RESTful Health Exchange

I have been involved in a new S&I-affiliated initiative called  RESTful Health Exchange (RHEx), which will test application of the REST-style (Representational State Transfer) architecture to health information exchange. REST is a popular approach of accessing and managing remote resources on the Internet that relies on a stateless, client-server, cacheable communications protocol. RHEx is attempting to develop specifications for secure RESTful transport for healthcare exchange to be used in conjunction with SOAP and SMTP currently being used in Exchange and Direct.

RHEx is billed as a open-source, exploratory project to pilot proven web technologies that support simple, secure, standards-based health information exchange. RHEx continues the government 2.0 tradition of federal partner investment to find innovative solutions to their health IT needs and share the results of their investment with the entire health IT community.

The RHEx project is funded by the Federal Health Architecture (FHA) program to help address the September 2011 NwHIN Power Team draft recommendations to the HIT Standards Committee to consider REST as a complementary technology to health information exchange. The FHA is an initiative led by the ONC to coordinate the health information technology efforts of the nearly two dozen federal agencies that provide health care services. The FHA is led by the departments of Defense, Veterans Affairs and Health & Human Services (HHS) with more than 30 additional participating agencies. Having this project run by the FHA as an S&I Affiliate provides clear benefits and savings across agencies. As Vish Sankaran, former program director has said, "You build the software once under the FHA and agencies can use it multiple times."

As an S&I Affiliated Project, RHEx is intended to inform a path forward for REST and explore an approach that facilitates:

• Patients’ ability to securely access and manage their health information over the World Wide Web (WWW) while preserving their privacy;
• Providers’ ability to obtain and exchange health information with each other to support patient care; and
• Organizations’ability to leverage technologies widely used on the web to foster health IT solutions that are relatively easy to implement and maintain.

The RHEx team made a presentation to the NwHIN Power Team of the HIT Standards Committee on Thursday, July 26, 2012. The slides below are synced to the audio from this presentation:

RHEx NwHIN Power Team 2012-07-26 

Progress Report on e-Prescribing - Surescripts SafeRx Awards

Surescripts has unveiled the top 10 e-prescribing states

Surescripts announced on July 31, 2012 that Minnesota achieved the highest rate of e-prescribing use in the nation during 2011 to capture the number 1 ranking in its 7th annual Safe-Rx Awards. One thing that likely helped is former Republican Minnesota Governor Tim Pawlenty signed into law in 2008 legislation that required electronic prescriptions and created quality reporting rules for physicians. Pharmacists, physicians and others who prescribe or dispense medication in the state were required to use electronic systems by 2011.

The rankings are determined by an analysis of data, which did not include any  protected health information (PHI), that measures electronic prescribing use by physicians, pharmacies and payers in each state. Behind Minnesota, nine states have more than 70 percent of physicians e-prescribing, with Massachusetts and New Hampshire leading with an 86 percent physician adoption rate. Ninety-one percent of retail pharmacies now support e-prescribing, according to Surescripts. “Ranking aside, e-prescribing use grew substantially across all states in the U.S. in 2011,” according to the report. Adoption and use statistics for all states and an online discussion of the Safe-Rx rankings are available at www.surescripts.com/saferx.

Growth in the adoption and use of e-prescribing – which includes prescription routing, utilization of benefit information and utilization of medication history – created the most changes in the rankings over its seven year history. This e-prescribing growth correlates with trends first identified in Surescripts 2011 National Progress Report released May 17, 2012. The data indicates that state and federal initiatives to increase the adoption and use of e-prescribing by healthcare providers as a means to improve quality, efficiency and help lower costs are significant drivers in e-prescribing’s growth.

Highlights from the 7th Annual Safe-Rx Awards and state progress reports:

• Prescribers in Minnesota routed 61 percent of prescriptions electronically.
• Massachusetts and New Hampshire have the highest rate of physician adoption at 86 percent.
• Nine states have over 70 percent of physicians electronically routing prescriptions.
• North Dakota made the largest gains year over year, boosting its ranking from #47 to #18.
• New Hampshire, Nebraska and Minnesota all made double digit gains in the ranking based on increased use of e-prescribing which includes: routing, medication history and benefit information.
• Nationally, 91 percent of retail pharmacies are able to receive e-prescriptions.

Top 10 States with Highest Rates of E-Prescribing

1. Minnesota*
2. Massachusetts
3. South Dakota
4. Delaware
5. New Hampshire*
6. Iowa
7. North Carolina
8. Maine
9. Vermont*
10. Michigan

*New to the top 10

Accepting the Safe-Rx Award for MN as the top e-prescribing state in the nation in 2011 is Dr. Marty LaVenture, Director of Health Informatics at the Minnesota Department of Health and director of the statewide Minnesota e-Health Initiative. Dr. LaVenture is this year’s recipient of the prestigious Safe-Rx Evangelist Award, which is given annually to the person or organization whose work has made an extraordinary impact on the awareness and use of e-prescribing as a critical means of reducing medication errors.



Prescribers in Minnesota routed 61 percent of prescriptions electronically last year. The state jumped from 11th place to the lead spot between 2010 and 2011, overtaking Massachusetts, which had held the top ranking for five years. "In Minnesota, there has been a strong commitment to a common e-prescribing objective by providers, pharmacies and payers statewide who worked collaboratively with the e-Health Initiative,” said Dr. Marty LaVenture, director of office of health information technology and e-health at the Minnesota Department of Health. “We have benefited from the strategic use of assessment data that helped us identify and respond to the gaps and needs associated with e-prescribing. Policy initiatives and grant and loan programs also helped to increase adoption and use for providers and pharmacies in underserved areas of the state."

The Safe-Rx Awards celebrate leadership and exceptional commitment to advancing health care safety, efficiency and quality through the use of e-prescribing. They reflect Surescripts' long-standing collaboration with the nation's pharmacies, payers, physicians and technology vendors to support the exchange of health information over a network that is non commercial, neutral, transparent and standards-based. The Awards are based on a ranking that measures states' actual use of e-prescribing.

What About My State?
Ranking aside, e-prescribing use grew substantially across all states in the U.S. in 2011. To view reports detailing the growth of e-prescribing adoption and use in all 50 states plus Washington, D.C., go to www.surescripts.com/saferx.

Effort advances to build national electronic health information infrastructure

NIH director Francis Collins talks at a workshop on electronic health data at Stanford, sponsored by a new nonprofit research organization that seeks to build a stronger health information network.

A worthy goal for the nation's still-nascent electronic health-information revolution would be the active involvement of as much 10 percent of the U.S. population as clinical research participants through digital data networks, National Institutes of Health director Francis Collins, MD, PhD, said at a July 2 workshop on the Stanford campus.

"We need to partner with the American public and to engage a large proportion of our population in medical research," Collins told participants.

The workshop, held July 2-3 in Arrillaga Alumni Center, was sponsored by the Patient-Centered Outcomes Research Institute, a nonprofit research organization, and attended by about 100 invited participants from across the country, representing almost every domain involved in health research: clinicians, researchers, bioinformatics experts, social-media mavens, patients, patient advocates, pharmaceutical-industry representatives, software developers, ethicists, government regulators, insurance payers and legal scholars. PCORI, with an annual budget of about $500 million, was created by Congress in 2010 under the Patient Protection and Affordable Care Act to both conduct and disseminate medical research that directly informs patients' and providers' health-care decisions.

Courtesy of the Patient Centered Outcomes Research Institute/Photo by Norbert von der Groeben

The event was designed to provide guidance to PCORI on how to efficiently target its research investments and form partnerships to make the best use of the many burgeoning islands of electronic health data —in the form of a diverse multitude of research networks and thousands of providers using electronic medical records — to produce a coherent system that could generate valid information critical for health-care decisions, said the workshop's organizer, Steven Goodman, MD, PhD, a Stanford professor of medicine and of health research and policy and a member of PCORI's methodology committee.

Creating the underlying electronic infrastructure to achieve this is an enormous challenge, Goodman said. "We have no good way to capture health outcomes on patients over time, and different medical record systems code diseases, treatments, outcomes and patient characteristics differently."

"The successful establishment of such a network could be PCORI's most significant contribution and enduring legacy," said Collins, who sits on PCORI's board of governors.

PCORI executive director Joe Selby, MD, PhD, noted that a well-designed information system will be competent not only to learn what works best, but also to feed back to the health system, rapidly disseminating these findings in as targeted a fashion as possible to patients and providers. "It's got to be a two-way street," Selby said.

During the course of the two-day session, the discussion moved from aggregating electronic health-record data for research to how to harness the power of activated patient networks through social media, and how to use smart phones both to record patient experience in real time and as activity sensors. Aggregating large numbers of patients in these networks holds immense potential for analyzing rare diseases, gauging therapies' effectiveness in different patient subgroups and tracking the progress of patients under different treatment regimes. But of equal importance, participants said, is putting patients at the center by facilitating affordable, efficient care; quickly pushing health information to those who need it; and obtaining patients' informed consent to use their health information for studies that haven't even been conceived of yet. Earning patients' trust is essential and will require their involvement in the leadership of these initiatives and the formulation of research questions, workshop participants said.

This research need not be limited to the effects of drugs and devices. "How health-care delivery is organized may determine its success more than what drug you get," said Goodman. "Is an appointment reminder system in place? Are there nurse-practitioners available for advice whenever it's needed?"
Another challenge participants addressed was the reigning publish-or-perish paradigm that discourages researchers from parting with their data, at least until the findings are published in a peer-reviewed journal. That slows down the timely dissemination of up-to-date health information.



The man who oversees the world's largest health-research budget had a suggestion. "One way you change the culture is to change funding incentives," Collins said. "You can't herd cats, but you can move their food."

via stanford.edu

Meaningful Use of Meaningful Use Measures

At the Health Forum and American Hospital Association 2012 Leadership Summit Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology, held a Town Hall style meeting to discuss the federal government's role in leveraging clinical information systems for improved performance. Final rules governing Stage 2 of meaningful use are on track to be released later this summer. In the interview below, Mostashari says the regulations will push on standards-based exchange and patient engagement. Also, he says IT must be an integral part of getting to the proverbial second curve.

The Future of Technology

In God We Trust: All Others Have to Bring Data

Eric Schmidt, chairman of Google, and Peter Thiel, technology investor, PayPal co-founder, and entrepreneur, participated in a lively debate at Fortune Brainstorm Tech in Aspen, CO, about the future of technology. Fortune's Adam Lashinsky moderated this sometimes heated discussion, where there was rarely any agreement, but an incredibly fascinating conversation.

Schmidt said technology and access to information has increased productivity and quality of life worldwide. Thiel thanked Schmidt for "doing a fantastic job" as "minister of propaganda" for Google. The tech sector has made remarkable strides in the areas of computers and software, he said, but has seen a "catastrophic” failure in other areas, such as energy innovation; ”Google is out of ideas." Schmidt called for more and better education, while Thiel proclaimed the inflation of an "education bubble."

Surveillance in America: In search of stricter standards

Economist correspondents discuss the worrying ease with which federal and state authorities can track the communications of American citizens.


via economist.com

NCVHS - Privacy and Security Update

Listen to Joy Pritts, chief privacy officer for the Office of the National Coordinator for Health IT (ONC), as she updates the National Committee on Vital and Health Statistics (NCVHS) on the privacy and security work of her office within the ONC.

NCVHS Privacy and Security Update

Dr. Oz in Portland, Oregon

Dr. Oz and a team of healthcare providers were at OHSU's Center for Health and Healing on July 16, 2012. More than 600 people who registered for the event got the chance to learn about common ailments that could be making them sick. Each received a free, 15-minute physical and walk away with a better knowledge of how they can improve their health. Using tabletop blood test devices and Practice Fusion's EHR, data from the screenings will be analyzed on site and presented as a report card to the city of Portland. I had the opportunity to interview Dr. Oz and discuss health IT and the benefits that technology brings to medicine, and will be writing a post including that video (courtesy of Open Affairs TV) later this week. I was very impressed with his understanding of EHRs, but in particular his work at NewYork-Presbyterian Hospital in 2009 developing personal health record uses Microsoft's HealthVault and Amalga technologies called myNYP.org. Dr. Oz made some bold statements about a patient's right to their data and the critical importance of patient engagement.

Watch for a more detailed report later, but for now see the video below from KATU News reporting on the event.

Responses to the NwHIN Governance RFI

The proposed framework for governance and operations of the Nationwide Health Information Network (NwHIN) that the Office of the National Coordinator of Health IT (ONC) has described in the recent request for information (RFI) elicited a great deal of stakeholder input. (You can read the through all of the responses at regulations.gov HERE). Many industry stakeholders were concerned that the process was moving too quickly and a lighter approach should be considered.

A sampling of the thrust of some of the comments are;

AAFP We need strong integration of the Direct Project standards with certified electronic health record systems and a well developed trust framework.

AHA ONC should focus on establishing a governance framework, but should not formulate regulations on "conditions of trusted exchange" (CTEs)

CCHIT NwHIN governance by a public-private entity would be a more effective approach in establishing trust, gaining wide adoption, and allowing for multi-stakeholder representation.

eHealth Initiative Heavy regulation under a national governance structure should be avoided.

HIMSS EHRA Initial focus should be on developing a governance mechanism, rather than specifying CTEs, which should be created by a public-private governing body.

If you saw Dixie Baker's excellent presentation to the HIT Standards Committee you will see that the NwHIN Power Team had some similar concerns. One thing that was very wise of the ONC was using the RFI process (which I thought would be an Advance Notice of Proposed Rulemaking) which allows for broad stakeholder input and the ability for greater flexibility in the rulemaking process. The ONC now has an opportunity to craft a much better proposed rule in collaboration with the exchange community.

The God Particle

Scientists at CERN have announced their most recent results in the search for the Higgs boson (God particle). The Higgs particle, first hypothesized in the 1960s by physicist Peter Higgs and others, would help explain why elementary particles, such as quarks, have mass. Finding the Higgs—or ruling out its existence—was the prime motivation for building the Large Hadron Collider (LHC), where researchers collide protons traveling at nearly light-speed to create new particles.

John Ellis, theoretical physicist, in the video below answers the question "Are we close to discovering the Higgs Boson and why is it so difficult to find it?" in preparation of the Press Conference following the scientific seminar announcing results of the searches for the Higgs boson on July 4 2012.

A VIDEO from Europe's CERN physics lab, apparently posted mistakenly on the eve of an announcement on the elusive "God Particle," reveals that a new subatomic particle has been observed in the relevant range. The leaked video was relocated to a password-protected part of the CERN Web site.

The video above was accidentally published on the CERN website and appears to have leaked the long-awaited discovery of the Higgs boson that was officially announced on the fourth of July. According to the Telegraph, Cern say that this is one of several videos they have made, one for each of the possible outcomes, as though it's a presidential election and they've written one speech for victory and one for defeat.

I will update this post as more facts com in...

“We have reached a milestone in our understanding of nature,” said CERN Director General Rolf Heuer. “The discovery of a particle consistent with the Higgs boson opens the way to more detailed studies, requiring larger statistics, which will pin down the new particle’s properties, and is likely to shed light on other mysteries of our universe.”

Soundbytes from the interviews of Peter Higgs, Francois Englert, Carl Hagen and Gerald Guralnik, recorded at CERN on the announcement of the latest results from ATLAS and CMS on the Higgs boson searches.

“We observe in our data clear signs of a new particle, at the level of 5 sigma, in the mass region around 126 GeV. The outstanding performance of the LHC and ATLAS and the huge efforts of many people have brought us to this exciting stage,” said ATLAS experiment spokesperson Fabiola Gianotti, “but a little more time is needed to prepare these results for publication.”

"The results are preliminary but the 5 sigma signal at around 125 GeV we’re seeing is dramatic. This is indeed a new particle. We know it must be a boson and it’s the heaviest boson ever found,” said CMS experiment spokesperson Joe Incandela. “The implications are very significant and it is precisely for this reason that we must be extremely diligent in all of our studies and cross-checks."

“It’s hard not to get excited by these results,” said CERN Research Director Sergio Bertolucci. “ We stated last year that in 2012 we would either find a new Higgs-like particle or exclude the existence of the Standard Model Higgs. With all the necessary caution, it looks to me that we are at a branching point: the observation of this new particle indicates the path for the future towards a more detailed understanding of what we’re seeing in the data.”