The federal government is on the cusp of leveling the playing field for healthtech startups. Health 2.0 events have shown an unprecedented wave of innovative healthtech startups have developed over the last few years. You can also see them at demo day events that Blueprint Health, Healthbox, Rock Health and StartUp Health host. However, the health sector may be the single most challenging arena for startups.
I would argue nothing would result in population health improvement (while decreasing healthcare costs) more than having greater engagement by patients in the healthcare process. The Office of the National Coordinator (ONC) could catalyze an unprecedented wave of innovation with a stroke of a pen by strong inclusion of patient engagement requirements in the Meaningful Use requirements.
Having high expectations for Patient Engagement will cause healthcare providers to rise to the occasion to solve this critical issue. It’s well documented that three-quarters of healthcare spend is on chronic disease and decisions that drive outcomes are made by individuals (aka “patients”). It’s long been said the most important member of the care team is the patient. Now is the time to transform that from a catchphrase to reality. The ONC can do that.
The biggest potential stimulus ever for healthtech startups
We have seen how Stage 1 Meaningful Use requirements (PDF) have spurred providers into action. By and large, that has meant an infusion of customers to EHR vendors. Legacy healthIT has had very, very little focus on the patient because financial incentives motivated the development of systems designed to get as big a bill out as fast as possible — i.e., there has been no incentive to involve the patient.
Health 2.0 is thrilled to announce that we are launching two challenges as part of the official kick-off of the Investing in Innovation (i2) program. Over the next 2 years the ONC will be issuing nearly $2 million in prize money for numerous challenges all designed to inspire innovation in health information technology. Along with our colleagues at Capital Consulting Corporation, Health 2.0 is the contractor supporting this effort. We started with a joint NCI/ONC effort which is already underway, but now the first two challenges are live. And they are:
- Reporting Device Adverse Events Challenge ONC is asking multi-disciplinary teams to develop an application that facilitates the reporting of adverse events related to medical devices, whether implanted or used in the hospital, clinic, or home. This challenge has $40,000 in total prizes
- Ensuring Safe Transitions from Hospital to Home Challenge. ONC is challenging software developers to improve care transitions and build upon these tools by generating an intuitive and easy-to-use application to empower patients and caregivers that fits into existing ways that providers communicate. This challenge also has $40,000 in total prizes.
These are both critical parts of health care where new innovation can make a big difference–and developers can win a substantial prize to get them on their way.
This is a summary of the HIT Trends Report for March 2011. You can get the current issue or subscribe here.
Government drivers. Federal communications dominated this month’s news. ONC defended its core EHR strategy through a report published in Health Affairs analyzing the most recent studies to prove the benefits. It found that 92% of studies reported positive or mixed but predominately positive results. The study updates prior research by Chaudhry (2006) and Goldzweig (2009).
It also released its 5 year HIT strategy that is more of a comprehensive tactical plan of the work over the next years. The plan seems generally aligned with most industry expectations. (Adopt EMRs. Exchange patient info. Make it secure and private. Get patients empowered. Measure everything.) ONC is asking for public feedback. Early comments wish the plan contained more on fraud prevention and innovative solutions and architectures.
There’s also some pushback on its Stage Two and Three requirements. A CCHIT industry survey indicates some potential overreach in areas such as agency reporting, formulary checking, medication reconciliation, patient info access and other areas. Yet CMS put out its first rules on ACOs for comments, and the HIT requirements are ginormous. Writing in the NEJM, CMS head, Don Berwick says, “Information management — making sure patients and all health care providers have the right information at the point of care — will be a core competency of ACOs.”Continue reading…
Meaningful Use has hit a speed bump. It’s of the low, wide and gentle type, not the old raggedy, narrow and mean bump you find in older parking lots. Now that a tentative proposal for Meaningful Use Stage 2 has been published by ONC, and duly commented upon by the public, it just dawned on folks that there isn’t enough lead time between Stage 1 and Stage 2 to allow for an orderly transition, and here is the problem in a nutshell.
Meaningful Use is divided into three, increasingly more demanding, stages, starting in 2011 with Stage 1 and advancing every two years to a higher Stage. So 2013 marks the beginning of Stage2 and 2015 is the start of Stage 3. It seems that ONC and CMS need about a year and a half to define each Stage from start to finish, so if they start working on Stage 2 right after Stage 1 commences, there are only 6 months left for NIST to define certification criteria, EHR vendors to update their wares and certify them, and physician and hospitals to roll the new and improved products out. Oops……
The hand wringing in “industry experts’” circles began immediately after this realization, culminating with an Advisory Board publication advising hospitals in particular to not apply for Meaningful Use incentives in 2011, but instead wait for 2012, which they can do without penalty, and the same advice is applied to ambulatory practices owned by hospitals. They did not recommend anything for physicians in private practice. Continue reading…
By DAVID BLUMENTHAL, MD
We’ve known for years that health information technology can improve health care. But until recently, the implementation rate among providers has been low, except for a few early adopters.
In the last two years, however, there has been a significant upward inflection in the adoption rate. For primary care providers, adoption of a basic EHR increased by half from 19.8 percent in 2008 to 29.6 percent in 2010.
And with HITECH Act programs now in full swing, it looks clear that adoption and use of health information technology will go into high gear. Already, 81 percent of hospitals and 41 percent of office physicians are saying they intend to achieve meaningful use of EHRs and qualify for Medicare and Medicaid incentive payments.
A recent edition of the American Journal of Managed Care (AJMC) helps us understand why the accelerated move to EHRs is so important. This special issue devoted to health information technology presents perspectives on health IT from a wide range of stakeholders—providers, policymakers, and patients. Contributors include representatives of private companies and public agencies, managed care organizations and academic medical centers, medical educators and a medical student—confirmation that the potential of health IT is compelling for a broad spectrum of Americans.Continue reading…
As one of the pilot sites for CCHIT’s EHR Alternative Certification for Hospitals (EACH), I promised the industry an overview of my experience.
It’s going very well. Here’s what has happened thus far.
1. Recognizing that security and interoperability are some of the more challenging aspects of certification, we started with the CCHIT ONC-ATCB Certified Security Self Attestation Form to document all the details of the hashing and encryption we use to protect data in transit via the New England Healthcare Exchange Network.
Next, I had my staff prepare samples of all the interoperability messages we send to patients, providers, public health, and CMS. Specifically, we created
CCD v.2.5 used to fulfill the Discharge summary criterion
HL7 2.51 Reportable lab
HL7 2.51 Syndromic surveillance
HL7 2.51 Immunizations
PQRI XML 2009 for hospital quality measures
We validated them with the HL7 NIST test site
and the HITSP C32 version 2.5 NIST test site.
CCHIT validated the PQRI XML as conforming.Continue reading…
ONC awarded four Strategic Health IT Advanced Research Project (SHARP) grants earlier this year to
”…address well-documented problems that have impeded adoption of health IT and to accelerate progress towards achieving nationwide meaningful use of health IT in support of a high-performing, learning health care system.”
One of these grants was awarded to a Harvard group led by Drs. Ken Mandl and Isaac Kohane, based in Children’s Hospital Boston and Harvard Medical School. This research team is tackling the problems associated with developing an ecosystem of modular, plug-and-play medical applications, what we have referred to as Clinical Groupware. (Disclosure: DCK is on the Harvard SHARP grant’s advisory board.)
The research is aimed at creating a “medical apps store” based on the iPhone/iPad model of substitutable applications running on a device or platform. The name of the project, SMArt, stands for “Substitutable Medical Applications, re-useable technology.” The approach could impact both the EHR industry and the federal regulatory and standards process, possibly within a relatively short period, i.e., 1-3 years, so we think it merits your attention.
The Health Information Technology Extension Program, created and funded by ONC, has completed funding for all 62 Regional Extension Centers (REC), with a grand total of well over half a billion dollars and, predictably, criticism of the program was immediately forthcoming. The RECs are supposedly an impediment to free EHR markets and doomed to failure from the start, which may seem a bit contradictory if you think about it. Anyway, before making further statements and assertions regarding the “recklessness” of the RECs, or the impeding “train wreck” they represent, it may be beneficiary to take a closer look at the program.
The HIT Extension Program consists of 62 RECs, at least one for each State and territory, and one national Research Center (RC). The stated goal of the program is “to provide outreach and support services to at least 100,000 priority primary care providers within two years”. The individual RECs are supposed to conduct outreach and education campaigns in their respective States and inform physicians on the latest HIT developments and available programs and incentives. The RECs are also chartered to offer support and guidance to physicians selecting and implementing EHRs, particularly Primary Care docs in small practices and in underserved areas. These are the doctors that were left out by the regular market process because they were hard to reach, too expensive to implement and too poor to bother with. While the individual RECs are locally oriented, with feet on the ground in each State and each County, the RC is basically a National forum for RECs to share information and exchange lessons learned.
Other than a small amount of seed money, RECs are not handed out all those hundreds of millions of dollars of grant funds. RECs are paid for performance. For each physician they touch and manage to recruit, the RECs are paid about $1500. If and when the provider implements an EHR, the RECs receive another equal payment. The last third of the money is handed to the REC if, and only if, the provider achieves Meaningful Use. This arrangement is only in effect for two years. All those who believe that RECs are bound to fail should be reassured by the fact that in that dire case most of the allocated funds will remain with ONC. The RECs are expected to use the ONC seed money and find a way to become sustainable businesses after ONC ceases to support them financially.
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.
By VINCE KURAITIS JD, MBA and DAVID C. KIBBE MD, MBA
Pop quiz: Among early-stage companies that are successful, what percentage are successful with the initial business model with which they started (Plan A) vs. a secondary business model (Plan B)?
Harvard Business School Professor Clay Christensen studied this issue. He found that among successful companies, only 7% succeeded with their initial business model, while 93% evolved into a different business model.
So let’s take this finding and reexamine our human nature. In light of these statistics, what makes more sense:
- Defending Plan A to your dying breath?
- Assuming Plan A is probably flawed, and anticipating the need for Plan B without getting defensive?
We question many of the assumptions underlying HITECH Plan A. We also want to talk about the need and content for Plan B in a constructive way.
In this essay we’ll discuss:
1) The Need for HITECH Plan B
2) Questioning Assumptions — Issues to Reconsider in Plan B
a) Rewarding Incremental Progress
b) Addressing Root Causes for Non-adoption of EHR Technology
c) Questioning Health Information Exchanges (HIEs) as Building Blocks for the Nationwide Health Information Network (NHIN)
d) Catalyzing Movement Toward Modular EHR Technology
e) Focusing Incentives on High Leverage Physicians
f) Recalibrating Expectations for EHR Technology Adoption
g) Getting Bang-for-the-Buck in Achieving Meaningful Use Objectives
h) Comprehensively Revamping Privacy/Security Laws vs. Tweaking HIPAA
i) Maximizing Sync Between HITECH and PPACA
j) Leveraging Potential for Patient-Driven Disruptive Innovation
k) Promoting EHR Adoption Beyond Hospitals and Physicians, e.g., long-term care, home health, behavioral health, etc.
l) Dumping CertificationContinue reading…