medical records (EMRs) is finally catching on.

There are a large number of EMR vendors, who offer systems that are either the traditional client server model (where the medical center hosts the system) or a product which can be delivered via Software as a Service (SaaS) architecture, similar to what salesforce.com did for customer relationship management (CRM).

Historically, the lack of extensive standards have allowed hospital idiosyncrasies to be hard-coded into systems.  Any one company’s EMR system isn’t particularly compatible with the EMR system from another company, resulting in – or, more fairly, perpetuating – the Tower of Babel that effectively exists as medical practices often lack the ability to share basic information easily with one another.

There’s widespread recognition that information exchange must improve – the challenge is how to get there.

One much-discussed approach are health information exchanges (HIE’s), defined by the Department of Health and Human Services as “Efforts to rapidly build capacity for exchanging health information across the health care system both within and across states.”

With some public funding and local contributions, public HIE’s can point to some successes (the Indiana Health Information Exchange, IHIE, is a leading example, as described here).  The Direct Project – a national effort to coordinate health information exchange spearheaded by the Office of the National Coordinator for Health IT – also seems to be making progress.  But the public HIEs are a long way from providing robust, rich and sustainable data exchange.

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Missive from the DMZ

Not everything about improving health care is breathlessly hanging on one high stakes decision.

The Supreme Court will rule soon enough on the constitutional challenges to the Affordable Care Act. Meanwhile, even amid the drama and bitter struggles, progress can occur in health care improvement—like the ever increasing adoption of health information technology. Believe it or not, there is broad agreement about using this technology in health care. Scott Gottlieb and J.D. Kleinke in a recent Wall Street Journal opinion said it well, “. . . promotion of health information technology is one of the only demilitarized zones in Washington—consistently attracting bipartisan support . . . .”

So, this rare consensus seems real and durable, but what is actually happening in the hallowed HIT ground where both sides have somewhat oddly come to a policy truce?

Since May of 2004 when President George W. Bush established the Office of the National Coordinator for Health Information Technology (ONC) we’ve witnessed a slow but relentless upturn in adoption. That progress dramatically accelerated with attention and funding in the American Reinvestment and Recovery Act in 2009. Since 2006, the Robert Wood Johnson Foundation (RWJF) in collaboration with ONC has supported an ongoing, independent effort to monitor the national adoption of the electronic health record.

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Breaking Down the Process of Innovation: The Value of Community

In just about a month, the third Annual Health Datapalooza will take place in Washington, DC – a celebration of data-driven healthcare innovation (tax-payer funded data, by the way).  The part of the program that I’m personally looking forward to is the Apps Expo of about a hundred or so health apps that will be showcased throughout the event.  While there will be center stage presentations by a cavalcade of inspiring leaders (including Thomas Geotz and Bob Kocher), what is noteworthy is that there will be the opportunity to participate in roundtable discussions and deep dive sessions on top-of-mind areas of development such as big data, ACOs, and consumer data liberation. (liberacion!)

But what is the value in attendance? Better question, why has the event attracted more and more new attendees recently?

I’ve spent the last few years supporting private-sector healthcare innovation – especially around health IT.  What I’ve come to appreciate from those dedicated to the space – whether a two person startup or a carve-out within a large technology prime – is that success at every stage of innovative development is predicated on how quickly one can create value based on the expectations of the relevant stakeholders at that stage.

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Health 2.0′s Boston Big Data Code-A-Thon

This weekend, the famous Health 2.0 Code-A-Thon is coming to Boston! Hosted in conjunction with Health 2.0’s Spring Fling: Matchpoint Boston, this one-day event taking place on May 11 – 12 aims to bring the best and most talented developers together to come up with new and creative applications to improve healthcare.

And that’s not all, a total of $10K in cash prize money will be distributed among three winning teams and four runner-ups (provided by the Office of the National Coordinator). The first place team will get free passes to Spring Fling: Matchpoint Boston, the industry’s preeminent deal-making and partnership forum, and sessions on growth and commercialization strategies for today’s dynamic healthcare market. First place winners will also receive an all-expense paid trip to athenahealth’s More Disruption Please conference—a conference for entrepreneurs, innovators, and investors to come together to share innovative and disruptive ideas in the HC/HIT space in Maine this September.

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CajunCodeFest Highlights the Silicon Bayou

When you hear of ‘health tech’ or ‘health innovation,’ the first places that come to mind are usually Silicon Valley, Boston or New York City. Yet, this past weekend’s event shook that notion for everyone that attended. It is not just big cities like SF, Boston or NYC that are experiencing a surge of innovation and entrepreneurship. In fact, even the smallest towns across the nation are taking technology and the power of internet to confront our nation’s growing health problems. CajunCodeFest, in Lafayette, Louisiana, is no exception.

An incredible crew of nearly 300 entrepreneurs, health experts, students, coders, and professionals gathered in Lafayette this weekend, representing 3 countries, 15 states, and 40 cities. With Louisiana having the second highest obesity rates (after Mississippi), the code-a-thon marked an important stepping stone for the state in its battle against obesity. As obesity rates continue to rise, the epidemic is now considered one of the nation’s biggest public health problems. The Louisiana Secretary of Health and Hospitals, Bruce Greenstein, put it loud and clear during his opening remarks, stating how “we have failed to take personal responsibility” for our obesity problems and we continue to blame others for this growing issue. That’s why the CajunCodeFest taking place in Lafayette was more important than ever.

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101 Ways to Engage Patients to Easily Exceed Stage 2 Meaningful Use Requirements

I believe the Health 2.0 community can put to rest any concerns that patient engagement will be difficult by commenting below on how apps they’ve built or seen can help blow away the requirements proposed in Stage 2 Meaningful Use.

In an earlier piece, I asked the question “Will the ONC provide a huge stimulus to Health 2.0 startups?” I touched on how this could be the biggest boost the health 2.0 startup community has ever received. Elsewhere, there has been pushback such as an article in Healthcare Informatics that describes patient engagement as The Least Popular Thing About Stage 2 MU So Far. In particular, providers question the requirement that 10 percent of patients access their data.

I don’t doubt that the proposed requirements will be difficult for some but I hope we aren’t, once again, beset by the tyranny of low expectations. 10% is a strikingly low # when you consider that health items are the 3rd most searched items across the entire population (not just sick people who should be much more motivated on a relative basis). While we know that some people are difficult to engage, it’s a llllonggggg way from 90%.

It’s only difficult (today) because the incentive systems have created a dynamic where providers have become highly skilled at getting as big a bill out as fast as possible. Why wouldn’t they have developed that skill? That is exactly what the flawed “do more, bill more” model of reimbursement has rewarded. The byproduct is they haven’t honed their skills at engaging patients. Having worked with hundreds of providers and dozens of vendors, these are smart and motivated people. I have ZERO doubt that they will rise to the expectations if they are given the chance.

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