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Above the Fold

2015 Forecast: A True Healthcare Market Takes Shape

Dec 9, 2014• 7

KELLY BARNES

2014 was the year of the Affordable Care Act. There were other profound and important developments in health, but for consumer interest, media attention, and impact on the health business, the ACA dominated the picture.

2015 is expected to be different. This increasingly wired, consumer-oriented, and innovative health industry is poised for profound transformation: 2015 will be the year that a true, industry-wide healthcare market begins to take shape. To help navigate this emerging market, we’ve identified ten Top health industry issues of 2015 driving transformation.

Three issues coalesce around consumer–centric digital health technology:

Do-it-yourself healthcare
U.S. physicians and consumers are ready to embrace a dramatic expansion of the high-tech, personal medical kit. Our Health Research Institute (HRI) surveys show that clinicians may be more open to using these tools than consumers. One-third of consumers said they would use a home urinalysis device. But more than half of physicians said they would use data from such a device to prescribe medication or decide whether a patient should be seen.

Making the leap from mobile app to medical device

The proliferation of approved and portable medical devices in patients’ homes, and on their phones, will make diagnosis and treatment more convenient, redoubling the need for strong information security systems. Regulatory approval may provide a competitive edge — 20 percent of consumers and 26 percent of clinicians said FDA approval was important when deciding to use apps.

The Federal Strategy For Collecting, Sharing and Using Electronic Health Information

Dec 9, 2014• 10

DeSALVO, PAZINKSKI, SWAIN and WYATT

Making our nation’s health and wellness infrastructure interoperable is a top priority for the Administration, and government plays a vital role in advancing this effort. Federal agencies are purchasers, regulators, and users of health information technology (health IT), as they set policy and insure, pay for care, or provide direct patient care for millions of Americans. They also contribute toward protecting and promoting community health, fund health and human services, invest in infrastructure, as well as develop and implement policies and regulations to advance science and support research.

The Office of the National Coordinator for Health IT (ONC) has a responsibility to coordinate across the federal partners to achieve a shared set of priorities and approach to health IT. To that end, today we released the draft Federal Health IT Strategic Plan 2015-2020, and we are seeking feedback on the federal health IT strategy. This Strategic Plan represents the collective priorities of federal agencies for modernizing our health ecosystem; however, we need your input. We will accept public comment through February 6, 2015. Please offer your insights on how we can improve our strategy and ensure that it reflects our nation’s most important needs.

A collection of 35-plus federal departments and agencies collaborated to develop the draft Federal Health IT Strategic Plan: 2015-2020, identifying key federal health IT priorities for the next six years (Exhibit 1). The landscape has dramatically changed since the last federal health IT strategy. When we released that Plan, the HITECH Act implementation was in its infancy. Since then, there has been remarkable growth in health IT adoption. Additionally, the Affordable Care Act implementation has begun to shift care delivery and reimbursement from fee-for-service to value-based care.Continue reading…

THCB Thanks Our Sponsors

Dec 8, 2014

THCBist

THCB thanks our corporate supporters.

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ONC Signals a Shift From Documents to Interfaces

Dec 7, 2014• 46

ADRIAN GROPPER, MD

All of you Meaningful Use and Health IT junkies should read Data for Individual Health Although long, it’s definitely worth a scan by everyone who cares about health tech. This is the third JASON-related report in a year out of ONC and it comes a month or so before the planned release of the first details of ONC’s announced 10yr plan. I think there’s a reason for that much of it introduced by ONC’s earlier post.

There are three key points I would highlight:

First, and most important, this report suggests that HIPAA Covered Entities (mostly hospitals, doctors and their EHRs) are no longer the center. The future, labeled as the Learning Health System, now makes mobile and patient-centered technology equally important as part of the architecture and talks about interoperability with them rather than “health information exchange” among HIPAA CE’s and their Meaningful Use mandates.

Second, this JASON report, unlike the previous two, does not talk about Meaningful Use any more. That money is spent. A lot of orgs are lobbying against any more MU mandates and, although I’m pretty sure there will be a Stage 3, it could be toothless or very much delayed.

Third, Direct, the original Blue Button, Blue Button Plus Push, and CCDA files are pretty much history. Although the JASONs don’t say it as plainly as I am, document-based interoperability has failed and we’re moving on to Application Programming Interfaces (APIs) that don’t use CCDA or any of the stuff mandated by MU 1 and 2. Blue Button Plus Pull and FHIR, both with a modern industry-standard OAuth security scheme, are the future for all sorts of good reasons which you need to read the JASON reports with some care to understand. It’s all there.

Germs. The Pseudoscience of Quality Improvement

Dec 7, 2014• 8

By Karen Sibert, MD

No one wants a hospital-acquired infection—a wound infection, a central line infection, or any other kind. But today, the level of concern in American hospitals about infection rates has reached a new peak—better termed paranoia than legitimate concern.

The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies. As far as I can tell, these new rules are made up by people who are under pressure to create the appearance that action is being taken.

Here’s an example. An edict just came down in one big-city hospital that all scrub tops must be tucked into scrub pants. The “Association of periOperative Registered Nurses” (AORN) apparently thinks that this is more hygienic because stray skin cells may be less likely to escape, though there is no data proving that surgical infection rates will decrease as a result. Surgeons, anesthesiologists, and OR nurses are confused, amused, and annoyed in varying degrees. Some are paying attention to the new rule, and many others are ignoring it. One OR supervisor stopped an experienced nurse and told to tuck in her scrub top while she was running to get supplies for an emergency aortic repair, raising (in my mind at least) a question of misplaced priorities.

HIT Newser: Health Data Outside the Doctor’s Office Part II

Dec 7, 2014

By MICHELLE RONAN NOTEBOOM

Health Data Outside the Doctor’s Office

A new JASON report offers recommendations for creating a health information system infrastructure that achieves interoperability between EHRs and integrates data from personal health devices, social media, demographics, and other sources. More details and a robust discussion from THCB readers found here.

It’s the Money, Stupid

The biggest factor influencing physicians to adopt EHRs since the passage of the HITECH act: incentive payments or financial penalties. An ONC data brief reveals that 62% of providers identify financial incentives as a major motivation for EHR adoption; board certification was the second most common influencer at 39%.

HIEs Facing Financial Struggles and Adoption Hurdles

Despite $600 million in federal funding, most HIEs are not financially viable, according to a RAND Corporation study. Only 25% of HIEs consider themselves financially sustainable and most are still struggling to find a value proposition. Physicians often resist HIE use because of interruptions in workflow, interface problems, and costs, while hospitals adoption lags due to a lack of a business case, insufficient standards, and legal/ethical issues.

Being Gawande

Dec 5, 2014• 11

ROBERT WACHTER, MD

“I learned about a lot of things in medical school, but mortality wasn’t one of them.” So begins Being Mortal, Atul Gawande’s fourth and most ambitious book.

All of Gawande’s prior books – Complications, Better, and The Checklist Manifesto – were beautifully crafted, lyrical, and fascinating, and all were bestsellers that helped cement his reputation as the preeminent physician-writer of our time. Each blended Gawande’s personal experience as a practicing surgeon with his prodigious skills as an author and journalist. They took readers behind the curtain of the hospital and the operating room, revealing much about some very important matters, like medical training, quality improvement, patient safety, and health policy.

But they were only partly revealing of Gawande himself. He told us what we needed to know about his thoughts and biases in order to make his points, but no more. Being Mortal is Gawande’s most personal book, and as such it reaches a level of poignancy that surpasses the others. Mind you, it’s not an easy read, it’s a bit dull in the early going before it hits its stride, and it has an attitude: Gawande’s indictment of modern medicine’s approach to aging and dying is pointed and withering. But, even more than his other books, this one matters deeply.

A Doctor is a Doctor is a Doctor, Right?

Dec 5, 2014• 5

HANS DUVEFELT, MD

I am a foreign born, foreign trained doctor, serving many patients from an ethnic minority, whose native language I never mastered.

So, perhaps I am in a position to reflect a little on the modern notion that healthcare is a standardized service, which can be equally well provided by anyone, from anywhere, with any kind of medical degree and postgraduate training.

1) Doctors are People

No matter what outsiders may want to think, medicine is a pretty personal business and the personalities of patients and doctors matter, possibly more in the long term relationships of Primary Care than in orthopedics or brain surgery. Before physicians came to be viewed as interchangeable provider-employees of large corporations, small groups of like-minded physicians used to form medical groups with shared values and treatment styles. The physicians personified the spirit of their voluntary associations. Some group practices I dealt with in those days were busy, informal and low-tech, while others exuded personal restraint, procedural precision and technical sophistication. Patients gravitated toward practices and doctors they resonated with.

PCORI Board to Consider Hepatitis C & PCORnet Funding at Dec. 8 Meeting

Dec 5, 2014

THCBist

The Board of Governors of the Patient-Centered Outcomes Research Institute (PCORI) will consider a plan for funding comparative clinical effectiveness research on hepatitis C virus infection at its day-long meeting on Monday, Dec. 8. In addition, the Board will vote on a plan to fund the second phase of development of PCORnet, PCORI’s initiative to improve the efficiency of health research by harnessing data from electronic health records (EHRs) and other resources.

The meeting will run from 10:15 a.m. to 5:45 p.m. EST Monday, Dec. 8, at the Renaissance Dupont Circle Hotel, 1143 New Hampshire Ave., NW, Washington, DC. The public may attend in person or via teleconference/webinar. Visit the meeting page on PCORI’s website to view the agenda and register to join the teleconference.

Paper EOBs? Please Make Them Stop!

Dec 5, 2014• 5

ACA Database

This one is important. Maggie writes in to ask:

When I had Premera Blue Cross (Washington state), I could opt-out of receiving paper EOBs. I received a email when an EOB was available and I viewed it online. Now I have MA BC/BS, and I do not have that option, and I can’t get anyone to tell me why? The EOB is available online. I dislike paper EOBs – lots of wasted space, and I have to put them thru the shredder before I can recycle them …