Interoperability, the cherished dream

Via Politico »

EXCHANGE OF VIEWS ON INTEROPERABILITY: CIOs who met at a Capitol Hill event Tuesday rejected comments by Allscripts CEO Paul Black suggesting that interoperability was just around the corner and that information blocking “has broadly been solved.” CHIME CEO Russ Branzell got the discussion going by asking panelists if they agreed.

“Not even close,” said Intermountain CIO Marc Probst, a former ONC adviser and never one to mince words. While some strides have been made by ONC and the private sector, “We have a long way to go to be truly, semantically interoperable, where data can be passed and not just PDF documents or automated faxes.”

Albert Oriol, CIO of Rady Children’s Hospital in San Diego, said his health system exchanged 500,000 records with others last quarter. Another 150,000 couldn’t be shared because they couldn’t correctly match records with the right patient, he said.

ONC head Vindell Washington also suggested that a culture of data sharing is a ways off. Providers and patients need to be able to expect information to be at their fingertips, he said — a far off goal. Health care providers need to incentivize information sharing, and standards need to be developed, he said.

Many of the doctors we’ve spoken to in recent weeks have given up on interoperability — at least in the lofty sense that HHS officials speak of it. They assume that the only way they can share data easily with another doctor is to belong to the same health care system — or at the very least share the same EHR. Some technologists agree, and think that EHRs are not the tools that will bring us free-flowing health information exchange.

Calling Apple….

Tweet of the Day: Brian Ahier @ahier Health insurers (finally) making use of #AppleWatch Looking forward to new #mHealth #apps for #wellness

Welcome to Wednesday eHealth, where we are too old to Twitch but still young enough to Zocdoc. Please send your reporting tips to, or tweet the most compelling and distracting rumors to @David_Pittman, @ arthurallen202, @DariusTahir @ POLITICOPro, @Morning_eHealth.

#AskVindell TWITTER CHAT: While Washington didn’t answer Branzell’s question about interoperability being “solved” during Tuesday’s event, he did say during a Twitter chat that “Information still does not flow as seamlessly as it needs to. That’s why we all need to work together to combat #datablocking.” Read a roundup of some of the key tweets in this post.

DIGITAL INSURANCE MOVEMENTS: Two pieces of business news point in a promising direction for health IT. First, HealthTap, which provides text, voice and video connections to doctors, announced Tuesday that health insurers are now covering its virtual consults. According to a news release, carriers such as United Healthcare, Cigna, Aetna and Humana will no longer require phoned permission to cover the visits; HealthTap will check patient eligibility in real-time, and the company also will submit electronic insurance claims on behalf of doctors to payors.

…. Aetna, meanwhile, announced that it will make Apple Watch available to some of its large employers and individual customers during open enrollment this fall, and will subsidize much of the cost, while allowing monthly payroll deductions to cover the rest. Aetna will provide Apple Watch for free to nearly 50,000 of its own employees as part of the company’s wellness program. Aetna is hoping that apps will help its customers improve their health and save it money. Apple Watch can help patients with medication adherence, wellness orientation, and decision support, according to a news release.

PDMP EXPANSION IN CALIFORNIA: Gov. Jerry Brown on Thursday signed into law a bill that requires all prescribers to check the state’s PDMP before prescribing opioids or other controlled substances. About 20 other states have laws requiring some degree of PDMP monitoring for physicians. Shatterproof CEO Gary Mendell, who lost his son Brian to addiction in 2011, led the fight for the bill in Sacramento.

PULL UP TO THE BUMPER, BABY: Ride-sharing provider Uber will start to work with hospitals in Massachusetts, Pennsylvania and Delaware to provide rides to medical appointments. Uber announced Tuesday it would partner with Circulation for the non-emergency medical transports. Because hospitals and health plans demand certain credentialing to get paid for lifts to doctors’ offices and hospitals, Uber needs a way to meet those higher standards, and Circulation provides it. Medicaid agencies spend $3 billion on non-emergency medical transportation, Uber says — and a third of the payments are inappropriate.

EVIDENCE TELEMEDICINE SAVES MONEY: Partners Healthcare has been using telemedicine to treat heart failure patients for some time and has data to show it has saved the sprawling Boston health system money — including for Medicare patients. At the CHIME event we mentioned above, CIO Cara Babachicos cited company data showing that remote monitoring of recently discharged heart patients has cut what Partners spends on Medicare patients by nearly 2 percent. It also reduced 30-day readmissions by 75 percent and 120-day readmissions in half. Congress has been working for years to boost Medicare reimbursement for telemedicine, but the Congressional Budget Office has said more remote doctoring will only increase federal spending on health.

EVERYBODY’S SHOOTING FOR THE MOON: The Patent and Trademark Office, which on Thursday announced the winners of its Cancer Moonshot Challenge, aims to leverage intellectual property data to illuminate new directions in research on cancer. First place was won by Dolcera, which makes rather “engaging visualizations” that offer insights on cancer research priorities. Second place went to Booz Allen Hamilton and Omnity, which built visual networks based on linguistic similarity among cancer patents and NIH-funded research. These findings, per the USPTO, will empower research funders of all stripes to point their money in the most promising directions. Get your details here.

KIBBLES ‘N BITS: The National Quality Forum’s Measure Applications Partnership brought on Chip Kahn, CEO of the Federation of American Hospitals, and Columbia psychiatrist Harold Pincus to co-chair a committee recommending the best measures to be used in federal programs that pay doctors. … Congress still hasn’t ponied up money to fight Zika, but University of Arizona researchers (who’ve been working with the CDC) launched a crowd-sourcing mobile app, called Kidenga, Tuesday to help detect outbreaks. … A VA inspector-general investigation showed that providers in the New Mexico VA Health Care System did not always respond to EHR alerts regarding irregular colonoscopies in a timely way — and as a result nine patients eventually diagnosed with colorectal cancer got their results late enough to potentially affect their clinical outcomes in 2013 and 2014.

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ONC offers help navigating complex EHR contracts, post-go-live usability

Via Healthcare IT News »

The Office of the National Coordinator for Health IT has put out new guidance for choosing EHRs and understanding the fine print of vendor contracts.

The EHR contract guide – subtitle: Selecting Wisely, Negotiating Terms, and Understanding the Fine Print – aims to help providers that are purchasing new systems better understand the intricacies of contract language and negotiate good terms with their vendors.

The guide points toward key rights and vendor obligations that providers can stipulate in their EHR contracts, and also advises about terms to avoid. It also covers patient safety and security risks, data integrity, downtime and other scenarios that can arise after go-live. It seeks to arm providers with the knowledge necessary to enable constructive relationships with vendors  handle disagreements with vendors.

“Purchasing processes and contracts have an important role in ensuring information can move freely and securely across all the devices and IT systems used in patient care,” said Ed Cantwell, executive director of the Center for Medical Interoperability. “This guide can help foster the dialogue between buyers and sellers to achieve that shared goal.”

ONC’s accompanying Health IT Playbook, meanwhile, is a web-based tool that offers clinicians guidance on specific usage topics as they put EHRs to work. It highlights best practices and success stories for system implementation; gives advice for workflow, usability and other optimization challenges, and offers guidance on HIPAA, data exchange, quality reporting and more.

“It is great to see ONC stepping up and creating the Health IT Playbook,” said Steven Waldren, MD, director of American Academy of Family Physicians’ Alliance for eHealth Innovation. “They have engaged family physicians to offer input during the development and we are excited to see it has launched.

“Physicians can find it difficult to keep up to date on the changing requirements for and breadth of information on health IT,” he added. “The simple structure and the interactive tools provided in the Playbook will be an asset to family physicians and their practices as they continue their journey of selecting, implementing, optimizing, and switching EHRs.”

Jonathan Perlin’s ‘Elevator Pitch to the President’ on Health IT

Via Healthcare Informatics »

Focus on learning health system, interoperability, cybersecurity, he says

What would you say if you had to make an “elevator pitch” in just three to five minutes to the President of the United States about what to focus on in terms of the nation’s healthcare system? That was the question put to panelists at a Sept. 26 meeting of the National Academy of Medicine (NAM). Jonathan Perlin, M.D., chief medical officer of Hospital Corporation of America (HCA), responded: “It’s all about the data.”

To inform debate and decision-making, NAM has launched a program called Vital Directions for Health and Health Care. It commissioned expert papers on 19 priority focus areas for U.S. health policy, including health IT. Together, these papers represent the guidance of more than 100 leading researchers, scientists, and policy makers from across the United States. Perlin co-authored a paper with  a cast of well-known health IT experts, including Dixie B. Baker, David J. Brailer, Douglas B. Fridsma, Mark E. Frisse, John D. Halamka, Jeffrey Levi, Kenneth D. Mandl, Janet M. Marchibroda, Richard Platt, and Paul C. Tang.

Representing these authors at the Sept. 26 meeting, Perlin said that knowing that data is central to every strategy for research and discovery and point-to-point healthcare, there is an opportunity that is ripe for the taking. “With meaningful use, the president, if you will, has bought the car and now it is time to drive it,” said Perlin, who before joining HCA in 2006 was CEO of the Veterans Health Administration. “The president’s opportunity is not to drive on a slow toll road but to realize the vision of a fast superhighway.”

In his elevator pitch, Perlin focused on three themes: development of a learning health system, end-to-end interoperability and cybersecurity initiatives.

Data strategy for learning health system. The notion of a learning health system is defined as a system that commits to the continuous use of data as a byproduct of care for continuous learning and a virtuous cycle.  Perlin pointed out that 98 percent of hospitals and 95 percent of physician practices are computerized. “We are clicking, but we’re not yet learning,” he said. “By virtue of all that clicking, a ‘data exhaust’ is created, and in the data are answers to numerous questions,” he said. That data exhaust in the form of structured data could be fed back into the system to spur discovery, knowledge and better population health management. As an example, Perlin noted that he grew up as a physician lumping diabetics into a few categories, when actually there are 14 or more forms of diabetes. “I need the decision support tools so I can best treat the patient in a personalized and precise way.”

He gave as an example of a learning health system project the recently completed landmark REDUCE MRSA study, which demonstrated a 44 percent improvement on known best practices for reducing bloodstream infections.

Interoperability. Perlin said end-to-end interoperability must extend from formal settings of care to medical devices and importantly enfranchise patients as consumers of healthcare and their health data, encompassing patient-reported outcomes as well as patient-generated data.

“We are not talking about a single structured monolithic system,” he said, “but rather a set of architectures that take advantage of technologies we use today in things like web services that would allow for the development of an ecosystem of utilities that can support plug-and-play and clinical decision support for formal caregivers but also the opportunity for the patient to reach in and access of information.”

Referring to FHIR (Fast Health Interoperabilty Resources), Perlin said there are new standards that have very much in common with the infrastructure we take for granted in applications we use on our smartphones or when we use web services on the Internet. “We can also get data that are extremely granular so they are available to research and discovery.  And the patient can be enfranchised as part of that data equation in that virtuous loop.”

In their recently published Vital Signs paper, Perlin and his co-authors note that  “a generation of legacy EHRs that lack the design and features needed for interoperation is widely in place, so it will be challenging and potentially expensive to reach this goal.

“Progress toward interoperability could be accelerated initially by focusing on high-value use cases, such as transitions of care, outcomes measurement, and public-health reporting. Achieving interoperability is like building the interstate highway system: we need to construct on ramps and off ramps one at a time, but we also need a master plan.

“In the absence of an authoritative private source, the federal government should be highly specific about standards for end-to-end interoperability. Interoperability needs to extend from medical devices to EHR systems. In the absence of interoperability, end-user costs are higher because users are compelled to cobble together inherently non-interoperable systems. In addition to all the risks posed by imperfect interoperation, there is a loss of the value that could be gained through research, care, and public health when these systems interoperate.”

Cybersecurity. Finally, Perlin said he would tell the president that we have an obligation as well as an opportunity to aggressively address cybersecurity vulnerabilities and create protections in that regard. “We are in an era where the penetration and threats are significant, not only in terms of frequency but in terms of sophistication, even with state actors.” He stressed the importance of sharing threat information and strategies to mitigate the threat. He said policies might need to protect those organizations that meet all of the requirements but still may be subject to the action of a state actor.

Will MACRA spark interoperability advancements?

The Center for Medical Interoperability introduced a new maturity model and HIMSS publicly commented that focusing on technical interoperability is not enough in the industry-wide move toward value-based care and alternative payment models.

MACRA interoperability advancements

Kerry McDermott, vice president of public policy and communication at the Center for Medical Interoperability said the organization’s recenlty released maturity model can be used to assess interoperability progress.

The rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be released early this fall. But even before it hits the street, the hefty law is having an impact.

MACRA, designed to overhaul how physicians are paid under Medicare and how they must use health IT to achieve value-based care, relies on a definition of interoperability written in 1990 by the Institute for Electrical and Electronics Engineering (IEEE), which calls for “the ability of two or more systems or components to exchange information and to use the information that has been exchanged.”

Under the Merit-Based Incentive Payment System (MIPS) portion of MACRA, an eligible clinician must allow a single unique patient to view, download or transmit their patient record, within a performance period, or allow them to use an application programming interface (API) to access their record–or a combination of both.

Indeed, value-based care cannot be achieved without the interoperable exchange of data and the analysis of the data, to improve care and lower costs.

Todd Cooper, principal of Breakthrough Solutions Foundry, a member of the IEEE Personal Devices Workgroup, said that when trying to implement HIT architectures and solutions, it helps to have a definition.

But he concedes that it would help to have one “with a bit more flesh on the bones to help direct roadmap and development planning” than the one ONC has been using. Whereas ONC has been using the IEEE definition, Cooper recommended a new one by The Center for Medical Interoperability.

The Center, which defines itself as “a united a group of industry leaders to change the status quo,” in fact, recently published an Interoperability Maturity Model.

The model includes five dimensions focusing on infrastructure, syntactic information exchange, terminology semantics, orchestration and the dynamic contextual ability of apps and devices to share patient data based on clinical workflow.

Kerry McDermott, vice president of public policy and communication at the Center said the model can currently be useful to assess progress toward interoperability.

Healthcare IT News parent Health Information Management and Systems Society (HIMSS), meanwhile, earlier this summer encouraged officials from the Office of the National Coordinator for Health Information Technology (ONC) to expand its view of interoperability.

“To simply focus on technical interoperability is not enough,” HIMSS said in its comments to ONC.

ONC should look at how much information is flowing and the extent to which clinicians make decisions by incorporating exchanged data, HIMSS said. That kind of analysis and guidance “could have a greater impact on care delivery than simply looking at the technical capabilities between interoperable systems.”

All of these dimensions, Breakthrough’s Cooper said, “should be addressed in parallel if you want the interoperability tide to raise all ships.”

Via Healthcare IT News »

Almost 70 Percent of Hospitals Provide Patients View, Download and Transmit Access to Health Information

While hospital adoption of key patient engagement functionalities is increasing, small and critical access hospitals are lagging behind

Seven out of 10 hospitals in the U.S. (69 percent) now provide their patients with the ability to view, download and transmit their health information electronically, an almost seven-fold increase since 2013, according to a data brief from the Office of the National Coordinator for Health IT (ONC).

The data brief takes a look at trends in hospitals’ adoption of key patient engagement functionalities between 2012 through 2015. The data, which is based on the 2015 American Hospital Association Health IT Supplement Survey, reflects trends among U.S. non-federal acute care hospitals. Vaishali Patel, Ph.D., senior advisor at ONC, also discussed the data findings during a joint meeting of the ONC Health IT Policy and Standards Committees on Tuesday.

According to ONC, the Shared Nationwide Interoperability Roadmap calls on health care providers to enable patients to electronically view, download, and transmit (VDT) their health information to a destination of the patient’s choice. The Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs required participating hospitals and health care professionals to enable patients with online access to view, download, and transmit their health information.

In 2013, only 10 percent of hospitals had adopted VDT capabilities. As of 2015, 95 percent of hospitals enable patients to view their health information electronically, up from 40 percent in 2013; 87 percent of hospitals enable patients to download their health information, up from 28 percent in 2013 and 71 percent of hospitals provide patients the capability to electronically transmit their health information, which is up from 12 percent in 2013.

“The tremendous growth in hospitals’ adoption of view, download, and transmit capabilities in a relatively short period of time points to the potential impact of the Medicare and Medicaid EHR Incentive Programs, and specifically to the measures related to view, download, and transmit that were required for Stage 2 of the program,” Patel wrote in the data brief.

The number and variety of patient engagement functionalities offered by hospitals continued to increase significantly in 2015, according to the data brief. Almost two-thirds of hospitals (63 percent) enable patients to send or receive secure messages and 37 percent provide the capability for patients to submit patient-generated data, an almost 3-fold increase since 2013.

In 2015, more than three quarters of hospitals (77 percent) enabled patients to request an amendment to their health data, and offered patients the ability to electronically pay their bills (74 percent).

It is interesting to note that fewer hospitals have, so far, adopted basic convenient electronic capabilities, such as enabling patients to request prescription refills online. Four out of 10 hospitals allowed patients to request prescription refills (42 percent) and schedule appointments online (44 percent).

Patel wrote in the data brief, “Certain ‘convenience’ functions that enable patients to schedule appointments or refill their medications electronically lagged behind in adoption compared to those that relate to the Medicare and Medicaid EHR Incentive Programs, Health Insurance Portability and Accountability Act (HIPAA) regulations, or billing.”

Nine in 10 hospitals possess four or more electronic patient engagement capabilities, while the percent of hospitals adopting seven to nine patient engagement functionalities increased from 38 percent in 2014 to 43 percent in 2015.

At the state level, the percent of hospitals with VDT capability has spread nationwide between 2013 and 2015, according to ONC. In 2013, no states had 40 percent or more of their hospitals with these three electronic capabilities; whereas by 2015, all states had 40 percent or more of their hospitals with these three capabilities.

However, ONC data also indicates that disparities exist in the adoption of view, download, and transmit functionalities between large hospitals and other types of hospitals, specifically medium, small and Critical Access Hospitals.

As an example, almost 8 in 10 large hospitals have all three VDT capabilities while only about 6 in 10 CAHs (61 percent) have all three capabilities. And, for further comparison, only 65 percent of small hospitals have all three capabilities and 71 percent of medium-sized hospitals have all three capabilities. There seems to be equity when it comes to providing the capability for patients to view their health information, as 93 percent of CAHs and small hospitals offer this capability and 97 percent of medium hospitals.

“Rural and smaller hospitals’ lower rates of VDT capabilities reflect lower rates of certified HER technology adoption, and will require continued monitoring,” Patel said when presenting the data at an ONC Health IT Policy and Standards Committee meeting on Tuesday.

Patel also noted that to increase usage of these capabilities, it will be important to make it easy for individuals to access, aggregate, and subsequently use their health information. And, she pointed out various ONC initiatives to foster patient engagement and access to health information, such as the patient engagement playbook, the consumer health data aggregator challenge and the Blue Button connector.

Moving forward, Patel said analysis of patient engagement should shift from gathering data on hospital adoption of patient engagement functionalities to now focus on usage of those functionalities and how it ultimately improves patients’ health.

Via Healthcare Informatics »