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Should the Government Provide Infrastructure For a Health Data Highway?

Susannah Fox, the CTO of HHS was talking at the AcademyHealth Concordium 2015 conference this week. Her energetic call for innovation got me thinking:

Should the government be in the business of funding infrastructure for healthcare communication?

Comparable infrastructures

The governments on local, state and federal level have deployed comparable infrastructures and licensing in the interest of public health and safety:

1. Licensing of car tags while providing infrastructure for roads

2. Licensing of planes and pilots while providing infrastructure for air traffic control

3. Licensing post office locations while providing infrastructure for moving mail

How about: Licensing providers (NPI) while providing infrastructure for health data exchange “highway”?

The communicating health professional

What if providers could communicate in a secure “healthcare highway” or cloud system?

Dr. Specialist: “Hey @npi.1234567890 attached a consult note.”

Dr. Primary: “Thanks @npi.0987654321, sending 3 more pts your way with similar symptoms. (attached)”

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Healthcare’s Perpetual War

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There are three visions of peace in the seemingly never ending, but really rather brief, Israeli-Palestinian perpetual crisis. One peace features two independent countries living in collaborative harmony on a piece of land approximately the size of New Jersey. Another peace yearns for a messianic Jewish state stretching from the blue Mediterranean shores to the Jordan River, and possibly beyond. The third and final peace is expected to materialize after the Zionist entity has been permanently erased from the face of this earth, or at least from the face of that New Jersey size holy piece of land.  Each definition is amenable to slight compromises in form, but not at all in substance.

There are three visions for the future of medicine in the seemingly insurmountable, but really rather minor, perpetual health care crisis in America. One future of medicine sees physicians unencumbered by useless administrative tasks, wielding sleek and useful technology tools, offering the best medical care to all patients who need and want attention. Another future is yearning for the revival of chickens and charity as bona fide methods of payment for whatever medical care the free market wishes to bestow on the less fortunate. The third and final future is one devoid of most middling and often faulty doctors, where the health of the nation is enforced by constant computerized surveillance with fully automated preemptive interventions.  Each definition is amenable to slight compromises in form, but not at all in substance.Continue reading…

Health 2.0: Exclusive Interview with Susannah Fox, CTO of HHS

Susannah Fox, CTO of HHS, shares how she is fostering patient empowerment and engagement through technology. Matthew Holt, Co-Chairman of Health 2.0, had the opportunity to personally chat with Susannah and learn more about the democratization of healthcare!

Don’t miss Susannah Fox at the 9th Annual Health 2.0 Fall Conference. Purchase your tickets here!

Matthew Holt: Matthew Holt here, delighted to be on with a really wonderful amazing person in healthcare who is not only my friend but also the CTO of HHS, Susannah Fox.  Susannah, thanks so much for joining us.

Susannah Fox: I am thrilled to be talking with you.

Matthew Holt: Well, so those of you who don’t know — Susannah originally was a journalist at U.S. News and World Report and spent many, many years at Pew Research, and is basically leading the survey research understanding the patient experience — probably in healthcare as a whole but studying the patient experience with the use of technology.  She happens to be the first proper keynote speaker we ever had at a Health 2.0 conference back in 2008, attended Health 2.0 in many different places with us, and has been a great friend and colleague.

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The HDE Project coming to Health 2.0’s annual Fall Conference!

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The Health Data Exploration project, sponsored by the Robert Wood Johnson Foundation, is building a network of academic, public sector, and corporate partners working together to catalyze the use of personal health data to conduct research that benefits the public good.

Individuals are tracking a variety of health-related data via a growing number of wearable devices and smartphone apps. More and more data relevant to health are also being captured passively as people communicate with one another on social networks, shop, work, or do any number of activities that leave “digital footprints.” Self-tracking data can provide better measures of everyday behavior and lifestyle and can fill in gaps in more traditional clinical or public health data collection, giving us a more complete picture of health.

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ICD-10 and the Apocalypse

Screen Shot 2015-09-28 at 9.42.44 AMOctober first is nearly upon us.  For many of us, this date has little significance beyond the promise of cooler weather, lovely autumn colors, and the invasion of neighborhoods with giant inflatable Halloween decorations.  While these decorations are fascinating to me, they do cause me to ponder the enormous gulf  between my taste and that of my neighbors.  I am not certain if this is meant to scare off potential alien invaders or simply to make them think we are not worth bothering with.

October 1, however, is a huge day to the medical community.  It is a day that will live in infamy.  It is the object of dread, of diaphoresis, of doom.  October 1 is ICD-10 day.  This view was further bolstered when I went to the CMS (Government Medicare) website, there was actually a doomsday countdown timer at the top of the page. Just looking at this makes me anxious.

For those still unaware, ICD-10 is the 10th iteration of the coding taxonomy used for diagnosis in our lovely health care system.  This system replaces ICD-9, which one would expect from a numerological standpoint (although the folks at Microsoft jumped from Windows 8 to Windows 10, so anything is possible).  This change should be cause for great celebration, as  ICD-9 was miserably inconsistent and idiosyncratic, having no codes describing weakness of the arms, while having several for being in a horse-drawn vehicle that was struck by a streetcar.  Really.

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Post-HITECH HIT: Still Waiting

flying cadeuciiWhen it comes to health information technology in the United States, are you an optimist or pessimist?

Do you think it’s likely people who want health information will soon have routine, seamless digital access to it?

Most physicians and hospitals have at least some sort of electronic health record, yet big adoption gaps remain among physicians as just over half now have electronic health records. We can declare success and move on, right?

Hardly.

Most of us still cannot get health information when we want or need it. Health professionals and care systems trying to implement value-based payment and delivery reforms struggle to get the information they need to do that transformation. Communities trying to improve the health of their citizens have trouble getting the data they need and turning it into useful information.Continue reading…

America’s Nursing Crisis

Many of the nation’s nurses understandably erupted in anger when the co-hosts of ABC’s The View mocked Miss America contestant Kelley Johnson for her pageant-night monologue about being a nurse — and for wearing scrubs and a “doctor’s stethoscope” (their words) in the talent competition. The co-hosts, Joy Behar and Michelle Collins, have since apologized, especially for implying that only doctors use stethoscopes. “I didn’t know what the hell I was talking about,” Behar later said.

It would be easy to attribute this episode solely to the ignorance of some TV personalities, but as most nurses know, the problem goes far deeper. The fact is that much of the nation doesn’t really understand nursing, either.

It’s true that the public rates nursing in Gallup surveys as the most honest and ethical profession. Yet it’s unlikely that most Americans understand the range of critically important roles that nurse’s play across the health care continuum, from health promotion, prevention, and research, to palliative and hospice care.

How many Americans know that patients who obtain organ transplants will have far more contact with – and obtain more hands-on care from – a transplant nurse than a surgeon? Or that two-thirds of all anesthetics given to US patients are delivered by certified registered nurse anesthetists, rather than anesthesiologists with medical degrees?

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Mercer’s Hard-to-Find “Winning Streak”

ROGER COLLIER“The winning streak continues as employers predict another year of low health benefit cost growth in 2016.” – That’s the headline to the announcement from international benefits consultants Mercer Inc. of the preliminary findings from their latest employer survey.

Sounds good, right? Finally, healthcare costs are under control.

Unfortunately, reading the survey results gives another, very different impression.

What the survey actually found was that employers predict that health benefit costs per employee will rise by 4.2 percent on average in 2016—after they make planned changes such as raising deductibles or switching carriers.

The survey announcement enthuses about what it calls the “slow-down in the underlying cost growth”(that is, the increase ifno changes were made to employer plans). Specifically, without plan changes employer costs would have increased by 6.4 percent for 2016, and 7.1 percent in 2015. Mercer notes that the 2016 projection is the lowest rate of underlying cost growth seen since 2005, and that 2016 will be the fifth year of benefit cost growth below 5 percent.

So, is this good news?

Well, no. For three reasons.Continue reading…

What ONC Got Wrong in their Guidance on Telehealth

Screen Shot 2015-09-24 at 1.38.45 PMTelehealth – which lets patients see a doctor immediately, anytime, anywhere – shows no signs of slowing.  We are seeing this cross-industry, as more health plans make telehealth a benefit to members, and hospitals fold these services into new or expanded offerings for patients.  Consumer-facing products are also on the rise.  Patients can download an app and in minutes, have a FaceTime-like visit with a doctor for faster, more convenient care.

It was great then to see this week that the Office of the National Coordinator for Health IT (ONC) is picking up telehealth as a new focus – by issuing guidance for consumer companies in the design and delivery of these technologies.  The problem is ONC issued guidance without learning first how telehealth is actually being used in the industry today, leading to some basic… let’s just call them “misunderstandings.”

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