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 http://cnet.co/2d1Nyxb 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 aallen@politico.com, 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.

Read more: http://www.politico.com/tipsheets/morning-ehealth/2016/09/interoperability-the-cherished-dream-insurers-start-buying-health-it-services-california-pumps-up-its-pdmp-216559#ixzz4Lm8gEIF5
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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.

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 »

The health care sector is seen as both a blessing and a curse to cities. On one hand, the sector continues to be a solid and steady employment base for regions. On the other hand, many of these jobs aren’t high-paying. Nationally, steep health care costs have placed untenable financial burdens on both individuals and families.

Missing from this narrative, in any event, is another, newer storyline about how cities can use health care-related economic activity as a source of high-value innovation and entrepreneurship to create well-paying jobs and grow the economy. In a new publication, for example, my coauthors and I focus on metro Nashville as a case study, analyzing how cities can leverage information technology (IT) to build best-in-class regional health care industries. But unlike the preponderance of literature, our expertise is not on health outcomes, but on how cities can create competitive industries—industries based not on the legacy model of high-cost fee-for-service care, but on a new business model driven by technology and value to patients.

Massive changes are underway in the U.S. health care system, shifting the competitive landscape, opening up new opportunities for some regions, and undermining traditional strengths in others. Information technology is playing a revolutionary role in these trends.

First, the passage of the Patient Protection and Affordable Care Act in 2010 inaugurated an era of unprecedented expansion in access to both care and health insurance. It also signaled the government’s intent to drive health care toward a value-based system based on health outcomes, threatening the solvency of those care providers that refuse to adapt.

Second, as patients become fed up with high costs, new competitors are emerging—particularly in outpatient care. For example, CVS’s Minute Clinics have grown at an average rate of 18 percent annually during the last several years, and between 2007 and 2013, patients using retail clinics increased by 133 percent. As Brookings scholar Jonathan Rauch wrote, “Health care is beginning to taste the disruptive culture of Silicon Valley, retailing, and many other American sectors.”

To say IT has disrupted nearly every other sector of the economy is an understatement. Yet its most disruptive opportunities are yet to come in health care, a field that has lagged behind other segments of the economy in adopting IT and data-driven innovation. Providers, payers, and suppliers across the care continuum are ramping up investments in data, analytics, and IT and finding abundant opportunities to carve out value and increase quality and productivity throughout the system.

Given all these macro forces, why focus on Nashville? The opportunity for Nashville revolves around multiple areas of competitive advantage: large and stable health care companies; a young but growing software sector, and; a high concentration of health-related research at Vanderbilt University. All position the region to emerge as a center for inno­vation in health IT.

Like many American cities with longstanding strengths in clinical care, hospital management, and research, Nashville is facing new competition from tech insurgents in places like San Francisco, Austin, and Seattle that are literally decades ahead of most the country in terms of IT talent and companies.

Given legacy strengths, but a clear and present danger to its competitive position, what should a city like Nashville do? The region—including its public, private, higher education, and philanthropic leadership as well as state government—should focus on efforts to strength its capabilities and competences. To improve commercial innovation in health care, the city should work with Vanderbilt to simplify technology transfer from the university, which continues to be arduous. To enlarge the region’s software workforce, stronger connections need to be forged between the city’s large health care companies and Nashville’s many software entrepreneurs, enabling more creative actors to understand the complex world of care delivery and payment reimbursements. Finally, Nashville—like many cities not known for its software industry—needs to put itself on the map for health IT. The city and its private-sector partners should develop a comprehensive firm attraction and marketing strategy.

No one really knows what health care in America will look like in ten years. Many have only experienced a bloated, inefficient, costly, and unfair system. But policy and economic forces are putting that legacy system under extreme pressure. With any luck, a new system will emerge. The question now becomes: Which U.S. cities will seize the moment to gain economic advantage?

The Brookings Metropolitan Policy Program would like to thank UnitedHealth Group, HCA Healthcare, and other members of its Metropolitan Council for its support of the program. 

Via Brookings.edu » 

The Office of the National Coordinator for Health IT advisory group, IXTF, outlined suggestions spanning government policy, technology, and public-private collaborations to improve health data sharing.

The Interoperability Experience Task Force recommended four tactics for enhancing the practice of health information exchange to national coordinator Karen DeSalvo, MD.

Created to advise the Office of the National Coordinator for Health IT, the IXTF suggested actions span policy, technical, and public-private approaches to improve the interoperability experience for providers and patients.

Here are IXTF’s recommendations:

1. Enable providers to effectively use health data. IXTF recommended that ONC stand up two new joint task forces, one to concentrate on reconciling and reducing the burden of importing clinical data, and the other to address IT systems design, usability and testing. ONC should also sponsor develop challenges to fuel user-centered design elements and create a national repository to test data that developers and technology vendors can tap to evaluate user interfaces in a standardized way.

2. Make it cost-effective for providers to exchange health data. IXTF recommended that ONC study total cost of ownership for EHRs as well the cost of patient-mediated exchange, outline best practices for including patient-generated health data in clinical decision-making, and work with the Center for Medicare and Medicaid Innovation to test Open APIs to determine whether to incent their use and what role they plan in IT systems other than EHRs.

3. Advance semantic and syntactic interoperability. This begins with enabling hospital and tech vendors to encode data and, as such, a new task force should home in on making non-clinical and unstructured information more valuable; IXTF cited behavioral data and social determinants of health as prime examples.

4. Monitor existing public-private collaborations. IXTF recommended that ONC engage efforts of Health Level 7 to optimize the CCDA (Consolidated-Clinical Document Architecture) standard, renew work to improve other codesets and terminologies, such as LOINC, collaborate with federal partners such as the National Quality Forum and Veterans Affairs on usability standards and quality measures.

IXTF explained in its letter to DeSalvo that these recommendations come from its own research and testimony by experts and industry professionals during a hearing in May 2016.

Clarification: ONC originally posted the IXTF letter to DeSalvo on its website for a short time then removed it because the Task Force decided more work is needed to focus the recommendations. A spokesperson said the task force chairs delayed the recommendations and took the materials down. So the recommendations could change. We’ll report those as well if changes happen.

Via HealthcareITNews »

The use of electronic health records for clinical research offers great opportunities to facilitate medical research but there’s a long road ahead before digital records can reliably used for that purpose.

That’s the warning of the American Medical Informatics Association (AMIA), which yesterday filed comments responding to the Food and Drug Administration’s proposed guidance on using EHRs for research purposes.

Both hospitals and physicians are gathering large amounts of information through the electronic records systems they’ve installed in recent years, AMIA noted. But the professional association, which represents the nation’s leading biomedical and clinical informaticians, said it doubted whether those systems contain data of high enough quality that could support randomized controlled trials.

“With more than 96 percent of U.S. hospitals and 83 percent of U.S. office-based physicians using EHRs to deliver clinical care, we have an unprecedented opportunity to utilize digitized healthcare data for supplemental uses, such as clinical investigations,” AMIA said in comments. “However, we strongly caution the FDA from assuming EHRs are readily configurable for clinical investigations, even among more advanced institutions.”

In proposed guidance issued in May, the FDA covers using EHRs that interoperate with electronic systems supporting trials, and discusses ensuring the quality and integrity of data collected and used. The new draft does not include provisions under which the FDA would assess compliance of records systems.

What the FDA eventually decides in this area is important because facilitating the correlation between EHRs and clinical trials would provide significant benefits in speeding and cutting the costs of clinical trials, as well as streamlining the process of finding patients for research.

FDA previously issued guidance on electronic source data in clinical investigations, which acknowledged that data can come from various sources and be entered into the trial sponsor’s Case Report Form (CRF), which is a paper or electronic questionnaire. This could include data from EHRs—this latest proposed guidance focuses on such data.

Another best practice for using EHR data in clinical trials is ensuring the data is attributable, legible, contemporaneous, original and accurate. Further, FDA recommends use of ONC-certified EHRs and other health information technology because of clear differences in interoperability and keeping data confidential.

Non-certified EHRs may be used, but should be assessed to determine if adequate controls are in place to ensure data confidentiality, integrity and reliability. The assessment should include limited access to electronic systems; identification of authors of records; audit trails to track changes to data; and availability and retention of records needed for FDA inspection.

Citing a lack of technical standards and an overreliance on the assurances resulting from ONC’s Health IT Certification Program, AMIA said data generated through the routine course of clinical care would likely fall short of more rigid research standards for data quality and integrity. EHR data is meant to support the care of individual patients, rather than generate research quality data, the organization noted.

“Ensuring data integrity and tracking data provenance in clinical settings is incredibly complicated because multiple, authorized individuals contribute to the EHR and the specificity of audit logs varies widely,” the association said in comments. “If the FDA is interested in which data populated the electronic data capture (EDC) system or electronic case reporting form (eCRF) and where they originated along the continuum of care, the answer could prove extremely difficult and burdensome.”

AMIA recommended FDA update the guidance by pointing clinical investigation sponsors towards data warehouses that utilize a common data model. “These sources may have better semantic interoperability and data integrity compared to sources that remain in the EHR default data model,” the group said.

“If we want to reach the goal of a learning health system, connecting our care systems to our research systems is essential, but we must do it right,” said AMIA President and CEO Douglas B. Fridsma, MD, PhD, FACMI. “Ultimately, we want every patient encounter recorded in the EHR to add to our knowledge about how to do a better job with all patients.”

Health IT Now reacted to the FDA’s proposed guidance, saying more direction is needed for data standards, saying the lack of standards could jeopardize the quality of data used in clinical research.

HITN, a diverse coalition of healthcare providers, patient advocates, consumers, employers and payers who support the adoption and use of health IT to improve health outcomes and lower costs.

“Data collected electronically in the clinical setting or by patients themselves through wearable technology can be useful in clinical research, pre-regulatory approval, and post-approval observation,” HITN’s statement said. “However, one barrier that remains for product sponsors and investigators in leveraging these data is a lack of clarity, especially around acceptable data standards and formats, from the Food and Drug Administration (FDA) and other regulators. Valuable electronic data can be sourced from data registries, wearables, and other forms of health IT which this guidance does not include.”

Via Health Data Management »