In this presentation Farzad Mostashari focuses on the strategy, principles and future direction of the Office of the National Coordinator for Health Information Technology. He outlines the notable health IT trends over the best year and gives and overview of the current efforts of the Office of the National Coordinator for Health Information Technology (ONC). He then goes on to show a future for healthcare in this country that is technology enabled and patient centered. This is an outstanding talk that is well worth your time...
Farzad Mostashari, MD, ScM serves as National Coordinator for Health Information Technology within the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. Farzad joined ONC in July 2009.
Previously, he served at the New York City Department of Health and Mental Hygiene as Assistant Commissioner for the Primary Care Information Project, where he facilitated the adoption of prevention-oriented health information technology by over 1,500 providers in underserved communities. Dr. Mostashari also led the Centers for Disease Control and Prevention (CDC) funded NYC Center of Excellence in Public Health Informatics and an Agency for Healthcare Research and Quality funded project focused on quality measurement at the point of care. Prior to this he established the Bureau of Epidemiology Services at the NYC Department of Health, charged with providing epidemiologic and statistical expertise and data for decision making to the health department.
He did his graduate training at the Harvard School of Public Health and Yale Medical School, internal medicine residency at Massachusetts General Hospital, and completed the CDC’s Epidemic Intelligence Service. He was one of the lead investigators in the outbreaks of West Nile Virus and anthrax in New York City, and among the first developers of real-time electronic disease surveillance systems nationwide.
He gave an overview of this talk, Ignite style, at the first Health Foo in Cambridge, Massachusetts. This is a great synopsis and a brilliant Ignite talk...
The Internet is about to get a whole lot bigger...
The Internet Corporation for Assigned Names and Numbers (ICANN) after years of discussion has finally decided to allow new custom generic top-level domains. Applications for the first round will open on January 12, 2012 and will close on April 12, 2012. New gTLD’s should be operational by November 2013.
Top Level Domians (TLDs) with two letters (such as .de, .mx, and .jp) have been established for over 250 countries and external territories and are referred to as "country-code" TLDs or "ccTLDs". They are delegated to designated managers, who operate the ccTLDs according to local policies that are adapted to best meet the economic, cultural, linguistic, and legal circumstances of the country or territory involved. Most TLDs with three or more characters are referred to as "generic" TLDs, or "gTLDs". In the 1980s, seven gTLDs (.com, .edu, .gov, .int, .mil, .net, and .org) were created. Domain names may be registered in three of these (.com, .net, and .org) without restriction; the other four have limited purposes. Now there will be waves of new gTLDs available for almost every conceivable purpose.
This could open things up quite a bit as anyone will be able to register virtually any word or phrase in almost any language or script as a gTLD. This could also provide some additional level of security for some industries. As David Talbot said in the MIT Technology Review:
A specialized top-level domain such as .bank might be secured with domain name security called DNS-SEC which verifies that a domain name seen by a user corresponds to the numerical computer address assigned to a bank's servers. This would require an additional vetting process for any company that applied for a .bank domain name. But then users could feel particularly confident that the site they are viewing is legitimate.
While there are concerns that new Top Level Domains could introduce confusion and possible security risks, I still think that there are some potential benefits and the risks could be mitigated. For one thing the $185,000.00 non-refundable cost would be a barrier. I am also confident that ICANN will have strong policies in place and agree that they are making the right move. This will ultimately be a good thing for the Internet.
I and some others have proposed for some time that healthcare would benefit from a gTLD of it's own. At the time Wes Rishel made some good arguments against the idea on his blog, but I have still thought that the idea has merit. As John Halamka points out on his blog the HIT Standards Committee has reconsidered a Top Level Domain for healthcare but it was decided that this may be considered in the future, but there is no need to implement one now. I would say that if there are going to be plans to implement this in the future the time to begin planning is now.
The 2011 State Healthcare IT Connect Summit held June 21-23, 2011 examined the role of state health IT modernization and transformation at the intersection of HITECH and State Health Reform. At the summit, policymakers and leading HIT strategists provided critical insights into state health IT's function at the intersection of HITECH and health reform. Administrators of leading edge Accountable Care Organization pilots and the associated technology infrastructures presented their experiences, and health IT experts looked at the developing role of statewide health information exchange and Regional Extension Centers as the supporting infrastructure for quality improvements and reform.
The session below from June 23, 2011 was on operationalizing Statewide HIE and gives some excellent insights into strategies that states are using to enable robust health information exchange capabilities in their states. One of the presenters is Carol Robinson from Oregon. Carol is currently serving as the State Coordinator of Health Information Technology for Oregon and is also the Director of the Health Information Technology Oversight Council (HITOC). Prior to her current appointment, she served Governor Kulongoski as the Interim Executive Director of the Oregon Health Fund Board during the 2009 legislative session. In that position, she led the political effort that resulted in the passage of HB2009, Oregon’s renowned health reform bill. From 2006-2009, Robinson held the post of Executive Director of Oregon Health Forum, where she also served as publisher of Oregon Health News. Robinson’s background spans both business and grassroots activism. She worked from 2003-2006 as Director of Public Relations and Development for Oregon Business Association, assisting many of Oregon’s leading employers develop consensus policy positions on issues including health care, renewable energy, state finance and education. She was an active force in the 1999, 2001 and 2003 legislative sessions, working with public school advocates and education organizations and she currently serves on the Advisory Board for the Center for Women in Politics and Policy at Portland State University.
Statewide Health Information Exchange: Becoming Operational
The Metadata Power Team has developed exchange use cases that link meaningful use and the report from PCAST (President’s Council of Advisors on Science and Technology), where they intersect at the importance of engaging the patient. The PCAST report called for a universal exchange language, which is an extensible markup-like (XML) language, and other standards to enable healthcare providers to share health information more reliably and effectively in order to modernize and coordinate patient care. PCAST's report also proposed that health data be separated into the smallest individual pieces that make sense to exchange. These data elements would be accompanied by a mandatory metadata tag or minimal standards that describe the data and the patient’s preferences for the data’s uses and security and privacy protections. The Power Team was charged to identify metadata elements and standards for three areas: Patient Identity, Provenance, and Privacy.
Dr. John Halamka gave a great overview of the metadata discussion on his blog:
Stan Huff led the metadata discussion and reviewed the work that has been done to date on patient ID and provenance standards. For patient ID, we considered many options but selected a very simple XML construct based on a streamlined CDA R2 header. This XML has nothing healthcare specific such as OIDs in it. For provenance, we considered many options but selected a very simple XML construct based on a streamlined CDA R2 header and X.509 certificates for digital signature. The signature could be an institution, a department, or an individual, as needed by the use case. For Privacy we considered many options and recommended a CDA R2 Header with a simple vocabulary to indicate that sensitive data is present. The list of sensitive data types could include mental illness, substance abuse, sexually transmitted disease data, HIV data, domestic violence data etc. or it could be a simple indicator that sensitive data is present. Specifying such a vocabulary is future work.
A robust discussion followed about privacy flags. Here are important clarifications:
During transmission, the envelope of metadata plus the payload of content is fully encrypted and so the metadata is not readable until it arrives inside the organization or to the person authorized to read it.
Much of the time, no privacy flags are needed because the patient will be the source of the data and will elect what to disclose to whom. Privacy flags would likely be needed when data is assembled from multiple sources and is received by a provider who needs to obtain special consent before viewing it or apply special protections before storing it.
A privacy flag would enable data to be automatically routed to specially protected areas of the EHR.
The CDA R2 header standards are used millions of times per day throughout the world but this subset of them and constrained specifications of how/when they are used should be tested before regulations require them for specific transactions.
The recommendation to use CDA R2 headers for metadata is the beginning of a formal ONC process to seek comment, feedback and stakeholder engagement regarding their use.
Based on all these clarifications, the HIT Standards Committee approved the use CDA R2 header for metadata as a formal recommendation to ONC as it begins the NPRM process.
Below is the slide deck and audio from the Metadata Power Team presentation at the June 22, 2011 HIT Standards Committee meeting:
The National Prevention, Health Promotion, and Public Health Council recently announced the release of the National Prevention Strategy, a comprehensive plan that will help increase the number of Americans who are healthy at every stage of life. The National Prevention Strategy (pdf 1.8MB) recognizes that good health comes not just from receiving quality medical care, but also from clean air and water, safe outdoor spaces for physical activity, safe worksites, healthy foods, violence-free environments and healthy homes. Prevention should be woven into all aspects of our lives, including where and how we live, learn, work and play.
Finding strategies to help prevent cancer is a big part of improving the health and wellness of Americans. Cancer is a major public health problem in the United States and many other parts of the world. Currently, one in 4 deaths in the United States is due to cancer. Newly published statistics from the American Cancer Society show that cancer death rates in the U.S. continue to decrease, but that cancer death rates for the least educated segment of the population are 2 ½ times higher than for the most educated.
The annual report, "Cancer Statistics, 2011," published in the American Cancer Society’s journal, and its companion piece "Cancer Facts & Figures 2011," estimates the numbers of new cancer cases and deaths expected in the U.S. this year.
Dr. Otis W. Brawley, MD, chief medical officer of the American Cancer Society, talks about the significance of the new statistics.
As Dr. Leonard Lichtenfeld, Deputy Chief Medical Officer for the national office of the American Cancer Society, said on his blog:
"We have been hearing for the past several weeks about the things that could cause cancer. We have been inundated with media reports telling us what is bad for us and perhaps not so good for us. We have started a national conversation about cell phones, airport scanners and now Styrofoam and formaldehyde.
But sitting right in front of our noses is the fact that if we did what we already know, at least 37% of cancer deaths in people between the ages of 27 and 64 could be avoided right now."
He quotes Dr. Samuel Broder, former director of the National Cancer Institute -
POVERTY IS A CARCINOGEN
Some highlights of the report "Cancer Facts & Figures 2011":
Death rates among African Americans for all cancers combined have been decreasing since the early 1990s. The decline has been larger in men (2.5% per year since 1995) than in women (1.5% per year since 1999). A similar decline in death rates has been observed among whites since the early 1990s, with a greater reduction in the rate among men than women.
Despite these declines, the death rates for all cancers combined continues to be substantially higher among African Americans than whites, although the gap is much smaller among women.
The racial difference in overall cancer death rates is due largely to breast and colorectal cancers in women and prostate, lung, and colorectal cancers in men.
In recent years, death rates for lung and other smoking-related cancers and for prostate cancer have decreased faster in African American men than white men, contributing to the recent narrowing of the racial disparity in overall cancer death rates. Notably, lung cancer death rates for young African Americans and whites have converged in both men and women.
In contrast to the trends for prostate and smoking-related cancers, the racial disparity has widened for colorectal cancer in both men and women and for breast cancer in women.
The causes of these inequalities are complex and are thought to reflect social and economic disparities more than biologic differences associated with race. These include inequities in work, wealth, income, education, housing and overall standard of living, as well as barriers to high-quality cancer prevention, early detection, and treatment services.
A total of 1,596,670 new cancer cases and 571,950 deaths from cancer are projected to occur in the U.S. in 2011. Between 1990 and 2007, the most recent year for which data is available, overall death rates decreased by about 22% in men and 14% in women. This translates to about 898,000 deaths from cancer that were avoided. The American Cancer Society credits improvements in cancer prevention, early detection, and treatment.
"The nearly 900,000 cancer deaths avoided over a 17-year period stand in stark contrast to the repeated claim that cancer death rates have not budged," said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society. "Nonetheless, we refuse to be satisfied, and are committed to doing whatever it takes, not only to ensure cancer death rates continue to drop, but to accelerate the decline."
Highlights of the "Cancer Statistics, 2011" report include:
Among men, cancers of the prostate, lung and bronchus, and colorectum account for more than half (about 52%) of all newly diagnosed cancers. Prostate cancer alone accounts for 29% (240,890) of incident cases in
The three most commonly diagnosed types of cancer among women in 2011 are breast, lung and bronchus, and colorectum, accounting for about 53% of estimated cancer cases in women. Breast cancer alone is expected to account for 30% (230,480) of all new cancer cases among
The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than women (
It is estimated that about 571,950 Americans will die from cancer, corresponding to over 1,500 deaths per
Cancers of the lung and bronchus, prostate, and colorectum in men, and cancers of the lung and bronchus, breast, and colorectum in women continue to be the most common causes of cancer death. These four cancers account for almost half of the total cancer deaths among men and
Lung cancer is expected to account for 26% of all cancer deaths among women in
The lung cancer mortality rate in women has finally begun to decline, more than a decade later than the decline began in men. The lag in lung cancer trends in women compared with men reflects a later uptake of cigarette smoking in women, among whom smoking peaked about 20 years later than in
Recent rapid declines in colorectal cancer incidence rates largely reflect increases in screening that can detect and remove precancerous
The overall cancer death rate decreased by 1.9% per year from 2001-2007 in males and by 1.5% in females from 2002-2007, compared to smaller declines of 1.5% per year in males from 1993-2001 and 0.8% per year in females from 1994-
Between 1990/1991 and 2007, cancer death rates decreased by 22.2% in men and by 13.9% in
Mortality rates have continued to decrease for colorectum, female breast, and prostate
Among men, the reduction in death rates for lung, prostate, and colorectal cancers account for nearly 80% of the total decrease in the cancer death rate, while among women, a reduction in death rates for breast and colorectal cancers account for almost 60% of the decrease.
The reports feature a Special Section on the impact of eliminating disparities on cancer deaths. Level of education is often used as a marker of socioeconomic status. In 2007, cancer death rates in the least educated segment of the population were 2.6 times higher than those in the most educated. This disparity was largest for lung cancer, for which the death rate was five times higher in the least educated than for the most educated. Differences in lung cancer death rates reflect the striking gradient in smoking prevalence by level of education; 31% of men with 12 or fewer years of education are current smokers, compared to 12% of college graduates and 5% of men with graduate degrees.
The special section also estimated the numbers of potential premature cancer deaths that could be avoided in the absence of socioeconomic and/or racial disparities. If all adults ages 25 to 64 in the United States in 2007 had the cancer death rate of the most educated non-Hispanic whites, 37% --or 60,370 out of 164,190—premature cancer deaths could potentially have been avoided. For African Americans, closing the gap between death rates among the most and least educated could potentially avert twice as many premature cancer deaths as eliminating racial disparities between blacks and whites, underscoring the preponderance of poverty in cancer disparities across all segments of the population.
Reducing cancer disparities will require breaking down barriers to health promotion and wellness care. As these reports have shown, there are thousands of cancer deaths that could be avoided by eliminating economic and racial disparities. Socio-economic status is the primary driver to the high death rate among different races. Poverty and low levels of education are prime factors in higher death rates from cancer. This years reports reinforce the truth:
The 16th Annual International Meeting of the American Telemedicine Association (ATA) took place at the Tampa Convention Center, May 1-3, 2011. The ATA 2011 opening plenary featured Dr. Martin Cooper, inventor of the modern cellphone and mHealth advocate, as well as David Pogue, consumer technology correspondent for the New York Times.
A pioneer in the wireless communications industry, Martin Cooper conceived the first portable cellular phone in 1973 and led the 10-year process of bringing it to market.
During 29 years with Motorola, Martin built and managed both its paging and cellular businesses and served as Corporate Director of Research and Development. Products he introduced have had cumulative sales volume of more than $80 billion.
Upon leaving Motorola, Martin co-founded Cellular Business Systems, Inc. a leader in the the cellular billing industry. More recently, Martin co-founded GreatCall Wireless, maker of the Jitterbug phone and a wide variety of personalized, customizable applications--including mHealth services.
The video below begins at the 60 Minutes segment featuring Dr. Cooper and then goes into the plenary talk at ATA 2011. There is also a great interview from the conference by Brian Dolan over at MobiHealthNews.
The IOM and HHS hosted The Health Data Initiative Forum on Thursday, June 9, 2011 to accelerate momentum for the public use of data and innovation to improve health. The Forum built on the success of The Community Health Data Initiative Forum: Harnessing the Power of Information to Improve Health, held in June 2010, and included a number of fast-paced demonstrations that presented a range of tools and applications developed using health data, a series of discussion sessions, and a data and apps exposition where participants interacted with featured innovators, learn more about available data, and identify opportunities to expand upon current efforts. The sessions were also webcast at http://www.hhs.gov/live
Participating speakers included:
Aneesh Chopra, chief technology officer of the United States
Harvey Fineberg, president, Institute of Medicine
Lisa Jackson, administrator, U.S. Environmental Protection Agency
Timothy O’Reilly, chief executive officer, O’Reilly Media
Todd Park, chief technology officer, U.S. Department of Health and Human Services
Kathleen Sebelius, secretary, U.S. Department of Health and Human Services
Below are the slides (in Flash format) from the morning session of the Health Data Initiative Forum held on June 9, 2011.
The Office of the National Coorivinator for Health Information Technology (ONC) announceiv toiay the Investing in Innovations (i2) Initiative – a boli new program designed to spur innovations in health IT. The program centers on prizes and competitions to accelerate the development of solutions and communities around key challenges in health IT.
This landmark initiative is the first Administration-wide program using prizes and challenges to advance an agency's mission made possible by the America COMPETES Reauthorization Act of 2010, signed into law by President Obama on Jan. 4, 2011. The Act invests in innovation through research and development and seeks to improve the competitiveness of the United States.
As part of the initiative's rollout, ONC has awarded nearly $5 million to the Capital Consulting Corporation (CCC) and Health 2.0 LLC, to fund projects supporting innovations in research and encouraging health IT development through open-innovation mechanisms like prizes and challenges.
"The initiative demonstrates ONC's recognition of the importance of investing in innovations and provides a platform that will attract an expanded community of innovators to the full range of the agency's programs. It opens the door to new opportunities for open collaboration from a wide range of diverse individuals and organizations that will increase the national rate of innovation and adoption of health IT as we improve health care of all Americans," said Farzad Mostashari, M.D., Sc.M., national coordinator for health information technology.
The i2 Initiative will consult stakeholders across the health care sector including hospitals, doctors, consumers, payers, states, employers, advocates, and relevant federal agencies to obtain direct input on execution and to build partnerships.
The core of the i2 Initiative is an effort to use prizes and challenges to facilitate innovation and obtain solutions to identified health IT challenges. Recognizing the promise of prizes and challenges, the President has called on agencies to promote innovation by using such innovation tools to address intractable problems. The use of prizes and competitions is widely regarded as a powerful tool to attract innovators from all walks of life to address hard problems with the added benefit of only rewarding best-in-class work. The approach makes possible rapid response to emerging issues that are difficult to address with more traditional funding approaches.
Examples of health IT competition topics developed in consultation with CCC and Health 2.0 LLC, include the following:
Applications that allow an individual to securely and effectively share health information with members of his or her social network;
Applications that generate results for patients, caregivers, and/or clinicians by providing them with access to rigorous and relevant information that can support real needs and immediate decisions;
Applications that allow individuals to connect during natural disasters and other periods of emergency; and
Tools that facilitate exchange of health information while allowing individuals to customize the privacy allowances for their personal health records.
Another component of the i2 Initiative will support analysis of the current health IT environment in an effort to track and model clusters of innovation, while simultaneously identifying connections between disparate innovator communities. The effort will identify technology development trends in a fast-moving sector to inform future advisory and policy-making activities.
Capital Consulting Corporation, Health 2.0 LLC, along with other contributors will help provide detailed and up-to-date analysis of relevant, emerging innovations and associated trends that will help ONC and other HHS agencies better understand these developments, as well as the issues that surround them.
ONC recognizes that policies that do not appropriately anticipate technological change can jeopardize success by potentially limiting competition and setting in stone inferior technologies. Accurate and timely information from this phase of the initiative will enable the Federal government to engage in methodical and strategic health IT policies.
"Through the i2 Initiative, ONC is directly supporting innovation in health IT to accelerate the nation's progress toward a high-performing, adaptive health care system," said Wil Yu, the special assistant for innovations within ONC.
On Thursday, June 2, 2011 at 10:00 am, the House Small Business Committee Subcommittee on Healthcare and Technology held a hearing entitled "Not What the Doctor Ordered: Health IT Barriers for Small Medical Practices."
The hearing examined the adoption of health information technology by small medical practices. The Subcommittee considered witness testimony regarding the barriers that small providers have encountered and possible solutions for addressing those barriers.
Farzad Mostashari, M.D., Sc.M., National Coordinator for Health Information Technology, testified at the hearing. Here is a clip from his testimony:
The full written testimony submitted by Dr. Mostashari for the hearing is below:
Much of the testimony was very supportive of the efforts on adoption of health IT. After this post was published Dr. Mostashari tweeted on the bipartisan nature of the hearing:
The Meaningful Use Workgroup of the HIT Policy Committee recommended at the June 8, 2011 meeting to delay the transition from stage 1 to stage 2 meaningful use requirements by one year, only for providers who qualify for meaningful use in 2011.
