Healthcare, Technology & Government 2.0

The Role of Health IT in Transforming Healthcare

2012-01-27T06:00:00.000-08:00

The Bipartisan Policy Center's (BPC) Task Force on Delivery System Reform and Health IT released a very timely set of recommendations for the most effective use of health IT dollars to support coordinated, accountable, patient-centered health care. The full report is available HERE. There was a webcast discussing the release of the report. Senators Tom Daschle and Bill Frist, Co-Leaders of BPC’s Health Project, and Governor Ted Strickland made remarks at the event. BPC Health IT Task Force members, including John Engler, President of the Business Roundtable, and Karen Ignagni, President and Chief Executive Officer of America's Health Insurance Plans, also provided insights on the findings and recommendations in the report.

The report recognizes that there remain several gaps in and barriers to achieving the health IT capabilities needed to support these common attributes of high performance and new models of care:

Misaligned Incentives New models of care, supported by the health IT capabilities required for their success, will not become the norm without transforming the nation’s primarily volume-based payment model to one that promotes higher quality, more cost-effective care.
Lack of Health Information Exchange While the exchange of information across the multiple settings where care and services are delivered is a central and necessary component of coordinated, accountable and patient-centered models of care, the level of health information exchange in the U.S. is extremely low.
Limited Level of Consumer Engagement Using Electronic Tools Health IT plays a critical role in supporting patient centered care, yet use of electronic tools to coordinate care, drive provider-patient communication, and empower patients to manage their health and health careis not widespread.
Limited Levels of EHR Adoption While EHRs are a necessary foundational component for new models of care, the level of EHR adoption and Meaningful Use among physicians, hospitals and other provider organizations remains low.
Privacy and Security Concerns Consumers expect that their health information will be kept private and secure. Solidifying public trust in health IT and electronic health information exchange initiatives will require assurance about the processes used to protect the privacy and security of health information.
Multiple Federal Priorities Require Focus and Attention Health care organizations are faced with numerous requirements associated not only with health IT, but also with delivery system and payment reforms, health care coverage and access challenges, administrative improvements, and program integrity brought about by the Patient Protection and Affordable Care Act (ACA) of 2010, HITECH and other federal, state and private sector programs.

But just as importantly the report lays out solutions that could be implemented in a bipartisan way to address these gaps. The full report goes into great detail on how to address each the key issues raised. One important recommendation regarding EHR adoption is to improve the usability and safety of EHRs and accelerate the maturation of the EHR market. They propose that vendors, clinicians, hospitals and other providers should collaborate to identify common challenges and issues related to usability, including those with implications for patient safety, and develop and execute strategies to overcome them. I believe that usability should be a component of the standards and certification criteria for future stages of meaningful use.

They also make some suggestions to increase engagement of consumers using technology tools. They urge that the consumer awareness campaign initiated by ONC be built upon, and that both the public and private sectors should take additional steps to demonstrate how electronic tools can help consumers manage their health and engage further with their providers. This should be an encouragement to Lygeia Ricciardi, the ONC's Consumerista.

They also make detailed recommendations on how to build a business case for health information exchange. Aside from encouraging expansion of requirements for meaningful use they also recommend that Federal, state and private sector purchasers and payers should require that data standards adopted by the secretary be reflected in the specifications associated with clinical quality measures required by their payment or incentive programs. Health information exchange is a critical component of any strategy to use health IT to improve care and lower costs. I know that policy makers are taking these recommendations into serious consideration. I strongly recommend anyone interested in using technology to improve health care read this report.

Get Ready for EHR and NwHIN Rules

2012-01-23T08:00:00.000-08:00

Stage 2 Meaningful Use and NwHIN Governance Rules

Sometime in the next month three long awaited proposed rules from CMS and the ONC should be published. You can see below the links to the Unified Regulatory Agenda submission. These rules are under review by the Office of Management and Budget (OMB) and should be published in the Federal Register within the next month or so:

Medicare and Medicaid Electronic Health Record Incentive Program--Stage 2 (CMS-0044-P)

New and Revised Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology

Governance for a Nationwide Health Information Network

The Office of Information and Regulatory Affairs (OIRA) is located within the OMB. OIRA has a great dashboard that gives an overview of rules under review. This dashboard graphically presents information about rules under OIRA review through an easy-to-use interactive display, and it allows the public to sort rules by agency, length of review, state of rulemaking, economic significance, and international impacts. I will be following the rule making process closely and posting updates as information is available.

The NwHIN Governance rule is being done with a Advance Notice of Proposed Rulemaking (ANPRM). This is a step that entails publishing the agency's initial analysis of the subject matter, often asking for early public input on key issues. Any data or communications regarding the upcoming rule would be made available to the public for review. Occasionally, a board of potentially affected parties is comprised to do give-and-take bargaining over rulemaking subject-matter which would otherwise result in deadlocked opposition by an interested party. This is commonly called "negotiated rulemaking", and usually results in a more custom-tailored proposed rule.

Stage 2 Meaningful Use will be deferred for an extra year for those who attested in 2011

Stopping Internet Pirates

2012-01-19T11:11:00.000-08:00

There has been much written about the legislative efforts called SOPA and PIPA. One of the best discussions on the subject is on Tim O'Reilly's Google + feed. The outcry over this terrible piece of legislation is one of the most effective grassroots campaigns I've ever seen. Citizens took to social media platforms, many websites protested throughout the day, and Congress listened. Several members of Congress switched their position. Despite powerful lobbying forces in Washington, D.C. attempting to guide this legislation through, the chances of it passing, or the President signing it are quite dim. So chalk on up for the good guys and the power of social media! There is a better way to deal with foreign websites who are trafficking in pirated content than infringing on the liberty and freedom of American citizens.

As reported in the Los Angeles Times the SOPA protests led 8 million Americans to look up representatives in Congress. Google reported 4.5 million people had signed its petition asking lawmakers to reject SOPA/PIPA. Twitter said 2.4 million SOPA-related tweets were sent in the first 16 hours of the day Wednesday. Below is an interesting YouTube video of a protest held in at the San Francisco Civic Center Jan. 18, 2012. Angel investor Ron Conway, Internet Archive co-founder Brewster Kahle and MC Hammer spoke out against SOPA.

Further Analysis of Data on Meaningful Use Attestation

2012-01-12T15:30:00.000-08:00

Comments on my previous post about the data on meaningful use attestation as well as emails, and conversations on social media have led me to want to show the specific data for inpatient and ambulatory attestations. I also include the excellent presentation to the HIT Policy Committee by Robert Tagalicod, Robert Anthony, and Jessica Kahn from CMS on their analysis of the data (including the element not available on data.gov - the money paid out in incentive payments). So first let's look at the Eligible Hospital attestations. Here are the top ten vendors on the inpatient side so far:

It is interesting that Cerner and Meditech are really doing great, while Epic is lagging so far on hospital attestations on the inpatient side, and it's important to note that HCA is using modular systems that incorporate much of Meditech's product. Here are the top ten vendors by attestation for EPs:

It appears that EPIC is by far the vendor with the greatest number of EP attestations (although I suspect that these are employed providers of large health systems). As the Medicaid programs are launched in all the states and those EPs attesting under AIU began to come in I suspect we will see greater numbers for vendors who are in smaller practices.

EHR Incentive Program Analysis

View another webinar from Brian Ahier

Data on Meaningful Use Attestation

2012-01-10T07:00:00.000-08:00

Some very interesting data on meaningful use attestations thus far. While the reports already posted by CMS provide good information (such as the map below with a state by state breakdown), the data released on Data.gov enables systematic analysis of the distribution of certified EHR vendors and products among those providers that have attested to meaningful use within the CMS EHR Incentive Programs. The data set can be analyzed by vendor, state, provider type, provider specialty, and practice setting. One data point that would make this even sexier is the dollar amount paid for each attestation, but hopefully that can be included in future releases. I'll be doing some deeper analysis of this data, but some initial interesting facts are noticeable about state and vendor figures.

Here are the top 25 states in number of attestations for meaningful use as of November 2011:

Attestations	State/Territory
1761	Texas
1653	Ohio
1533	Illinois
1450	Pennsylvania
1387	Florida
1287	California
1272	New York
963	Minnesota
931	Massachusetts
812	Wisconsin
752	New Jersey
638	New Hampshire
606	Oregon
588	Virginia
525	North Carolina
520	Michigan
502	Georgia
457	Washington
384	Tennessee
370	Arizona
351	Missouri
302	Indiana
288	Colorado
280	Oklahoma

Here are the top 25 vendors by attestation:

Attestations	Vendor
6330	Epic Systems Corporation
1847	eClinicalWorks LLC
1502	Allscripts
1158	athenahealth, Inc
999	Community Computer Service, Inc.
921	GE Healthcare
899	NextGen Healthcare
770	e-MDs, Inc.
712	Greenway Medical Technologies, Inc.
567	Cerner Corporation
565	Sage
397	BioMedix Vascular Solutions
264	HCA Information & Technology Services, Inc.
256	MEDITECH
252	AmazingCharts.com, Inc.
239	Eyefinity/OfficeMate
210	meridianEMR, Inc.
206	McKesson
199	Sammy Systems
179	SOAPware, Inc.
174	Health IT Services Group
164	ChartLogic, Inc.
147	MedInformatix, Inc
144	Compulink

Health IT Trends in 2012: Clouds and Mobile Health

2012-01-04T07:00:00.000-08:00

This coming year should be a very exciting time for health IT. With coming IT enabled changes in payment models, continued efforts at obtaining meaningful use incentive payments, switching to ICD10, and intense focus on health information exchange we will stay very busy. Two areas that I believe are going to show a lot of activity in the coming year are cloud services for healthcare and mobile health. There is also opportunity for the two of these trends to intersect as cloud services can be a solution to provide greater capabilities to platforms for mobile health information delivery, access and communication.

Hospitals, health systems, and physician practices are beginning to consider cloud-based solutions for the storage of patient health information. Lower cost, reliability, and pervasive availability are some advantages to moving to the cloud. However, there are serious legal and regulatory issues which must be considered before storing sensitive patient data in the cloud. For instance it is not entirely clear is whether, and under what circumstances, and to what extent, a cloud services provider would be considered a business associate under HIPAA.And the HITECH Act expanded the definition of business associate to include in some cases subcontractors who are simply "downstream entities." So my advice is to proceed cautiously, but I still believe cloud is a very viable option in many cases. Cloud computing presents a huge potential for hospitals, health systems, physicians and even health insurers to obtain and maintain cost-effective databases. Web based applications have some attractive features that will allow for more seamless exchange of health information. And there are some very good cloud based EHRs on the market now that I will discuss in future posts.

Mobile health (mHealth) is another area that is showing remarkable growth. So much so that HIMSS has started a new platform, mHIMSS, dedicated to progress on technology, policy, security, and implementation surrounding mHealth. mHIMSS is available for all existing active individual HIMSS members at no additional cost. This should be a very good resource. To be honest, I get most of my mHealth news from MobiHealthNews, and excellent website run by Brian Dolan. Very simply mHealth describes the practice of medicine and public health, supported by mobile devices. There is little doubt that the online health-information environment is going mobile. According to a Pew Internet study in 2010 17% of cell phone users have used their phone to look up health or medical information and 9% have apps on their phones that help them track or manage their health. I think these numbers have likely increased and we will see much higher adoption rates. And doctors are also embracing mobile technology. A report from Jackson & Coker found that 4 out of 5 practicing physicians use their personal mobile devices in their daily practice, from prescribing medicine to scheduling patient follow-ups and entering billing data.

And these two trends will have a synergistic effect upon each other, as mobile drives greater need for cloud services, and cloud computing opens up greater opportunities for innovation in mHealth. Mobile devices have limited computational capacity so using cloud computing to help off load some of the processing allows greater flexibility in applications. With web based applications optimized for mobile viewing, this opens up possibilities for tablet and smartphone use in ways not previously available. Combing cloud computing and mHealth makes for ubiquitous computing that allows the health data to be available where and when it's needed.

Looking back at 2011...

2011-12-30T08:00:00.000-08:00

2011 has been an interesting year for healthcare informationtechnology. Starting in February with the launch of Direct Project pilot therehas been continued momentum for health information exchange and a strong pushfor interoperability. Less than a year from the birth of the project, havingreal world implementation is lightening speed for a government sponsoredeffort. The Direct Project has been a remarkable success story and will have longlasting impact on health information exchange. In April I helped facilitate theDirectProject Boot Camp, which was a remarkable success.

Also in February, the annual HIMSSconference was a usual highlight of the year. There was a focus on newpayment and delivery models and the health IT infrastructure necessary toenable the future of healthcare, as well as a great deal of mobile healthcareapplications and other innovative solutions demonstrated. One of best parts isalways the Interoperability Showcase, and this year had some really great demonstrations.The new HIT X.0 format wasexciting and I am looking forward to seeing how this develops in the future.Perhaps my favorite part was the increasing status of the social media efforts.The Social Media Pavilion seems to be growing by leaps and bounds and I expectnext year to be bigger than ever.

In April we saw the changingof the guard at ONC as Farzad Mostashari took the helm from the departingDavid Blumenthal. It was widely expected that Dr. Blumenthal would only leadthe agency for two years. Blumenthal had cast the vision for PHR adoption andimplementation of health IT and I believe that Dr. Mostashari is the idealperson to listen to the next phase. There is been a huge increase this year andthe number of providers and hospitals registering for meaningful use incentivepayments. With over $2 billion paid out this year so far, I expect the 2012will be a very big year for the ONC.

In June the IOM and HHS hosted the HealthData Initiative Forum to accelerate momentum for the public use of data andinnovation to improve health. There was an amazing array of sessions, whichwere webcast live, and a truly outstanding set of speakers and panel presentations.There were fast-paced Ignite style demonstrations of a variety of innovativetechnology solutions.

In July we launched our own DirectProject pilot. As our local health information exchange efforts have goneforward we have been blessed with a strong sense of collaboration from areastakeholders. Gorge Health Connect Inc. also achieved status as a 501(c) threecharitable organization with the IRS. This was no small feat and I'm verypleased at our progress on governance and designing our technical architecture.The partnership with our vendor Medicity has been excellent and I am lookingforward to watching the data flow 2012.

Also in July was the first ever Health Foo in Cambridge, Massachusetts. The best summary I've seen of that amazing weekend is by Susannah Fox. O’Reilly Media and Robert Woods Johnson Foundation gathered a mind blowing stew of thought leaders. This was one of the brightest group of people I have ever been exposed to and it was an honor to participate.

NationalHealth IT Week was in September withcontinued strong efforts at advocacy for the health IT community. One of thehighlights of the week was the launch of a Consumer Health IT Program by theONC to support greater consumer engagement in health and healthcare viainformation technology. The ONC’s focus on consumer engagement really gainedsteam this year, especially with the work of Lygeia Ricciardi, Senior PolicyAdvisor on Consumer eHealth. This was followed in October by the Puttingthe 'IT' in Care Transitions event, which brought together thought leadersfrom around the country to work on some of the most pressing issues facing ourhealthcare system.

Health reform and health IT go hand in hand as the linchpinof efforts to reforming our healthcare system is technology enabled. And mygreatest disappointment by far in 2011 was the departure of Don Berwick fromCMS. He cast a vision for investment and research in information technologyleading to accountable care organizations, medical homes and other innovationsin delivery and payment models. However, I am hopeful that he may actually beable to accomplish more released from the bonds of government service. Hisfarewell speech The Moral Test:Remember the Patient is must reading for anyone interested in healthcare.

The creation of the Center for Medicare and MedicaidInnovation will be an enduring legacy of Dr. Berwick’s work at CMS. Theirmission to transform Medicare/Medicaid by improving the healthcare deliverysystem as well as implementing new models of payment will have wide rangingimpact for the next generation. The HealthCare Innovation Challenge is one place I expect to see some significantresults.

These are really just a handful of the events over thisremarkable year in health IT. I felt like I should write something before theyear was up, so these are only some highlights that came to mind this morning. Thereis a great deal more that has happened which will springboard us into anamazing future for our healthcare system. Maybe I'm overly optimistic, but Itruly believe that we're in the midst of a hinge point in history. Years fromnow I believe we will see that the changes underway lady a foundation thatenabled improvements in innovative solutions we can now only barely imagine. Iam looking forward to this next year…

Healthcare Innovation Challenge Materials

2011-12-24T07:00:00.000-08:00

The CMS Innovation Center's Health Care Innovation Challenge

The Centers for Medicare & Medicaid Services (CMS) hosted four webinars on its Health Care Innovation Challenge, which will spend a billion dollars through awards of up to $30 million over three years to projects that identify and test promising new payment and care delivery models for Medicare, Medicaid and the Children's Health Insurance Program. I have synced the slides with the audio to make the webinar archive easier to view.

The objectives of this initiative are to:

Engage a broad set of innovation partners to identify and test new care delivery and payment models that originate in the field and that produce better care, better health, and reduced cost through improvement for identified target populations.
Identify new models of workforce development and deployment and related training and education that support new models either directly or through new infrastructure activities.
Support innovators who can rapidly deploy care improvement models (within six months of award) through new ventures or expansion of existing efforts to new populations of patients, in conjunction (where possible) with other public and private sector partners.

You can view and listen to each of the webinars below. There are resources listed under that. I will also be updating this post with additional useful information for those who are applying for this opportunity. The expanding FAQ for this funding is available at innovations.cms.gov

CMS Innovation Center staff hosted the first is a series of informational webinar on
the Health Care Innovation Challenge for all interested individuals and organizations
on Thursday, November 17, 2011. Staff provided an overview of the initiative and
were available to answer questions from the audience.

This second webinar was held on Tuesday, December 6th, 2011 to provide guidance on the application process with specific attention towards designing effective project proposals.

In this third of four-webinar series on the Innovation Challenge held December 19, 2011,
CMS Innovation Center staff presented an explanation of "Total Cost of Care" and how
potential applicants can demonstrate their path to achieving lower costs through improvement.

This fourth presentation was the final overview webinar on the Innovation Challenge
before applications are due. CMS Innovation Center staff presented how potential
innovative proposals can demonstrate measurable impact on the aims of better care
and better health in addition to considerations for operational planning for potential applications.

RESOURCES:

Public Sources for CMS or HHS Approved Quality Measures

HHS Measures Inventory http://www.qualitymeasures.ahrq.gov/hhs-measure-inventory/browse.aspx
Medicaid and CHIP Programs; CHIPRA Core Set Technical Specifications Manual https://www.cms.gov/MedicaidCHIPQualPrac/Downloads/CHIPRACoreSetTechManual.pdf
Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults http://www.gpo.gov/fdsys/pkg/FR-2010-12-30/pdf/2010-32978.pdf
Medicare Health Outcomes Survey http://www.hosonline.org/Content/SurveyInstruments.aspx
Accountable Care Organizations –Measures used in the Shared Savings Program https://www.cms.gov/MLNProducts/downloads/ACO_Quality_Factsheet_ICN907407.pdf
Health Indicators Warehouse http://healthindicators.gov/
Healthy People 2020 http://healthypeople.gov/2020/default.aspx

Other Measure Sources
IOM Health Services Geographic Variation Data Sets http://www.iom.edu/Activities/HealthServices/GeographicVariation/Data-Resources.aspx
National Quality Forum http://www.qualityforum.org/Home.aspx
NCQA http://ncqa.org
MATCH County Level Health Rankings http://www.countyhealthrankings.org/

Other Resources:
Demographic data from US Census: http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml

Remember the Patient

2011-12-08T16:20:00.000-08:00

The Picker Award for Excellence, which recognizes outstanding achievement in promoting and furthering patient-centered care, was awarded to Dr. Don Berwick on Wednesday, Dec. 7, the last day of the 23rd annual national forum hosted by the Institute for Healthcare Improvement, which Dr. Berwick cofounded in 1989. Below are his comments accepting the award:

The Moral Test

Don Berwick, MD

IHI National Forum

Orlando, Florida: December 7, 2011

Let me begin by thanking the Picker Institute for this honor. I am touched to be in such good company, and especially for a theme so close to my heart – patient-centered care. And let me also say a word of personal reverence for Harvey Picker. He was a man of grace, vision, and action. He changed forever our understanding about the proper relationship between the people who get care and the people who give it.

And, I need to say a word about Maureen Bisognano. For years, I have known that the luckiest step in my entire professional career was Maureen’s joining IHI in 1995. She made into the organization it has become. She is the best colleague I have ever had – bar none. Now, I know that that was the second luckiest step. The new luckiest step was Maureen’s willingness to become IHI’s President and CEO. Thanks to her, I can see after this time away, IHI has soared to entirely new heights with stronger patient voice, wider global reach, an Open School that now includes 74,000 students, and a whole new level of presence and gravitas in the global health care scene. Maureen, you are a treasure – a global treasure, and it is an honor to have you as our leader.

It is good to be back. For me, the past 16 months have been quite an expedition; I feel like Marco Polo. Never having expected it, I journeyed into the world of national policy and politics at the most tumultuous time for both modern American health care and the modern global economy. To keep things in perspective, I also watched grandson #1 – Nathaniel – grow to 2 ½ years old, and we welcomed grandson #2 – Caleb – into the world 8 weeks ago.

The time at CMS has been a privilege. I got the chance to work with thousands of career public servants, and to learn how much these people do for us all, unsung and too often unappreciated. These are the people who translate laws into regulations and regulations into deeds. In CMS these are the people who keep the lights on – they see that providers get paid, they protect the public trust, they help the most vulnerable people in America, and make sure that they get the care they need.

And, I got the chance to help pilot toward harbor the most important health care policy of our time – the Affordable Care Act. A majestic law. I learned that a law is only a framework; it’s like an architect’s sketch. If it’s going to help anyone, it has to be transformed into the specifications that regulations and guidance documents. Only then can become real programs with real resources that reach real people. On my expedition, that, mostly, was what I was doing.

I would have loved to keep at that job longer. But, as you know, the politics of Washington, and especially the politics of the United States Senate, said, “No.” But, overall, I don’t feel an ounce of regret. What I feel is grateful for the chance I had to serve, and for the generous support I felt, including from so many of you.

I want this afternoon to share with you a little of what I learned on the expedition; and what I think it means for you – for all of us. It’s a sort of good-news-bad-news situation. The good news: the possibility of change has never been greater – not in my lifetime. The bad news: if it’s going to be the right change, the burden is yours.

When I first got the job, my brother, Bob, a retired middle school science teacher and a very wise man, gave me a sign to put on my desk. It read, “How will it help the patient?” It was there from the minute I arrived until the minute I left. Maureen gave me the same sort of advice just before I left IHI. I asked her how I could succeed at CMS, and she said, “That’s easy; just mention a patient five times a day.” Bob’s advice and Maureen’s was the best I got – hands down – from anyone else anywhere else. Remember the patient.

As it turns out, that’s not easy in an office just a few hundred yards from the US Capitol Building – less than a mile from the White House. Every morning at breakfast, the stewards of national policy and politics rush to scan the Washington Post and Politico and to wolf down the day’s Capitol Hill newsletters and blogs. What they are finding out is what each other says. Which Senator has raised an eyebrow? Which lobbyist has cried foul? Which Committee is launching which outraged inquiry into which shocking development. In Washington, a day without a shocking development is hardly worth getting up for. And, of course, who is ahead? Always, who is ahead? My son, Dan, when he first knew I was going to Washington, and who had lived there, said to me: “Just remember, Dad, Washington is a city where everyone is trying to get into a room they aren’t yet in.”

In that self-absorbed culture, the question, “How does it help the patient?” isn’t always the first one asked. In fact, it can seem naïve – not on point. And yet, I learned that, in Washington, DC, just like here, it is exactly the right question. The best public policy and the best public management answer it. This is only Harvey Picker’s idea reframed – from patient-centered care to patient-centered policy.

And that leads me to a second big lesson. I can best explain it to you by describing a visit I made in the fall of 2011 to a small rural hospital – Lower Umpqua Hospital in Reedsport, Oregon. I was on a so-called “Rural Road Trip” visiting rural hospitals to learn from them.

At a meeting there, one of the doctors spoke up – Dr. Robert Law – and he captivated me. Dr. Law, I learned, was the Oregon Academy of Family Practice’s “Family Physician of the Year” in 1999. And two sentences into his remarks at the meeting, I could see why. He spoke from his heart. He said how deeply he cared about his community, his patients, and his professionalism. He told why he felt lucky to be serving, and how willing he was to try out new ways to meet needs, even while resources get tighter. He said how offended he was by waste in the health care system – even in Reedsport – and how hard he wanted to work to make sure that every single thing done to, for, and with patients and families would actually help them – on their terms, not his. And – most importantly – he asked for help – for a context of policy, payment, and information that, simply put, would help him get his work done with pride and joy. “If things don’t change soon,” he told me last week, “I am not sure how we can keep going.”

Cynicism grips Washington. It grips Washington far too much... far too much for a place that could instead remind us continually of the grandeur of democracy. I vividly remember my first trip ever to Washington, DC. I was twelve years old, and friends took me to the Lincoln Memorial just after sunset. I looked from the statue of Abraham Lincoln, past the Reflecting Pool and the Washington Monument, to the glowing Capitol Building in the distance – the same Capitol that I saw outside my office window every day for the past 16 months. And, twelve years old, I cried in awe and admiration for – what shall I call it? - majesty.
Two weeks ago, Congress’s approval rating fell to an all-time low: 9%.

How did that happen? It happens when the cynics are winning. In a city where everyone wishes to be in a room they are not yet in, it is easy to see everyone as on the make, everyone maneuvering, everyone with elbows sharpened. It becomes too easy to lose hope and confidence, and to forget what can be noble in human nature.

When the lens through which one sees the world magnifies combat, dissembling, and greed, then trust decays and those who deserve to be trusted feel bad – misunderstood, confused, and impeded in their good works.

Dr. Robert Law is not cynical, and he is not on the make. He is dedicated to a life of service to a community he loves, and in which he raised his own three children – Alison, Brian, and Duncan. The job of public servants is to serve him so that he can better serve others. He needs help, resources, encouragement, voice, and respect. His promise – what he can offer our nation – has nothing to do with preventing fraud, holding his feet to the fire, or audits, and it has little to do with payment for performance, public measurement, incentives, or accountability. He is a good person who needs dignified assistance to do good work… and he is legion.

He can be the future. He, in fact, can and will rescue us, if we will help him help us.

If lesson one for me is, “Remember the patient,” then lesson two is this: “Help those who help others.” Those thoughts – not the negativity – guided my in DC, and they made my time there meaningful.

They are reminders of what is truly important; not the noise, but simply this: to help the people who need our help the most. Inscribed on the wall of the great hall at the entrance to the Hubert Humphrey Building, the HHS Headquarters in Washington where my office was, is a quotation from Senator Humphrey at the building’s dedication ceremony on November 4, 1977. It says: "The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped."

I believe that. Indeed, I think that Senator Humphrey described the moral test, not just of government, but of a nation. This is a time of great strain in America; uncertainty abounds. With uncertainty comes fear, and with fear comes withdrawal. We can climb into our bunkers, each separately, and bar the door. But, remember, millions of Americans don’t have a bunker to climb into – they have no place to hide. For many of them, indeed, the crisis of economic security that we all dread now is no crisis at all – it is their status quo. The Great Recession is just their normal life.

The rate of poverty in this country is rising. Over 100 million Americans – nearly one in every three of us – is in poverty or near-poverty today – 17 million of them children. I will tell you – state by state, community-by-community, and in the halls of Washington, itself – the security of the poor – their ability to find the health care they need, and the food, and the housing, and the jobs, and the schools – all of it, hangs by a thread. The politics of poverty have never been power politics in America, for the simple reason that the poor don’t vote and the children don’t vote and the sickest among us don’t vote. And, if those who do vote do not assert firmly that Senator Humphrey was right, and if we do not insist on a government that passes the moral test – the thread will break, and shame on us if it does.

Cynicism diverts energy from the great moral test. It toys with deception, and deception destroys. Let me give you an example: the outrageous rhetoric about “death panels” – the claim, nonsense, fabricated out of nothing but fear and lies, that some plot is afoot to, literally, kill patients under the guise of end-of-life care. That is hogwash. It is purveyed by cynics; it employs deception; and it destroys hope. It is beyond cruelty to have subjected our elders, especially, to groundless fear in the pure service of political agendas.

The truth, of course, is that there are no “death panels” here, and there never have been. The truth is that, as our society has aged and as we have learned to care well for the chronically ill, many of us face years in the twilight our lives when our health fades and our need for help grows and changes. Luckily, palliative care – care that brings comfort, company, and spiritual and emotional support to people with advanced illness and their families – has grown at its best into a fine art and a better science. The principle is simple: that we can and should offer people the very best of care at all stages of their lives, including the twilight.

The truth is, furthermore, that patient-centered care demands that the ways in which a person is cared for ought always to be under his or her control. The patient is the boss; we are the servants. They, not others, should direct their own care, and the doctors, nurses, and hospitals should know and honor what the patient wants. Some of us want to be guaranteed that, no matter how sick or close to death we are, every single machine, drug, and device that could help us live even a moment longer should be used; and that is, therefore, exactly what they should have. And, other if us want not to spend our final days in an intensive care unit, attached to machines, but rather, say, to be at home, in our own bed surrounded by our loved ones in a familiar place, but still receiving world-class treatment for pain and complications; then that is, therefore, exactly what they should have. It is one of the great and needless tragedies of this stormy time in health care that the “death panel” rhetoric has denied patients the care that they want, denied caregivers the information they need to give that care, and denied our nation access to a mature, open, informed, and balanced discussion of the challenge of advanced illness and the commitment to individual dignity. It is a travesty.

If you really want to talk about “death panels,” let’s think about what happens if we cut back programs of needed, life-saving care for Medicaid beneficiaries and other poor people in America. What happens in a nation willing to say a senior citizen of marginal income, “I am sorry you cannot afford your medicines, but you are on your own?” What happens if we choose to defund our nation’s investments in preventive medicine and community health, condemning a generation to avoidable risks and unseen toxins? Maybe a real death panel is a group of people who tell health care insurers that is it OK to take insurance away from people because they are sick or are at risk for becoming sick. Enough of “death panels”! How about all of us – all of us in America – becoming a life panel, unwilling to rest easy, in what is still the wealthiest nation on earth, while a single person within our borders lacks access to the health care they need as a basic human right? Now, that is a conversation worth having.

And, while we are at it, what about “rationing?” The distorted and demagogic use of that term is another travesty in our public debate. In some way, the whole idea of improvement – the whole, wonderful idea that brings us –thousands – together this very afternoon – is that rationing – denying care to anyone who needs it is not necessary. That is, it is not necessary if, and only if, we work tirelessly and always to improve the way we try to meet that need.

The true rationers are those who impede improvement, who stand in the way of change, and who thereby force choices that we can avoid through better care. It boggles my mind that the same people who cry “foul” about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people – elders, the poor, the disabled – who are least able to bear them. When the 17 million American children who live in poverty cannot get the immunizations and blood tests they need, that is rationing. When disabled Americans lack the help to keep them out of institutions and in their homes and living independently, that is rationing. When tens of thousands of Medicaid beneficiaries are thrown out of coverage, and when millions of Seniors are threatened with the withdrawal of preventive care or cannot afford their medications, and when every single one of us lives under the sword of Damocles that, if we get sick, we lose health insurance, that is rationing. And it is beneath us as a great nation to allow that to happen.

And that brings me to the opportunity we now have and a duty. A moral duty: to rescue American health care the only way it can be rescued – by improving it.

I have never seen, nor had I dared hope to see, an era in American health care when that is more possible than this very moment. The signs are everywhere. In the past two years, major hospital systems are asking at last how they can coordinate care. Specialty societies are coalescing around plans for more evidence-based care, the use of clinical registries, serious recertification, and reduction of overuse of unhelpful care. The patient safety movement is maturing, with numerous national efforts to bring excellence to scale, including the billion-dollar Partnership for Patients that we launched in HHS. Insurers are experimenting with much more integrated payment models, of which Accountable Care Organizations are only one breed. Transparency is, I believe and hope, about to leap forward. Patients’ and consumers’ groups are more active and more sophisticated, and they are gaining the footholds they need in governance. Employer groups and labor unions are uniting in their demands. And states are on the move – states like Oregon, Arkansas, and Massachusetts – where courageous and visionary governors – like John Kitzhaber, Mike Beebe, and Deval Patrick – are catalyzing transformation.

And, though no sane person would have wished on us the most serious economic crisis since the Great Depression, the global downturn has added tons to the pressure for change. We are headed for a cliff, and we need to change course. And that means health care needs to change course.To be clear, we have not changed course yet. Not enough. Not hardly. All the unfreezing has not yet moved health care into its new and needed state. In truth, we have only been getting ready. The Affordable Care Act helps, but, a law is not change – it set the table for change. A Constitutional provision for a free press does nothing until a press turns somewhere. And a law that provides support for seamless, coordinated care has done nothing until some person who needs it gets it.

This is the threshold we have now come to, but not yet crossed: the threshold from the care we have to the care we need.

We can do this… we who give care. And nobody else can. The buck has stopped. The Federal framework is set by the Affordable Care Act and important prior laws, such as the HITECH Act, and, quite frankly, we can’t expect any bold statutory movement with a divided Congress within the next year or more. The buck has stopped; it has stopped with you.Now comes the choice. To change, or not to change.

It is not possible to claim that we do not know what to do. We have the templates.If you doubt it, visit the brilliant Nuka care system at Southcentral Foundation in Anchorage, which just won the Baldrige Award. I visited in October. Thoroughly integrated teams of caregivers – physicians, advanced practice nurses, behavioral health specialists, nutritionists, and more – occupying open physical pods in line-of-sight contact with each other all day long, weaving a net of help and partnership with Alaska Native patients and families. The results: 60% fewer Emergency and Urgent Care Visits, 50% fewer hospitalizations, and 40% less use of specialists, along with staff turnover 1/5th as frequent as before the new care.

If you doubt that we know what to do, visit Denver Health or ThedaCare or Virginia Mason, and see the Toyota principles of lean production learned, mastered, adapted, and deployed through entire systems and into the skills and psyches of entire workforces. The result, over $100 million in savings at Denver Health while vastly improving the experience and outcomes of patients.

If you doubt that we know what to do, contact George Halvorson at Kaiser Permanente and ask him how they have reduced sepsis mortality – sepsis is the cause of death in 24% of seniors who die in California hospitals. Kaiser-Permanente has driven down sepsis mortality by nearly half – to 11% in less than three years.
Let me put it simply: in this room, with the successes already in hand among you here, you collectively have enough knowledge to rescue American health care – hands down. Better care, better health, and lower cost through improvement right here. In this room.The only question left is: Will you do it?

When we entered the world of health care improvement as our life’s work, we didn’t ask for the burden we now bear. We did not ask to be responsible for rescuing health care.But, here we are, and, as intimidating as the fact may be, that burden is ours. Our nation is at a crossroad. The care we have simply cannot be sustained. It will not work for health care to chew ever more deeply into our common purse. If it does, our schools will fail, our roads will fail, our competitiveness will fail. Wages will continue to lag, and, paradoxically, so will our health.

The choice is stark: chop or improve. If we permit chopping, I assure you that the chopping block will get very full – first with cuts to the most voiceless and poorest us, but, soon after, to more and more of us. Fewer health insurance benefits, declining access, more out-of-pocket burdens, and growing delays. If we don’t improve, the cynics win.That’s what passes the buck to us. If improvement is the plan, than we own the plan. Government can’t do it. Payers can’t do it. Regulators can’t do it. Only the people who give the care can improve the care.

What’s the strategy? Let me show you one. I owe much of this to my friend and colleague, Andy Hackbarth, who has been collaborating with Joe McCannon, others, and me for much of the year to develop a set of lenses clear enough to let us see the pathway to success.We began with work far from health care – the work of a Princeton economist and environmental expert named Robert Socolow. Professor Socolow published an important article in 2004 in Science magazine, trying to answer a very important question: “What is the way to slow the rate of atmospheric carbon production enough to avert catastrophic carbon levels in the future.”Here is his answer: “There is no way.” That is, there is no single way to do it. Automobile emission control can’t do it. Solar power can’t do it. Conservation can’t do it. The only way we can do it is to do, not one thing, but everything. When I read Socolow’s article, I thought instantly of Göran Henrik’s answer to me when I asked him a few years ago how Jönköping County in Sweden was achieving such pace-setting results in total health system performance. Göran said, “Here’s the secret: We do everything.”

“Do everything” – that’s Socolow’s answer to the global warming problem. Luckily, nothing more than everything is necessary, and, unluckily, nothing less than everything is sufficient. Socolow diagrammed “everything” as what he called, “wedges.” In his chart, the lower line is the line of “sustainability.” It shows the highest levels of atmospheric carbon that do not lead to runaway warming. It’s the goal. The top line is the “business as usual” line; it shows how fast carbon levels rise if we stay on the current course.

The “wedges” – Socolow proposes 15 of them – 15 changes that affect carbon output – fill what Socolow calls the “sustainability triangle.” The “wedges” framework looks a lot like a strategic plan, or at least a system of strategic goals, whose cumulative effect – all together – is a sustainable level of carbon, so that we don’t cook Planet Earth.

Solving the health care crisis has wedges, too. We don’t have as crystal clear a target – a sustainability level that works for total US health care spend – but for sure our business-as-usual line isn’t it. Pay on that line over time, and schools suffer, roads suffer, museums suffer, and private consumption suffers because, as Tom Nolan said years ago, “It’s our money.” It is all wages.

Now, I probably owe you an apology for talking about costs. I know that, among the important dimensions of quality – safety, effectiveness, patient-centered care, timeliness, efficiency, and equity – I am not sure any of us would have chosen “efficiency” – the reduction of waste – as our favorite. It’s not my favorite. Nonetheless, it is the quality dimension of our time. I would go so far as to say that, for the next three to five years at least, the credibility and leverage of the quality movement will rise or fall on its success in reducing the cost of health care – and, harder, returning that money to other uses – while improving patient experience. “Value” improvement won’t be enough. It will take cost reduction to capture the flag. Otherwise, “cutting” wins.

But, I am not going to apologize. That’s because if you are a student of lean thinking or quality, itself – if you have taken the time to study the work of Noriaki Kano, or Jim Womack, or Taichi Ohno, or Dr.Deming, you know that great leverage in cost reduction comes directly – powerfully – exactly from focusing on meeting the needs of the person you serve. “Waste” is actually just a word that means, “Not helpful.” So, that initial wave of reaction – “Who wants to work on efficiency” – is actually off the mark. In very large measure, improving care and reducing waste are one and the same thing.

How much cost reduction? Well, If we look to Europe for ideas, then a target of, say, 12% of our GDP, far below our current 17% would look plausible. If you want to stay at home for signals, find the lowest cost quartile of American health can economies – hospital referral regions or HRRs – and we’d be somewhere in the neighborhood of 15% of GDP.

Or, maybe that looks tough, and you’d be more comfortable if health care began to behave just as well as, but no better than, the rest of the economy – that is, rising in synch with the GDP, itself, and just staying where it is – 17% or so.

The point is, with costs rising a great deal faster than that, no matter what your goal is, you’ve got a sustainability triangle to fill – the growing, cumulative difference between unsustainable “business as usual” costs and the sustainable ones.The social imperative for reducing health care cost is enormous. And, to meet that enormous need, I suggest, just as with the environmental triangle, for the health care cost triangle, nothing works. Only everything works. It’s all or none, or we head straight on and over the cliff.

Andy Hackbarth and I took a stab at defining the “wedges” for health care costs. These are the names of the forms of waste whose removal from the system both helps patients thrive and reduces the cost of care. We found six wedges, for starters, and we estimated their size.

Overtreatment – the waste that comes from subjecting people to care that cannot possibly help them – care rooted in outmoded habits, supply-driven behaviors, and ignoring science.
Failures of Coordination- the waste that comes when people – especially people with chronic illness – fall through the slats. They get lost, forgotten, confused. The result: complications, decays in functional status, hospital readmissions, and dependency.
Failures of Reliability – the waste that comes with poor execution of what we know to do. The result: safety hazards and worse outcomes.
Administrative Complexity – the waste that comes when we create our own rules that force people to do things that make no sense – that converts valuable nursing time into meaningless charting rituals or limited physician time into nonsensical and complex billing procedures.
Pricing Failures – the waste that comes as prices migrate far from the actual costs of production plus fair profits.
Fraud and Abuse – the waste that comes as thieves steal what is not theirs, and also from the blunt procedures of inspection and regulation that infect everyone because of the misbehaviors of a very few. We have estimated how big this waste is – from both the perspective of the Federal payers – Medicare and Medicaid – and for all payers.

Research and analytic literature contain a very wide range of estimates, but, at the median, the total annual level of waste in just these six categories (and I am sure there are more) exceeds $1 trillion every year – perhaps a third of our total cost of production.

This is our task… our unwelcome task – if we are to help save health care from the cliff. To reduce costs, by reducing waste, at scale, everywhere, now.I recommend five principles to guide that investment:

Put the patient first. Every single deed – every single change – should protect, preserve, and enhance the well-being of the people who need us. That way – and only that way – we will know waste when we see it.
Among patients, put the poor and disadvantaged first – those in the beginning, the end, and the shadows of life. Let us meet the moral test.
Start at scale. There is no more time left for timidity. Pilots will not suffice. The time has come, to use Göran Henrik’s scary phase, to do everything. In basketball, they call it “flooding the zone.” It’s time to flood the Triple Aim zone.
Return the money. This is the hardest principle of them all. Success will not be in our hands unless and until the parties burdened by health care costs feel that burden to be lighter. It is crucial that the employers and wage-earners and unions and states and taxpayers – those who actually pay the health care bill – see that bill fall.
Act locally. The moment has arrived for every state, community, organization, and profession to act. We need mobilization – nothing less.

On my last night in Washington, I visited the Lincoln Memorial again – standing at the same spot that I had stood at as a twelve-year-old boy 53 years ago. The majesty was still there – the visage of Lincoln, the reach of the Washington Monument, the glow of the Capitol Dome. It was still unbearably beautiful. Still majestic.

But, there was one change. Chiseled in the very stone where I was standing is now the name of Dr. Martin Luther King and the date – August 28, 1963, when he gave his immortal “I have a dream…” speech.

When I first stood at that spot, the Montgomery Bus Boycott was only three years in the past, and Dr. King’s speech lay five years in the future. Rachel Carson’s book, “Silent Spring,” was four years in the future. And it would be six years before the phrase, “Women’s Liberation,” would first be used in America.

I thought, standing there, of something I once heard Dr. Joseph Juran say: “The pace of change is majestic.” And I mused about that majesty, and its nature. It occurred to me that the true majesty lay not just in the words – not just in the call – but also in the long and innumerable connections between the ideas that stir us – the dreams – and the millions and millions of tiny, local actions that are the change, at last. A dream of civil rights becomes real only when one black child and one white child take one cooling drink from the same water fountain or use the same bathroom or dine together before the movie they enjoy together. An environmental movement becomes real only when one family places one recycle bin under one sink or turns off one unneeded light out of respect for an unborn generation. Women’s rights are not real until one woman’s pay check stub reads the same as one man’s, and until my daughter really can be anything she wants to be. The majesty is in the words, but the angel is in the details.

And that is where you come in. Here is the lesson I bring you from 16 months in Washington, DC. Your time has come. You are on the cusp of history – you, not Washington, are the bridge between the dream and the reality – or else there will be no bridge. Our quest – for health care that is just, safe, infinitely humane, and that takes only its fair share of our wealth – our quest may not be as magnificent as the quest for human rights or for a sustainable earth, but it is immensely worthy. You stand, though you did not choose it, at the crossroads of momentous change – at the threshold of majesty. And – frightened, fortunate, or both – you now have a chance to make what is possible real.

Berwick's Vision Will Continue Under Tavenner

2011-12-06T15:20:00.000-08:00

The White House has nominated Marilyn Tavenner to run the Center for Medicare and Medicaid Services (CMS), following the resignation of former CMS Administrator Don Berwick, which is a huge disappointment. She will serve as the agency's interim administrator during the confirmation process. Tavenner has served as CMS' principal deputy administrator since February 2010 and served as CMS' acting administrator between February 2010 and July 2010. During her tenure at CMS, Tavenner has helped oversee Medicare, Medicaid and the Children's Health Insurance Program. She also had responsibility for the Center for Consumer Information and Insurance Oversight (CCIIO) which has been responsible for the health reform waivers issued by the agency.

Prior to working for CMS, Tavenner served as secretary of Virginia's Health and Human Services agency. She also has worked for the Hospital Corporation of America, where she started as a staff nurse and eventually served as president of outpatient services. Then former Governor Timothy Kaine appointed her as Virginia’s Secretary of Health and Human Resources where she oversaw 12 agencies that employed 18,000 people.

Senior HHS Officials highlight some of the immediate benefits of health reform for America's seniors before answering questions from the public:

Kathleen Sebelius, HHS Secretary
Kathy Grennee, Assistant Secretary for Aging
Marilyn Tavenner, Centers for Medicare and Medicaid Services (CMS)

Many stakeholder groups have praised the nomination of Marilyn Tavenner as Berwick's successor. The AMA released a statement in favor of the appointment saying "she has been fair, knowledgeable and open to dialogue." The AHA said in a statement that Tavenner’s "varied and rich background as a former nurse, health care executive, and government official at the state level gives her a very unique perspective in understanding both the implications of public policy and their implementation."

AHIP gave a simple endorsement saying simply: "Marilyn Tavenner’s proven leadership ability and wealth of experience in both the private and public sectors are invaluable assets to CMS as it seeks to address the many health care challenges facing the nation. We look forward to continuing to work with her to improve the quality, safety, and affordability of health care in America."

However not all groups are in favor of Tavenner. "Scrutiny of Tavenner should be no less intense than of Berwick,” stated Jane M. Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS). The AAPS released a statement very critical of her appointment. There is also likely to be continuing scrutiny from Republican lawmakers, despite House Majority Leader Eric Cantor's approval, who said, "Obviously, I'm not in the Senate, so I don't have that vote, but I do think she is qualified."

If confirmed as CMS administrator, Tavenner would also oversee the allocation of an estimated $27 billion in health IT incentive payments. Under the HITECH Act, healthcare providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

In remarks to the National Association of Medicaid Directors last month, Tavenner shared her thoughts on how to control health care costs in ways very similar to the ideas Berwick has expressed. "The only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest health care costs," she said. She also opposed Republican efforts to turn Medicaid into a block grant that would limit the amount of federal funding states can receive for the program. "That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above," she said. Politico has also unearthed audio of Dr. Berwick's replacement speaking quite highly of the health reform legislation, which will certainly be an issue at confirmation hearings.

Marilyn Tavenner speaking to the Nashville Healthcare Council in reference to replacing Berwick said,“Whether I'm nominated or not, we would not have a different approach."

The full audio of her statements from Politico is below:

Alarming Rise in Healthcare Data Breaches

2011-12-01T20:20:00.000-08:00

We need to be guarding our backside with health data...

A new "Benchmark Study on Patient Privacy and Data Security," conducted by the Ponemon Institute, and sponsored by ID Experts, found that health data breaches are rising rapidly. This is partly contributing to medical identity theft which is costing the healthcare industry billions annually. From 2010 to 2011 the frequency of data breaches in health care organizations increased by 32 percent, with hospitals and health care providers averaging four data breaches per organization, according to the study.

Three leading causes of data breaches in health care were lost or stolen equipment, errors by third parties and employee mistakes. Third-party mistakes, including business associates, account for 46 percent of data breaches reported in the study. However, sloppy mistakes by employees have led to many data breach increases, according to 41 percent of respondents. And unintentional employee negligence was the primary cause of data breaches, due in part to increased use of mobile devices by employees.

Nature or root causes of the data breach incident (more than one choice permitted)

More than 80 percent of health care organizations use mobile devices that collect, store, and transmit some form of personal health information, yet half of all respondents to the study reported that measures were not taken to protect these devices. Securing health information on mobile devices is a new frontier for many organizations.

According to the research, 55 percent of health care organizations say they have little or no confidence they are able to detect all privacy incidents. In fact, 61 percent of organizations are not confident they know where their patient data is physically located. Only 22 percent of organizations say their budgets are sufficient to minimize data breaches. 83 percent of hospitals have clearly written policies and procedures to notify authorities of a data breach, but 57 percent don’t believe their policies are effective.

“Health care data beaches are an epidemic,” said Larry Ponemon, chairman and founder of the Ponemon Institute. “These problems are a direct result of our national economy. Healthcare organizations — especially not-for-profit hospitals and small clinics — have thin margins, are trimming staff and resources and are lacking sufficient security and privacy budgets needed to adequately protect patients. I don’t see this getting better anytime soon.”

“Hospital employees are exposing patient data like the back of a hospital gown,” said Rick Kam, president and co-founder of ID Experts based in Portland, Oregon. “Identity theft and medical identity theft resulting from data breach exposure are commonplace, causing patients financial harm, frustration and embarrassment. Hospitals must vaccinate against data breach risks in order to take better care of patients and their data.”

Videos: 2011 ONC Annual Meeting

2011-11-18T09:30:00.001-08:00

The Office of the National Coordinator for Health Information Technology (ONC) held its 2011 ONC Annual Meeting this week. Much of the event was webcast and their was some great discussion on Twitter using the hashtag #ONCMeeting. Below is a menu of the videos from the sessions:

Opening Remarks

Play Flash Video

Plenary: The Ice Has Broken!
David Blumenthal, Samuel O. Thier Professor of Medicine and Professor of Health Care Policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School

Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology, Office of the National Coordinator for Health Information Technology (ONC), HHS

Play Flash Video

Acceleration and Tipping Points
Moderator: Josh Seidman, Director, Meaningful Use, ONC
Topics to be discussed include:
E-Prescribing
Speaker: Troy Trygstad, PharmD, MBA, PhD,Director of the Network Pharmacist Program, Community Care of North Carolina
EHR Adoption
Speaker: Carol L. Steltenkamp, MD, MBA, Chief Medical Information Officer, Associate Professor Pediatrics, University of Kentucky; Director, Kentucky Regional Extension Center
Informed Transitions
Speaker: Holly Miller, MD, MBA, FHIMSS, Chief Medical Officer, MedAllies
Consumer E-Health
Speaker: Ted Eytan, MD, MS, MPH, Director, The Permanente Foundation, Kaiser Permanente

Play Flash Video

Keynote: Achieving Big Changes
Jay Walker, Curator, TEDMED Conference

Play Flash Video

Interactive Session: Privacy and Security - You can do it!
Moderator: Joy Pritts, Chief Privacy Officer, ONC
Speaker: Leon Rodriguez, Director, HHS Office for Civil Rights

Play Flash Video

Keynote Presentation
Rick Gilfillan, MD, Acting Director, Centers for Medicare and Medicaid Innovation (CMMI), Centers for Medicare and Medicaid Services

Play Flash Video

Getting it Done
Moderator: Claudia Williams, Director, State Health Information Exchange (HIE) Program, ONC
Speakers from the State HIE, Regional Extension Centers, Workforce, Beacon Communities, and SHARP programs will discuss progress, challenges, and solutions.
HIE Grantee
Speaker: Harris Frankel, MD, Assistant Professor, University of Nebraska Medical Center (UNMC); Medical Director, UNMC Clinical Neurosciences Center;Â President, Nebraska Health Information Initiative (NeHII)
REC Grantee
Speaker: Lisa Rawlins, Executive Director, South Florida Regional Extension Center
SHARP Grantee
Speaker: Josh C. Mandel, MD, Research Faculty, Children's Hospital Boston & Harvard Medical School
Workforce Grantees
Speaker: Norma Morganti, Executive Director, Midwest Community College Health Information Technology Consortium, Cuyahoga Community College
Speaker: Julie A. Jacko, PhD, Professor of Public Health, University of Minnesota; Principal Investigator and Director, University Partnership for Health Informatics (UP - HI)
Beacon Grantee
Speaker: Julie Schilz, BSN, MBA, Director, Community Collaboratives and Practice Transformation, Colorado Beacon Consortium

Play Flash Video

Meaningful Use is the Foundation for Better Care
Moderator: Janet Wright, MD, Executive Director, Million Hearts Initiative, Centers for Medicare and Medicaid Innovation (CMMI), Centers for Disease Control and Prevention (CDC)
A series of four presentations focusing on how meaningful use can be used to transform care.
Improving the Quality, Safety, and Efficiency of Patient Care
Speaker: Peter Basch, MD, FACP, Medical Director, Ambulatory EHRÂ and Health IT Policy, MedStar Health
Engaging Patients and Families
Speaker: Christopher H. Tashjian, MD, FAAF, Rural Family Physician, Ellsworth Medical Clinic
Improving Care Coordination
Speaker: Deb Aldridge, MSN, RN-BC, Beacon Program Director, Community Care of Southern Piedmont
Improving Population and Public Health
Speaker: Bruce D. Greenstein, Secretary, Louisiana Department of Health and Hospitals

Play Flash Video

IT Bricks and Mortar to Optimize Patient Centered Medical Homes
This session will showcase concrete examples of how information technology-enabled Patient Centered Medical Home (PCMH) care models have led to improvements in health outcomes. Panelists will discuss their use of strategies and tools (such as registries, clinical decision support and panel management) to increase IT-enabled PCMH-effectiveness in a variety of healthcare settings, and will discuss how to support better uptake and spread of promising practices. Questions the panelists will address include:
What are the high yield HIT investments to optimize PCMH cost, quality and population health outcomes?
What are the key operational learnings for practices across the country?
What should other stakeholders (i.e., payers, employers, state government, vendors) consider to improve IT-enabled PCMH performance?

Play Flash Video

Closing Remarks
Aneesh Chopra, United States Chief Technology Officer, Office of Science and Technology Policy, Executive Office of the President

Play Flash Video

Which of these presentations was your favorite?

Encryption and Electronic Health Records

2011-11-09T20:00:00.000-08:00

Your Health and Your Privacy: Protecting Health Information in a Digital World

The Subcommittee on Privacy, Technology and the Law of the Senate Committee on the Judiciary held a hearing entitled “Your Health and Your Privacy: Protecting Health Information in a Digital World” on Wednesday, November 9, 2011. Deven McGraw, Director of the Health Privacy Project at the Center for Democracy and Technology presented testimony (video below). "We know from the statistics on breaches that have occurred since the notification provisions went into effect in 2009 that the healthcare industry appears to be rarely encrypting data," she said. "The wild, wild west for data is not an environment of trust," she added.

Senator Tom Coburn, R-Okla., the subcommittee's ranking member who is also a physician, questioned whether switching to electronic records was worth the riskes. He raised concerns about hackers finding a way to take sensitive records. "They gotta get into my office to get it when it's on a piece of paper," said Senator Coburn. "Maybe we ought to rethink some of what we're doing," he said.

Senator Franken, D-Minn., chairperson of the subcommittee asked Leon Rodriguez, director of the Office for Civil Rights at HHS, when the enforcement rules would be finalized. She could not give a timetable, so Senator Franken told her "OK, well hurry up." After the hearing Senator Franken said, "The bottom line is that people have a right to privacy and to know that their data is safe and secure, and right now that right is not a reality."

These concerns were also discussed in the PCAST Report "A well-designed combination of encryption, authentication [and] authorization…can yield a health IT infrastructure that is secure and where all principals are auditable," the report stated. Earlier this year a survey of more than 500 auditors by the Ponemon Institute, "What auditors think of crypto technologies," found encryption the top choice over data tokenization or other cryptographic techniques. There is little doubt that encryption is a piece of the security puzzle; however, it is not the total answer.

Health Reform and the Supreme Court

2011-11-06T21:02:00.001-08:00

I thought this video encapsulated the issues around the upcoming battle over healthcare reform in the Supreme Court and makes a great companion to my post on the topic.

Supreme Court and Healthcare Reform

2011-11-02T07:11:00.000-07:00

"Scarcely any question arises in the United States which does not become, sooner or later, a subject of judicial debate."
Alexis de Tocqueville, Democracy in America (1835)

The Supreme Court of the United States of America

It is very likely the Supreme Court will decide to eventually hear cases challenging to the new federal health reform law at its Conference on Thursday, November 10. As Jonathan Cohn has said there is no remaining chance that the Supreme Court will pass on the issue altogether. I have included brief biographies and their likely votes when the Court ultimately hears the case(s) below. One of the best resources around on this subject is the SCOTUS Blog healthcare section. I will be following the progress of these important cases and hope to provide a laypersons perspective, while also focusing on some specific aspects of the law pertaining to technology.

One of the first issues to dispense with is the idea that there may be any recusal of any of the Justices on these cases. This will not happen and all of the Justices will participate. While there is clamoring for both Justice Kagan to recuse herself, and Justice Thomas to recuse himself, I would be willing to bet that neither will. Since the justices themselves are their own final arbiters on this decision, they can do what they want and they will hear the case.

The next big question is the final outcome: It will be 5-4 or 4-5. It is still too close to call, but as we get closer to their deliberations I will make a prediction. For now though, I think it is safe to say that Kennedy will (as usual) be the swing vote. As Ilya Somin said on a "Constitutionality of the Individual Mandate" NEJM Perspective Roundtable:

I think the key swing voters then are Chief Justice Roberts and Justice Kennedy, and particularly in the case of Kennedy, it’s very difficult to predict where he’ll come down. I would note that in recent opinions, including most recently in Bond vs. the United States, he has emphasized the importance of structural limits on federal power. And he has emphasized the ways in which those limits promote individual liberty.

I disagree that Roberts is likely to uphold the law, but agree that Kennedy will be the deciding vote. Justices Roberts, Scalia, Thomas and Alito will vote to overturn the individual mandate. Justices Ginsberg, Breyer, Sotomayor, and Kagan will vote to uphold the law. So the real question will be how is Kennedy going to vote...

John Roberts, Jr. was born January 27, 1955 and is the 17th and current Chief Justice of the United States. He has served since 2005, having been nominated by President George W. Bush after the death of Chief Justice William Rehnquist. He has been described as having a conservative judicial philosophy in his jurisprudence. He is likely to find the individual mandate of health reform unconstitutional, but it isn't clear if he would throw out the entire law.

Justice Antonin Scalia was born March 11, 1936. As the longest-serving justice on the Court, Scalia is the Senior Associate Justice. Appointed to the Court by President Ronald Reagan and has served since Sept. 26, 1986. Scalia has been described as the intellectual anchor of the Court's conservative wing. He is almost certain to find the individual mandate unconstitutional and would likely also overturn the entire law.

Justice Clarence Thomas was born June 23, 1948. He was appointed by President George H.W. Bush and has served since Oct. 23, 1991. Succeeding Thurgood Marshall, Thomas is the second African American to serve on the Court. Thomas is a staunch conservative and has rarely asked any questions during arguments before the court. There is very little doubt that Thomas would find the health reform legislation unconstitutional.

Justice Samuel Alito, Jr. was born on April 1, 1950. He was nominated by President George W. Bush and has served on the court since January 31, 2006. Alito votes with the conservative side of the court. Alito's position will probably be very close to Chief Justice Roberts. I do not think he will find the individual mandate constitutional.

Justice Anthony Kennedy was born July 23, 1936. He was appointed by President Ronald Reagan in 1988. Since the retirement of Sandra Day O'Connor, Kennedy has often been the swing vote on many of the Court's politically charged 5–4 decisions. Conservatives have felt betrayed by some of his decisions, but other observers say he reaches conservative results more often than not. Kennedy would be the swing vote on health reform.

Justice Ruth Bader Ginsburg was born March 15, 1933. Ginsburg was appointed by President Bill Clinton and took the oath of office on August 10, 1993. She is the second female justice (after Sandra Day O'Connor) and the first Jewish female justice. She is viewed as belonging to the liberal wing of the Court. She will very likely support the legislation.

Justice Stephen Breyer was born August 15, 1938. He was appointed by President Bill Clinton in 1994, and known for his pragmatic approach to constitutional law, Breyer is associated with the more liberal side of the Court. Breyer would likely support the individual mandate and certainly will not support overturning the entire law.

Justice Sonia Sotomayor was born on June 25, 1954. She was nominated by President Barack Obama to replace retired Justice David Souter and has served on the court since August 8, 2009. Sotomayor is the Court's 111th justice, its first Hispanic justice, and its third female justice. Sotomayor will vote in favor of health reform.

Justice Elena Kagan was born April 28, 1960. She was nominated by President Barack Obama to replace Justice John Paul Stevens and has been serving since August 7, 2010. Kagan is the Court's 112th justice and fourth female justice. Kagan will support the health reform legislation.

Putting the 'IT' in Care Transitions

2011-10-08T16:20:00.000-07:00

Healthcare transitions which are not well coordinated can lead to emergencies, higher costs and lower quality. This is a big problem. Breaking the cycle of hospitalization, nursing home admissions, home health visits, followed by repeated hospitalizations, then spiraling into decline with eventual death is something we must do. In the case of my mother the last years of her life went through this revolving door with very high mental, emotional and financial costs.

A study published recently in The New England Journal of Medicine, confirms what many of us have observed: health care transitions, such as moves in and out of the hospital from a nursing home, do not lead to positive outcomes. More common are frequent medical errors; poor care coordination, infections and additional medications. For patients with acute dementia, these transitions can exacerbate already present symptoms such as agitation, confusion and emotional distress. But improving care transitions is important for everyone.

On Friday, October 14th, 2011, a group of innovators, policy and health IT experts, healthcare providers, patient organizations, technology companies, and government agencies will gather in Washington, D.C. to assess progress in improving transitions in care and to prioritize how better use of health IT can address some of the most difficult challenges related to care transitions on a broader scale. Conference participants will identify:

Best practices using health IT that can be implemented immediately to improve care transitions
Best practices that can be implemented within a year
A research agenda focused on finding solutions to persistent barriers to further progress.

As a wonderful example of using government as a platform, the John A. Hartford Foundation, the Gordon and Betty Moore Foundation, and Kaiser Permanente, with the Office of the National Coordinator for Health IT and the Beacon Communities as key participants, are convening this event. Portions of the event will be webcast and there will be active discussion on Twitter and Google Plus. One goal is to encourage debate and interaction among all participants about this important subject through social and traditional media, before, during and after the meeting. Sign up for registration HERE, look for the hashtag #ITrans, and join in the conversation.

The event will focus on a set of prominent drivers of errors that are major opportunities for improvement by better using technology. There will be breakout session during the event on each of these levers. They are:

Discharge process
Medication reconciliation
Information flow/exchange
Patient and care-giver activation

One of the aims of the event will be to coordinate and align multiple ongoing efforts related to transitional care interventions, with a special focus on the role of health IT in improving transitional care interventions. We will also review the most promising transitional care levers and attempt to achieve consensus among experts and practitioners about the most important characteristics or practices currently available. There will be an effort to identify current problems or constraints within each lever and specific actionable steps that can be taken by government, foundations, and the private sector to foster greater innovation/development. Strategies for spreading promising IT-enabled models, and barriers outside the realm of HIT will also be explored.

As HHS CTO Todd Park said, "Care transitions are difficult for patients and families for many reasons. If we can clearly identify the most challenging issues, for which no solutions exist today, we will provide much needed focus to innovators and investors across the country who are energized to improve care for patients, and systems of care for providers."

Some of the speakers participating in the event will be: National Coordinator for Health IT, Dr. Farzad Mostashari; Todd Park, Chief Technology Officer of HHS; Dr. Aaron McKethan, ONC Director of the Beacon Community Program; Dr. Eric Coleman, creator of the Care Transitions Intervention; Dr. Joanne Lynn, Altarum Institute; Carol Beasley, Institute for Healthcare Improvement (IHI) and Health Affairs Editor-in-Chief, Susan Dentzer.

Using technology to improve care transitions can have an incredible impact, not only on outcomes but eventually also on the cost of care. Health IT will be key to improving quality by better coordinating care across the healthcare continuum. “By expanding the smart use of health information technology during transitions, we are paving the way for smarter, lower-cost health care and new levels of sustainable health care quality,” said George Bo-Linn, MD, Chief Program Officer of the San Francisco Bay Area Program with the Gordon and Betty Moore Foundation. “This kind of large-scale, systemic change has the potential to make a difference in people’s lives that will be both lasting and significant.”

“With our eyes on the prize to ensure seamless transitions, we are pursuing a range of aligned strategies including standards, interoperability, exchange and provider adoption and meaningful use. Through our programs, we need to deeply understand and spread the simple yet powerful HIT-enabled solutions that address the complex problem of care transitions,” said Farzad Mostashari.

Care transitions refer to any movement patients make between practitioners and health care settings, but for the purpose of this meeting, are defined as hospital to post-hospital. Hospital readmissions, one common outcome of an unsuccessful transition, are extremely expensive: one in five Medicare patients is back in the hospital within 30 days of discharge, at the cost of approximately $17 billion per year, and many of these readmissions are considered avoidable.

“All health care providers understand both the human need to improve the patient experience during transitions of care, as well as the new demands that Medicare and others will be placing on systems to improve transitions. This meeting is an important service to anyone trying to create patient-centered transitions that are high quality, safe and efficient,” said Scott Young, MD, Associate Executive Director of Clinical Care and Innovation at Kaiser Permanente.

“It is increasingly clear that health information technology, implemented in a patient-centered way, has vast potential to help us reduce the number of injuries, accidents and re-hospitalizations that are causing stress and harm to patients, particularly older patients, every year,” said Christopher Langston, PhD, Program Director of the John A. Hartford Foundation. “We are committed to helping identify and support the best examples of health IT to assist complex patients in their most vulnerable moments.

Ada Lovelace 2.0 - Her Head in the Clouds and Feet on the Ground

2011-10-07T11:11:00.000-07:00

Today is Ada Lovelace Day. Last year I wrote an Ada Lovelace post on Jennifer Pahlka, one of the the visionary founders of Code for America. Jennifer actually wrote a post on Carolyn Lawson two years ago for Ada Lovelace Day and this year I want to write about Carolyn. Carolyn recently served as director of the California eServices office and deputy director of the state’s Technology Services and Governance Division and was previously the CIO of the California Public Utilities Commission (CPUC). While at CPUC, she led an effort to bring cloud computing to the agency and brought serious expertise in website re-design in various projects for California state government. In July this year she began her job as CIO of the Oregon Health Authority (OHA) and I am super excited about her role here.

I first met Carolyn at the Gov 2.0 events that Tim O'Reilly convened and then started following her on Twitter and watching her great work in California. This year we had some great discussions in Cambridge, Massachusetts at the first Health FOO. Carolyn presented last year at the Gov 2.0 Expo during a panel on "Finding Value in the Cloud" and in the video below she was interviewed by Alex Howard of O'Reilly Media during the conference:

Carolyn pioneered things like crowd sourcing and greater use of cloud services when she was with California and now in Oregon we will benefit from her experience and vision. Carolyn was also a winner of the prestigious in 2009 for her work in with CPUC for developing a secure mobile environment so employees could work from anywhere on any device, and 2010 for her work at the California eServices Office. One of the many innovations they instituted was a widget created for the state's Employment Development Department that combined the department's news, Twitter and YouTube services for the public. Within two months, the widget had received 2 million impressions and now after being placed on over six thousand websites it has received tens of millions of impressions. The office also worked with six other state organizations to develop and launch a website, at business.ca.gov, in support of the Office of Economic Development, after that office was created through the consolidation of other departments. Carolyn is able to use innovation and technology to do more with less.

This is exactly the kind of thinking that we need to apply to healthcare. With decreasing budgets and increasing needs we are approaching a crisis point in healthcare and as the landscape continues to shift Carolyn will be able to bring her insights and approach to help solve some of these vexing problems.

One area that Carolyn has been a thought leader in is in cloud computing. Carolyn's motto is "You don't say we can't, you say we can if..." Carolyn told me, "Could computing has now overcome many of the issues around security and now there is great opportunity for both government and business." John Foley from Information Week interviewed here after her panel discussion back in 2008 at Enterprise 2.0's "Evening in the Cloud." which you can view below. Since then the industry has matured and some of the barriers to moving into the cloud have fallen away. "Regarding cloud computing 'No!' should not be engraved in your thinking. Maybe in some cases it is 'Not today,' but always be willing to look to the future." I couldn't agree more...

HIMSS EHR Association Comments NwHIN Power Team Deliberations

2011-09-27T17:00:00.000-07:00

The NwHIN Power Team, a subcommittee of the HIT Standards Committee, has been working over the past few months to analyze and score the NwHIN Exchange (SOAP) and Direct (SMTP/SMIME) specifications on such criteria as:

Need for specified capability
Maturity of the specification
Maturity of the underlying technology used in the specification
Deployment and operational complexity
Industry adoption
Available alternatives

The Power Team reviewed and refined these scores through several iterations, and will present their final analysis and recommendations at the September 28, 2011 HIT Standards Committee meeting.Below are the slides from the NwHIN Power Team recommendations:

Based on industry experience and investments in these efforts not only by health IT suppliers but also by provider organizations, the EHR Association has provided comments to the NwHIN Power Team, focused on several key points, including:

Vendor readiness to support the NwHIN Patient Discovery, Query for Documents, and Retrieve (IHE XCPD & XCA) standards is more advanced than reflected in the Power Team analysis.
We encourage the Power Team to address the gap resulting from the decision to not consider the use case for sharing health Information among HIE communities.
Concerns expressed regarding the “complexity” of the Patient Discovery specification do not reflect the reality that this complexity comes not from the specifications, but from policy decisions not to develop shared patient identification principles and related operational deployment issues.
The rationale for proposing to develop a RESTful approach as an alternative to the NwHIN needs to be validated.
The Power Team discussion about why a specification gets a low or medium rating should be documented for the sake of transparency.

The full comments (available here) containing a detailed discussion have been submitted to the Power Team. I will post more after the Power Team makes their recommendations to the HIT Standards Committee.

The EHR Association is comprised of industry experts in the field of healthcare information technology with a broad scope of expertise such as medical and clinical informaticists, physicians, nurses, pharmacists, and technology experts who not only represent the EHR software industry but also interact and represent the entire healthcare community. The EHR Association offers unmatched experience and expertise, and provides a forum and structure for EHR leaders to work toward standards development, interoperability, the EHR certification process, performance and quality measures, HIT legislation, and other EHR issues.

Hearing on Healthcare Industry Consolidation

2011-09-23T11:11:00.000-07:00

On September 9, 2011 the U. S. House Ways and Means Health Subcommittee held a hearing on the consolidation taking place in the healthcare industry. The hearing focused on the impact healthcare consolidation is having on the cost of private health insurance, Medicare spending, and beneficiary costs. The subcommittee's ranking member, Rep. Pete Stark (D-Calif.) Rep. Charles Boustany (R-La.) said "It's refreshing to see our majority raise concerns about competition in the marketplace and how it may result in outcomes that are bad for consumers and for Medicare." Rep. Charles Boustany (R-La.) a cardiovascular surgeon and chairman of the Ways and Means oversight panel, said the healthcare reform law focused too much on getting doctors and hospitals to work together and not enough on the potential downsides.

Chairman Wally Herger (R-CA) called the meeting with the following statement:

Recent years have seen a large number of acquisitions and mergers in the health care industry. Among typical transactions, hospitals are buying or merging with other hospitals, hospitals are purchasing physician practices, physician practices are merging with physician groups, and large insurance companies are purchasing smaller plans. Industry experts expect regulations and policies contained in the new health care overhaul to exacerbate this trend.
While such consolidation may facilitate greater efficiencies and deliver higher quality services by eliminating duplication and excess capacity, many experts are concerned that some consolidations are being driven primarily by a desire to increase reimbursements. Richard Feinstein, director of the Bureau of Competition at the Federal Trade Commission, warned that provider consolidation “can create highly concentrated markets that may harm consumers through higher prices or lower quality care.”

In announcing the hearing, Chairman Herger stated, “While consolidation within the health care industry is not new a phenomenon, all signs point to it accelerating in the coming years. In some circumstances, consolidation produces desirable results like improved efficiency and quality. However, we must ensure that consolidation is not simply used as a tool to increase revenues by driving up Medicare spending and the cost of private health insurance. This hearing will provide members with a better understanding of what is currently taking place, what is expected to occur, and how we can protect America’s seniors and those with private health insurance and the employers who offer it.”

The following witness presented during the hearing:

Martin Gaynor, PhD
Professor, H. John Heinz III School of Public Policy and Management, Carnegie Mellon University
(Testimony)

Paul B. Ginsburg, PhD
President, Center for Studying Health System Change
(Testimony)

Dianne Kiehl
Executive Director, Business Health Care Group
(Testimony)

Michael Guarino
Member, Board of Directors, Ambulatory Surgery Center Association
(Testimony)

David Balto
Senior Fellow, Center for American Progress Action Fund
(Testimony)

The American Medical Association (AMA) also submitted a statement during the hearing on the topic. The AMA’s statement examined the current state of consolidation in the health care industry, including areas where changes are needed to protect patients and encourage the success of new models of patient care.

“Existing antitrust policies allow significant consolidation in some areas of our health care system while overly restricting the coordination of care by physicians,” said AMA President Peter W. Carmel, M.D. “It is time to update these policies to allow physicians in all practice sizes the ability to lead and participate in innovative new models of care while protecting patients from anticompetitive practices.”

A full 78 percent of office-based physicians in the United States work in practices with nine physicians or less, and a majority of those are in practices of one to four. Under existing antitrust enforcement policies, these physician practices are effectively prohibited from forming clinically integrated groups that can jointly contract with private payers and participate in care improvement and coordination efforts.

Over the last decade AMA studies have consistently found that a wide majority of local health insurance markets across the nation are highly concentrated, which can mean decreased competition and higher prices for patients. The trend of hospitals merging and acquiring physician practices can also lead to reduced competition and an increase in the amount of care patients receive in more costly inpatient settings.

“We applaud the Ways and Means Committee for examining current policies related to consolidation in health care,” Dr. Carmel said. “We will continue to work with them to design policies that encourage the development of innovative, physician-led new models of patient care designed to improve quality, lower costs and promote competitive health care markets.”

The National Association of Chain Drug Stores (NACDS) has asked for scrutiny on the proposed merger of pharmacy benefit managers Express Scripts and Medco and outlined the “problems” it believes would result from the mega-merger in a letter submitted to the committee. NACDS stressed that the anticompetitive nature of this merger ultimately will hurt patients the most, limiting their choice in how and where they obtain their pharmacy services and prescription medications.

“NACDS thanks the Committee for consideration of our comments on healthcare industry consolidation. We are extremely skeptical that the American public can trust a ‘super PBM’ to look out for the best interests of patients and payors, including Medicare Part D, or to pass any purported ‘savings’ along to beneficiaries and other consumers. These concerns are compounded by the fact that the PBM industry as a whole is virtually unregulated,” NACDS concluded in its comments.
Three House Democrats also urged the Federal Trade Commission to closely scrutinize the merger in a letter to FTC Chairman Jon Leibowitz."The proposed merger would affect hundreds of millions of Americans with private health insurance and have a potentially significant impact on drug cost for government programs," said Reps. Henry Waxman (D., Calif.), Frank Pallone Jr. (D., N.J.) and Diana DeGette (D., Colo.).

VIDEO:

President Proclaims National Health IT Week

2011-09-12T11:11:00.000-07:00

NATIONAL HEALTH INFORMATION TECHNOLOGY WEEK, 2011
BY THE PRESIDENT OF THE UNITED STATES OF AMERICA

A PROCLAMATION

Technological advances have always driven America's economy forward and improved the lives of our people, from the industrial innovations of the nineteenth century to today's cutting edge science. Progress in our Nation's health care system is no different, and hinges on the work of hospitals, private practices, and information specialists as they modernize our health information systems. During National Health Information Technology Week, we highlight the critical importance of secure and efficient information systems to improving the delivery of health care in the United States.

Health information technology connects doctors and patients to more complete and accurate health records. Tools like electronic health records and electronic prescriptions help patients and providers make safer, smarter decisions about health care. This technology is critical to improving patient care, enabling coordination between providers and patients, reducing the risk of dangerous drug interactions, and helping patients access prevention and disease management services. It is currently being used with great success to coordinate and improve care for members of our Armed Forces, as well as our Nation's veterans. Better technology can also cut costs for providers by reducing paperwork and duplicative tests.

Ensuring the security of health information records is a top priority for my Administration. The American Recovery and Reinvestment Act, passed in 2009, promotes the use of Health IT while significantly strengthening Federal laws protecting patient privacy. Entities violating privacy laws are now subject to increased penalties. The Recovery Act also provides landmark financial incentives to eligible professionals and hospitals that adopt and meaningfully use electronic health records while protecting the privacy and security of health information.

Everyone can play a role in improving our health care system. An important part of this vision is recognizing the pivotal role patients play in maintaining and improving their own health. Patients can work with their doctors to access information about their care. And those who design and implement Health IT systems can enable software that puts patients and their families at the center of their own care, empowering and engaging them in reaching their health goals.

America is home to the world's best universities and technical schools, and the most creative scientists and entrepreneurs. As we challenge ourselves to push forward into a new century of health technology, we will continue to foster and promote the innovative spirit that has made our country what it is today.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim September 11 through September 17, 2011, as National Health Information Technology Week. I urge all Americans to learn more about the benefits of Health IT by visiting HealthIT.gov, take action to increase adoption and meaningful use of Health IT, and utilize the information Health IT provides to improve the quality, safety, and cost effectiveness of health care in the United States.

IN WITNESS WHEREOF, I have hereunto set my hand this twelfth day of September, in the year of our Lord two thousand eleven, and of the Independence of the United States of America the two hundred and thirty-sixth.

BARACK OBAMA

via whitehouse.gov

Things changed that day...

2011-09-11T06:59:00.000-07:00

I will never forget ten years ago on September 11, 2001. That day I woke up to a beautiful sunny morning and went out on the front porch to smoke a cigarette. It was the last one in the pack, so I knew I would be stopping by the store to pick up some more. My wife Joan called me in the house to see what was happening on the news. Naturally we were stunned as we saw these events unfold. As the hours went by I didn't even notice that I would usually have had a smoke by then. I told Joan, "Hey, that was my last cigarette!" meaning that I was out and would need go get more. She said "Really?" perhaps misunderstanding, but as it turns out that was indeed the last cigarette I have smoked. Considering the events of that day, it seemed natural to make the final decision to embrace life.

Later in the day we watched as the members of Congress gathered on the steps of the Capitol Building to pray and sign God Bless America. My son Jason, who was 14 years old at the time, said, "Dad, we should do something like that here." We called the mayor's office and after some discussion and many telephone calls that day it ended up that over 1,000 people gathered together as a united community in front of City Hall in The Dalles, Oregon to pray, sing and mourn together. This was the day I started to become more politically active, serving on boards and committees and eventually holding elected office.

As I reflect on the past ten years, I am sometimes amazed at the changes in our world and in my life. In the days after 9-11 our nation was united and there was a sense of caring for each other on such a broad scale. This unity and strength of purpose did not always hold fast, but on days like today when we commemorate the tenth anniversary of that fateful day I am hopeful. I am hopeful that one day we will live in a world where people are kind to each other, where understanding others is more important than getting our own way, and where peace reigns.

Health Information Exchange Efforts Heat Up

2011-09-06T05:20:00.000-07:00

The need for robust health information exchange (HIE) continues to grow, and not just because it is a part of the meaningful use incentive program. Having infrastructure to support HIE will be a critical component to enable new payment and care delivery models like accountable care organizations and medical homes.

Background on HIE Efforts

There has been a strong national effort in developing the Nationwide Health Information Network (NwHIN), as well as a dramatic increase in local and regional efforts to create viable health information exchange organizations (HIOs). These efforts include the Direct Project, which created a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. The Direct Project -- which was sponsored by the Office of the National Coordinator for Health IT -- has become an important on-ramp to the health information superhighway.

But just as state and local governments alone could not build and maintain the Interstate Highway system, the federal government has stepped in to provide funding and a policy framework to develop the NwHIN. As part of the HITECH Act -- most famous for its incentives for the meaningful use of electronic health records -- 56 states and territories received $548 million to build out HIE capabilities at the state level, with a requirement that nearly a third of their budget be allocated toward interstate exchange...

Read more at my iHealthBeat post

EHR Incentives Likely to Improve Quality

2011-08-31T14:00:00.000-07:00

Federal Investment in Electronic Health Records Likely to Reap Returns in Quality of Care

Healthcare is one of the last industries in the United States to universally incorporate technological advancements. While most sectors have made significant investments in information technology to improve efficiency and consumer relationships, America’s health care system is still largely paper-driven. As a result the healthcare system is plagued by inefficiency and poor quality. Delivery is slower, more prone to errors, and harder to measure and coordinate than it should be. Investments in health information technology can help improve this situation. Research published in the New England Journal of Medicine (FREE FULL TEXT) gives cause for optimism that efforts to increase adoption of electronic health records (EHRs) will provide major benefits in better patient care and health outcomes. Perhaps we can finally move away from using a dead tree medical recod system in this country.

To start with take a look at this video from a 1961 study that concluded that one day it is going to be possible to relieve the nurses and doctors of some of their paperwork, it is going to be possible to have correlation of diseases which we have not had before, and it is going to be possible to eliminate errors in medications and tests which would have been harmful to the patient:

“We were not surprised by these results,” said Randall D. Cebul, M.D., a professor of medicine at Case Western Reserve University and the study’s lead author who I was able to speak with earlier today. “They were influenced by several factors, including our public reporting on agreed-upon standards of care and the willingness of our clinical partners to share their EHR-based best practices while simultaneously competing on their execution.”

The research involved more than 500 primary care physicians in 46 practices that are partners in a region-wide collaborative known as Better Health Greater Cleveland (Better Health). This alliance of providers, businesses and other stakeholders is dedicated to enhancing the value of care for patients with chronic medical conditions in the region. Launched in 2007, the organization is one of 16 that the Robert Wood Johnson Foundation chose to support in its nationwide initiative, called Aligning Forces for Quality. This initiative is the foundation’s signature effort to lift the overall quality of health care in targeted communities as well as reduce racial and ethnic disparities and provide models that will help propel national reform. Common themes across the communities include public reporting of performance and community-wide initiatives to improve care.

As important as electronic health records are, Dr. Cebul said, their greatest value merges when used in conjunction with other approaches, such as the sharing of best practices and coaching offered through collaborations such as Better Health Greater Cleveland. "We've been doing summits twice yearly and will continue in the future so that we can identify and share best practices among providers. We also will provide ongoing coaching to practices that wish to continue to improve clinical outcomes," he said. The patient centered medical home is built on the foundation of electronic health records, and Better Health is working with employers and payers in the region to develop medical homes as well as exploring opportunities to participate in new payment models.

I asked Dr. Cebul what impact health information exchange will have on continuing improvements, particularly in the area of clinical care coordination. "I think that HIE will have a big benefit and it's value will be as much in cost reductions as it will in improving quality of care. For the smaller practices it will be very valuable in providing data from outside providers and specialists. HIE will enable us to reduce unnecessary emergency room visits and hospital readmission, as well as reducing duplicate testing. This will also accelerate the process of clinical evaluation and save money."

The authors did caution that they could not conclude that EHRs were the only explanation for quality differences. Other potential causes could be "the participation of exceptional EHR-based organizations, a nonrepresentative sample of paper-based organizations and inadequate adjustment for patient characteristics," they stated. Their study also would have provided even more compelling evidence for an advantage to EHR use if they had measured before-and-after performance for groups that had switched away from paper-based to using an EHR. But this study absolutely provides a basis for determining that digitizing medical records can have a substantial impact on quality of care.

The study involved more than 27,000 adults with diabetes and found that those in physician practices using EHRs were significantly more likely to have health care and outcomes that align with accepted standards than those where doctors rely on paper records. Improvements in care and outcomes over a three-year period also proved greater among patients in EHR practices. The study’s findings remained consistent for patients regardless of insurance type, including the uninsured as well as patients insured by Medicare, Medicaid, and commercial payers.

The data shows a staggering difference in performance among practices with EHRs as compared to those without: 51 percent of diabetes patients in EHR practices received all the care they needed as compared to only 7 percent in practices with paper records. A similar variation was also reported for diabetes patient outcomes—how well patients and their doctors were able to effectively manage their condition. For both care and outcomes, patients treated at practices with EHRs far outpaced those in paper practices across all insurance types—whether patients were on Medicare, Medicaid, a commercial plan or uninsured. Breaking the data down further shows that for practices using EHRs, the percentages of patients meeting standards for diabetes care were higher for making sure hemoglobin A1c tests were performed, kidney management was maintained, eye examinations were made than for those practices using paper records.

The Better Health study focused on a 12-month window spanning 2009 and 2010, and also followed trends over a three-year period. The study also measured achievement by age, gender and racial and ethnic categories as well as language preference and estimated patient income and education. The locally vetted national standards for care included timely measurements of blood sugar, management of kidney problems, eye examinations, and vaccinations for pneumonia. Outcome measures included meeting national benchmarks for blood sugar, blood pressure and cholesterol control, as well as achieving a non-obese Body Mass Index and avoidance of tobacco use. Patients who made at least two visits to the same primary care practice within a single year were included. The researchers reported results for individual standards as well as separate composite standards for care and outcomes. In the future they will be also developing metrics for patient satisfaction, as well as possibly adding childhood obesity and hypertension.

The study’s findings were striking – even after researchers statistically accounted for differences between EHR and paper-based practices in the characteristics of their patients.

Standards of Care: Nearly 51 percent of patients in EHR practices received care that met all of the endorsed standards. Only 7 percent of patients at paper-based practices received this same level of care – a difference of 44 percentage points. After accounting for differences in patient characteristics, EHR patients still received 35 percent more of the care standards.
Patient Outcomes: Nearly 44 percent of patients in EHR practices met at least four of five outcome standards, while just under 16 percent of patients at paper-based practices had comparable results. After accounting for patient differences, the adjusted gap was 15 percent higher for EHR practices.
Trends Over Time: After accounting for patient differences, EHR practices had annual improvements in care that were 10 percent greater than paper-based practices as well as 4 percent greater annual improvements in outcomes.
Performance Across Insurance Types: Patients in EHR practices showed better results, including improvements over time, in both standards of care and outcomes across all insurance categories – commercial, Medicare, Medicaid and uninsured.

“These results support the expectation that federal support of electronic health records will generate quality-related returns on our investments,” said David Blumenthal, M.D., M.P.P., professor of medicine and health care policy at Harvard Medical School and past National Coordinator for Health Information Technology. “I am especially pleased that the benefits reported in this investigation spanned all insurance types, including Medicaid and uninsured patients, since it is essential that the modern information technologies improve care for all Americans, including our most vulnerable citizens.”

“Cleveland stands as a pioneer in the burgeoning movement to leverage local resources and federal reform opportunities to improve health care quality,” said Anne F. Weiss, M.P.P., who leads efforts to improve the quality of American health care at the Robert Wood Johnson Foundation. “Electronic health records alone cannot solve the nation’s health care quality problems, but they are an important part of the fix. Cleveland’s use of electronic health records is a model for all health care organizations working to implement health reform.”

“Better Health seeks to improve the value of health care for all of the region’s residents and those who pay for their care,” said David L. Bronson, MD, FACP, president of Cleveland Clinic Regional Hospitals and President-elect of the American College of Physicians. “As the program moves forward, we expect that EHR-based sharing of information across different health care systems, and with our patients, will help us to keep our patients healthier and foster more discriminating use of expensive resources, such as our emergency departments and hospitals.”

This perspective is also echoed by other national leaders as well. Not only do such collaborations enhance care and outcomes, but they also provide rich opportunities to test the impact of different approaches and innovations. As Dr. Carolyn Clancy, M.D., director of the federal Agency for Healthcare Research and Quality, explained: “The results of this study support both the value of electronic health records and community-based partnerships to improve quality of care.”

Sharp Focus Roundup

2011-08-21T09:00:00.000-07:00

I've been thinking about the Strategic Health IT Advance Research Projects (SHARP) Program lately and plan to give an update soon on some of the progress being made. SHARP has four major efforts underway at major collaborative efforts at the University of Illinois at Urbana-Champaign, the University of Texas at Houston, Harvard University, the Mayo Clinic of Medicine, and Massachusetts General Hospital. The websites for each of these projects are:

SHARP Area 1 – Privacy and Security: the University of Illinois at Urbana-Champaign is helping develop technologies and policy recommendations that reduce privacy and security risks and increase public trust. (my Sharp Focus post)

SHARP Area 2 – Patient Cognitive Support: Innovative cognitive research is being led by the University of Texas, Houston to harness the power of health IT to integrate and support physician reasoning and decision-making as providers care for patients. (my Sharp Focus post)

SHARP Area 3 – Health Care Application and Network Design: Harvard University is leading platform-based research to create new and improved system designs that facilitate information exchange while ensuring the accuracy, privacy, and security of electronic health information. (my Sharp Focus post)

SHARP Area 4 – Secondary Use of EHR Information: Mayo Clinic of Medicine is developing strategies to improve the overall quality of healthcare by leveraging existing EHR data to generate new, environmentally appropriate, best practice suggestions.

SHARP Affiliate – Medical Device “Plug-and-Play” Interoperability Program: Massachusetts General Hospital is developing technology, software, standards, and tools to provide higher quality patient data by enabling medical device manufacturers to create products that will interoperate with other manufacturers’ devices, EHRs, and Health IT systems.

I believe that the research being done here will be a spark for innovation that can help drive healthcare into the future. I'm looking forward to the results of this research having a real world impact soon.

...

Mobile Health Whitepaper from Sprint and Frost & Sullivan

2011-08-08T08:00:00.000-07:00

Sprint has recently sponsored a Frost & Sullivan a whitepaper, Mobile Devices and Healthcare: What’s New, What Fits, and How Do You Decide? (414K pdf), which examines the proliferation of mobile devices in healthcare. The paper looks at the strengths and drawbacks of four major mobile device types – smartphones, tablets, push-to-talk communication devices, and machine-to-machine (M2M) remote medical monitoring devices. Each device category is evaluated for application in three unique environments – the hospital, physician’s office, and the patient’s home. Criteria for selecting a mobility partner are also discussed.

“The healthcare sector has never been known for being an early adopter of information technology. However, now there are innovative, powerful mobile devices that must be recognized as absolutely key to expanding and improving patient care, to controlling costs, and to complying with regulatory mandates,” said Frost & Sullivan Senior Industry Analyst, Jeanine Sterling.

Smartphone penetration among U.S. healthcare providers continues to surge, and understandably so. As these devices have become more powerful and convenient, their assortment of medical software applications has grown. Caregivers can now use their smartphones to easily access medical reference libraries, view lab results, monitor patient vitals, and access patient electronic health records (EHR). A second device category – today’s next-generation tablets – is now taking these capabilities and magnifying their usefulness with the aid of larger screens, high-resolution displays, and dual cameras.

Even the familiar push-to-talk devices are augmenting their instant voice communications benefit with new form factors and an array of new capabilities, providing needed functionality in multiple scenarios, including the emergency room and in natural disaster situations. And, lastly, M2M remote monitoring devices are starting to bridge the geographic gap between healthcare providers and patients who find it difficult to make in-person office visits. In addition to supporting patients with chronic conditions, M2M technology is being used for personal wellness monitoring and for helping elderly or at-risk individuals to live independently. M2M is improving outcomes and cutting expense – a win-win combination of benefits that few can afford to ignore.

“Mobile technology promises to transform healthcare. It all begins with the mobile device, and vendors are working hard to tempt healthcare providers with a broad, and often bewildering, set of choices. Different types of medical staff will have different information and communications needs. We discuss the criteria to consider when selecting the optimal device(s) and mobility partner. And we offer Sprint as an example of an end-to-end mobile solution provider that has done the due diligence and assembled a top-tier portfolio of solutions and partners,” stated Sterling.

EHR Incentive Program Gaining Ground

2011-08-04T20:00:00.000-07:00

Substantial momentum is building in the EHR Incentive Program as more and more states begin accepting registration and more providers and hospitals begin attesting to meaningful use. Robert Tagalicod, the new director of CMS Office of e-Health Standards and Services, and Elizabeth Holland, CMS director of health IT initiatives group, updated the HIT Policy Committee on August 3, 2011. The audio and slide deck from that portion of the meeting are below:

Meaningful Use Analysis

The report was given with the repeated caveat that these are preliminary results that should not be used to draw conclusions for policy making. However, there was some discussion of the report and as you heard above, Dr. Neil Calman, a policy committee member and CEO of the Institute for Family Health in New York, said "Once you have the capability of doing something in your system, people tend to do it much more than the thresholds we’ve set. So once you start doing e-prescribing, you can do it for everybody. I wouldn’t be surprised if these high levels are maintained as people qualify."

A new feature of the report was that the medical specialties associated with the eligible physicians and other professionals were separated. The two top specialties are family practice and internal medicine, with Cardiology a distant third place (see page 2 of report below). Twenty-one states have launched their Medicaid EHR program, with Arizona, Connecticut, Rhode Island and West Virginia in the past month according to the report. The CMS EHR Medicaid program also announced the addition of two new states that are now accepting provider registration, New Mexico and Wisconsin. These additions bring the total number of states participating in the Medicaid EHR program to 23.

The full report from CMS is below:

2011 July EHR Monthly Report

Secrets of HIE Success Revealed: Lessons from the Leaders

2011-08-01T07:00:00.000-07:00

The National eHealth Collaborative (NeHC) will release the much anticipated report, Secrets of HIE Success Revealed: Lessons from the Leaders, during a live webinar on Tuesday, August 2, 2011. The program will feature Kate Berry, CEO of NeHC, and executives from the 12 HIEs profiled in the report. You can access information on the webinar HERE.

NeHC recently hosted the HIE Leaders Roundtable to introduce the 12 HIE leaders and preview the findings of the report, Secrets of HIE Success Revealed: Lessons from the Leaders. During the event, the leaders were asked to give a brief overview of their organizations and comment on their sustainability models. The discussion also covered how the HIEs are engaging consumers and offering services to empower them to become more engaged in their care.

The report was commissioned by NeHC in order to provide in-depth studies of successful and mature HIEs in diverse geographies and market types. The report captures the key dimensions of success for HIE leadership and sustainability, provides insight and guidance for emerging HIEs, and contributes to the development of a national roadmap for health information exchange. The report aims to continue this conversation and provide a guide for emerging HIEs. In developing the report, NeHC worked with the State HIE and Beacon Community teams at the Office of the National Coordinator for Health Information Technology (ONC) to ensure that the findings in the report would provide value and work to inform the ongoing conversation about the national roadmap for HIE to improve healthcare for all Americans.

Health IT Provides Tools to Improve Patient Safety

2011-07-21T07:11:00.000-07:00

Wider use of EHRs, along with computerized provider order entry (CPOE), clinical decision support (CDS) and barcode medication administration, could play critical roles in addressing the Joint Commission’s National Patient Safety Goals, according to a recent commentary in The Journal of the American Medical Association. In the interview below , one of the co-authors, Dr. Ryan P. Radecki discusses the commentary.

Download MP3

The Joint Commission's 2011 National Patient Safety Goals (NPSG) include identifying patients correctly, getting test results to the right staff person at the right time, making sure medications are labeled correctly, checking medications for possible adverse reactions, preventing infections and identifying patients at risk of suicide. Incorporating the National Patient Safety Goals into the criteria for EHR certification would facilitate the use of EHRs to address patient safety issues.

Below Patricia Adamski, Director, Standards Interpretation for The Joint Commission, speaks at IHI's 22nd Annual National Forum on the NPSGs:

EHRs and related health IT have been promoted as tools to improve patient safety, but the promise remains largely unfulfilled, wrote co-authors Ryan P. Radecki, MD, department of emergency medicine, East Carolina University Brody School of Medicine, in Greenville, N.C., and Dean F. Sittig, PhD, professor at The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics. The authors of the JAMA commentary conclude:

"The 2011 NPSGs provide high-yield guidance to EHR certification and oversight bodies who should refine their criteria for meaningful use to include incentives for development and use of tools to enhance safety. As with all computer-based interventions, incorporation of EHRs into routine clinical workflow is critical; their effectiveness depends on appropriate maintenance, effective user training, periodic institutional self-assessment of EHR safety and effectiveness, and clinically focused policies to support their use. Although EHRs by no means represent all necessary mechanisms to address critical safety problems, they can provide tools to help organizations improve their performance."

Xerox Survey Shows Impact of Electronic Health Records

2011-07-20T10:00:00.000-07:00

Patient education and communication required to ease transition to digital

More needs to be done to assure patients that their personal medical information will be safe and secure following the nationwide switch to Electronic Health Records (EHRs), according to results of a recent online survey conducted among 2,720 U.S. adults for Xerox Corporation (NYSE: XRX) by Harris Interactive.

Nearly 80 percent of respondents who have concerns about digital medical records indicated stolen personal information by a computer hacker to be their number one worry, followed by the threat of lost, damaged or corrupted records at 64 percent and the misuse of information at 62 percent.

“The survey results indicate an urgent need for better patient-provider communication,” said Paul Solverson, partner, strategic advisory services, ACS, A Xerox Company. “Providers need to start conveying the benefits of electronic records, particularly the security advantages over today’s paper-based system.”

And despite healthcare reform dominating the news for the last year, the survey indicates that respondents are still unclear on how EHRs impact them. Only 18 percent (up just 2 percent from Xerox’s 2010 survey) of U.S. adults who have a healthcare provider have been approached by their provider to discuss EHRs.
Botsford Hospital in Farmington Hills, Mich., is launching its Electronic Medical Records (EMR) system at the end of this year. The system will allow EHRs to “follow” a patient as he or she moves through different departments of the hospital, enhancing the quality of care.

“When a patient moves from the Emergency Center to Radiology or Critical Care, for example, their EHRs will be immediately available to the various caregivers, greatly increasing patient safety and quality of care,” said Dr. Paul E. LaCasse, president and CEO, Botsford Hospital.

The benefits of Botsford’s EMR system, which is being implemented by Xerox, are already being communicated to staff. And, the hospital has a detailed communication plan in place for patients. “We consider communication and training an important part of implementation,” added LaCasse. “It’s essential to allay concerns and demonstrate what a powerful tool EHRs can be in providing quality healthcare.”

In addition, this year’s survey found that more than half of U.S. adults familiar with the conversion of paper records to digital records (51 percent) do believe that EHRs will result in better, more efficient care – up from last year’s survey when only 49 percent agreed.

Methodology:

This survey was conducted online within the U.S. by Harris Interactive on behalf of Xerox Corporation from May 5 – 9, 2011 among 2,720 adults ages 18 and older. The survey in 2010 was conducted Feb. 17 – 19, 2010 among 2,180 adults ages 18 and older. This online survey is not based on a probability sample and, therefore, no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables, please see below media contacts.

About Xerox

Xerox Corporation is a $22 billion leading global enterprise for business process and document management. Through its broad portfolio of technology and services, Xerox provides the essential back-office support that clears the way for clients to focus on what they do best: their real business. Headquartered in Norwalk, Conn., Xerox provides leading-edge document technology, services, software and genuine Xerox supplies for graphic communication and office printing environments of any size. Through ACS, A Xerox Company, which Xerox acquired in February 2010, Xerox also offers extensive business process outsourcing and IT outsourcing services, including data processing, HR benefits management, finance support, and customer relationship management services for commercial and government organizations worldwide. The 134,000 people of Xerox serve clients in more than 160 countries.
For more information, visit
http://www.xerox.com,
http://news.xerox.com,
http://www.realbusiness.com or http://www.acs-inc.com.
For investor information, visit http://www.xerox.com/investor.

Reflections from the Federal Chief Information Officer

2011-07-18T08:00:00.000-07:00

The President’s Council of Advisors on Science and Technology (PCAST) met on July 15, 2011. Outgoing Federal CIO Vivek Kundra updated the committee and gave insights into many of the challenges he sees ahead. "I think the privacy implications are very, very serious," Kundra said. "From a national security perspective what we've done is we've made sure that the NSC (National Security Council) is involved as we're vetting some of these critical data sets."

The four areas he focused on were:

1. Structural Challenges (See: 25 Point Plan to Reform Federal IT)

2. Efficiency and Effectiveness

3. Cybersecurity

4. Open Government

The video of his testimony is below:

Vivek Kundra, Federal Chief Information Officer, Office of Management and Budget, The White House

Transparency and Federal Management IT Systems

2011-07-17T22:00:00.000-07:00

The Committee on Oversight and Government Reform held a meeting on July 14, 2011 entitled "Transparency and Federal Management IT Systems." The hearing examined how federal agencies use their financial management IT systems, highlighted best practices, and looked at systems in need of improvement. Specifically, the hearing focused on the information technology systems federal agencies use to report spending, examined how these systems connect with government-wide systems, and looked at problems that lead to inaccurate, delayed, or incomplete reporting.

Vivek Kundra, Federal Chief Information Officer, presented at the meeting, for perhaps the last time before Congress. His full written testimony submitted for the meeting is below the video:

EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF MANAGEMENT AND BUDGET WASHINGTON, D.C. 20503

STATEMENT OF VIVEK KUNDRA
FEDERAL CHIEF INFORMATION OFFICER, ADMINISTRATOR FOR E-GOVERNMENT AND INFORMATION TECHNOLOGY
OFFICE OF MANAGEMENT AND BUDGET

BEFORE THE HOUSE COMMITTEE ON OVERSIGHT AND GOVERNMENTAL REFORM
SUBCOMMITTEE ON TECHNOLOGY, INFORMATION POLICY, INTERGOVERNMENTAL RELATIONS AND PROCUREMENT REFORM

“Transparency and Federal Management IT Systems”
July 14, 2011

Good afternoon, Chairman Lankford, Ranking Member Connolly, and members of the Subcommittee. Thank you for the opportunity to testify on ongoing efforts to improve transparency through information technology.
Since day one, the Administration has been committed to open government and increased transparency. As President Obama stated in his Inaugural Address, we must “spend wisely, reform bad habits, and do our business in the light of day, because only then can we restore the vital trust between a people and their government.” Transparency strengthens our democracy and promotes efficiency and effectiveness in Government.

Open Government platforms have helped the Federal government crack down on wasteful technology spending, attack fraud and abuse, and spur innovation by democratizing data.

As we scale these practices we undoubtedly will face obstacles on many fronts. Yet, our efforts to date have revealed key principles that will guide us as we move forward.

Cracking Down on Wasteful Technology Spending

We launched the IT Dashboard and transformed the way we look at Federal IT investments. Information on the performance of IT projects – such as budgets and schedules – that was once stored within agency walls on reams of paper and seldom updated is now publicly available online and refreshed every month.

Using the Dashboard, anyone from agency officials to the American people can now identify and monitor the performance of IT projects, on their laptops and mobile phones, just as easily as they can monitor the stock market or baseball scores. If a project is behind schedule or over budget, the Dashboard tells you that.

The Dashboard ends the days of faceless accountability. It provides the name of the agency official responsible for the project, shows you their picture and lets you contact them directly to provide feedback on the project’s performance.

Figure 1

The release of this information was a massive change in the way we had traditionally managed Federal IT. Vendors, project managers, and agency Chief Information Officers are now executing their projects in the light of day.

For the Dashboard to drive transparency effectively, it had to be easy to use. We sought to build a consumer-class product that opened up the operations of the Federal Government to the world – not a compliance-oriented tool that would be seldom used outside the halls of government. So we focused relentlessly on the customer from the outset. During the 60 days we took to build it, we reviewed early versions of the IT Dashboard with members of Congress, GAO, industry, and various good government groups. Their feedback was instrumental in shaping the end-product.

We also wanted to make the Dashboard as easy as possible for agencies to update. To help them learn to use the IT Dashboard and see in advance how their data would be reflected, we held a series of open houses with agency CIOs, capital planning leads, project managers, and other IT staff. These sessions not only enabled them to become familiar with the IT Dashboard prior to launch, but also allowed us to hear directly from them how we could improve the IT Dashboard and reduce their burden in reporting on the status of IT projects.

We didn’t wait until the data was perfect to launch. In fact, had we waited for perfect data, the IT Dashboard would still be awaiting launch today. Only by exposing the data and holding agencies accountable will the data quality improve. GAO is a part of the effort, holding regular audits of IT projects reported to the Dashboard, to make sure the data is timely and accurate. And several members of Congress have sent letters to agency heads to underscore the importance of the data quality effort.

In addition to capturing accurate data, we must capture meaningful data. The information sources for much of the Dashboard1 had become stand-alone processes to request and justify funding rather than serving as management tools for monitoring program health. Just last week, we took an important step in increasing transparency by redesigning the exhibits to be used in budget processes. This effort will increase the relevance of IT investment data, better align budget with management processes, improve data quality, and reduce the reporting burden on agencies.

Going forward, we will continue to improve the Dashboard to provide even better insight into the performance of Federal IT investments. We continue to solicit and incorporate feedback from Federal agencies, Congress, and the American people.

But simply shining a light and hoping results follow is not enough. We must also take action. That is why in January 2010, we held the first TechStat Accountability Session. A TechStat session is a face-to-face, evidence-based review of an IT program to turnaround, halt or terminate underperforming projects. TechStat sessions yield results. To date, they have led to over $3 billion in life-cycle cost reductions, and have reduced average time to delivery from over two years to eight months.

We have scaled this capability across the Federal government, increasing the number of programs that can be reviewed and hastening the speed at which interventions occur. So far this year, we have trained 129 agency representatives to implement the TechStat model at their respective agencies and major agencies now conduct their own TechStat sessions.

We have open-sourced the IT Dashboard code and the TechStat process, making them freely available for any organization to use of these tools. Already, 38 states and territories have expressed interest in using the platform for state government use, taking advantage of a proven system instead of building their own from scratch.

Attacking Waste, Fraud and Abuse

From day one, the President identified transparency and accountability as essential to having government programs function effectively and efficiently in serving the American people. And the Recovery Act was implemented with these priorities top of mind. Throughout the life of the Recovery Act, the Administration has worked with Congress, the Recovery Accountability and Transparency Board, recipients and other stakeholders to ensure that the funds were spent with a minimal amount of waste, fraud, or abuse. Given the speed at which the funds were allocated, we knew there would be considerable challenges. Despite that, the Recovery Act has had an unprecedented low level of fraud, with less than 0.6% of all awards experiencing any waste, fraud, or abuse.

The approach we took was to allow unprecedented visibility into how these funds were being spent. Recovery.gov to provide taxpayers with user-friendly tools to track Recovery funds – how and where they are spent – in the form of charts, graphs, and maps that provide national overviews down to specific zip codes. In doing so, we provided a powerful tool for an army of citizen inspectors general to help us root out waste, fraud and abuse. Because transparency was a fundamental component from the beginning, it deterred much fraud before it ever occurred.

There were many challenges along the way, as we developed a new system for those receiving the funds to report how they were being used. Early on, we adopted uniform identifiers and data standards wherever feasible to ease the flow of data and reduce system complexity. Still we had instances where data entry difficulties led us to lessons learned to prevent such problems in the future. For example, early analysis of Recovery.gov showed that recipients were reporting money flowing to Congressional Districts that did not exist. To prevent this from happening again, the reporting system was modified to check for errors at the point of entry and collection. This prevented these bad data from entering the system in the first place.

The Administration also has improved the type of data available on USASpending.gov. Beginning in October 2010, taxpayers have been able not only to track obligations by Federal agencies but also can track obligations made by those recipients to other entities (for example, tracking payments from a prime contractor to a sub-contractor). As of May 2011, USASpending.gov displays – for awards made beginning in 2000 – over $25.4 trillion in prime awards, based on over 47,000 individual prime awards, and more than $3.9 trillion total in sub-awards.

Building on the lessons learned from the implementation of the Recovery Act, the President signed an Executive Order on June 13th establishing the Government Accountability and Transparency (GAT) Board. The GAT Board will provide strategic direction for enhancing the transparency of Federal spending and advance efforts to detect and remediate waste, fraud and abuse in government programs.

Figure 2

Spurring Innovation by Democratizing Data

The idea behind Data.gov was simple: to release as much government data in its raw, machine-readable format to the web, without compromising national security or individual privacy, and to spur public development of new data-driven, innovative business ideas.

On May 21, 2009 after six weeks of development, Data.gov launched, enabling the public to easily find, access, understand, and use data generated by the Federal government. Rather than creating a huge, complex system, which would have taken years, we took the approach of a lean start-up and launched a minimum viable product with just 47 datasets. Today, there are more than 390,000 datasets available.

Beyond that, Data.gov has democratized data and tapped the ingenuity of the public, inspiring scores of citizen-created applications that turn raw data into services to help the American people. Just as the Defense Department’s release of GPS data created a new industry, Data.gov has unleashed an “app economy” with over 300 high-value tools and apps developed to date. Innovators from across the country have been busy putting these datasets to work because the data is accessible, useable, machine-readable, from authoritative sources, in an open platform, and incorporates user feedback. Citizen-created apps now help parents keep their children safe, assisting travelers find the fastest route to their destinations, and informing home buyers about the safety of their new neighborhood.

Data.gov is at the vanguard of a global movement. 29 U.S. states, 11 U.S. cities, one tribe, and 19 countries have followed in Data.gov’s footsteps in implementing open data platforms.

Figure 3

Scaling Transparency

Moving forward, we must expand our efforts to shine light on the entire $3.7 trillion in the Federal Budget2, including entitlements, insurance, loans, operational costs, payroll, and tax expenditures.
Tackling this challenge will force us to confront obstacles on many fronts. For example, on the technical front, there are currently more than 12,000 systems, composed of hundreds of thousands of subsystems and countless databases.

The way we fund IT, agency-by-agency, bureau-by-bureau, creates additional obstacles, leads to duplication, and hinders our ability to share services government-wide. This has resulted in a multitude of separate Federal data collection and display websites.

Leveraging the lessons learned from the Administration’s transparency efforts, we have distilled the following key principles to guide us as we shine light on the $3.7 trillion in all Federal spending.

1. Build end-to-end digital processes – Automate transfer of data between systems to increase productivity, protect data integrity, and speed data dissemination. Capitalize on game-changing technologies to increase transparency.

2. Build once, use often – Architect systems for reuse and share platforms to reduce costs, streamline systems and processes, reduce errors, and foster collaboration.

3. Tap into golden sources of data – Pull data directly from authoritative sources to improve data quality, shorten processes and protect data integrity.

4. Release machine-readable data and encourage 3rd party applications – Make data machine-readable to allow the public to easily analyze, visualize and use government information.

5. Use common data standards – Develop and use uniform, unique identifiers and data standards to ease the flow of data and reduce system complexity.

6. Validate data up front – Correct errors during collection and at the point of entry to block bad data from ever entering the system.

7. Release data in real time and preserve for future use – Release data as quickly as feasible to enhance its relevance and utility while maintaining future accessibility.

8. Reduce burden – Collect data once and use it repeatedly. Pull from existing data sets to reduce costs and burden and to increase productivity and uniformity.

9. Protect privacy and security – Safeguard the release of information to increase public trust, participation, preserve privacy, and protect national security. Open Government doesn’t mean vulnerable government.

10. Provide equal access and incorporate user feedback – Provide a common view of data to all stakeholders to foster collaboration. Incorporate user feedback to help identify high-

value, meaningful data sets, set priorities, to continuously drive and improve future planning and processes.

Conclusion

As I reflect on the last two and a half years, the benefits of an open and transparent government are now clearer than ever before. We have saved $3 billion by shining light on Federal IT spending so far. We have seen an unprecedented low fraud rate in the implementation of the Recovery Act by taking a transparent approach from the outset. We sparked a new “app economy” by releasing government data through Data.gov.

This Committee has long recognized the importance of an open and transparent government and I appreciate its ongoing support of our efforts and its help in securing funding for the government’s transparency efforts.
Going forward, it will take all of us – Congress, Executive branch agencies, and recipients of Federal funds – working together to ensure accuracy and transparency of government data. Thank you again for your interest and I am happy to answer your questions.

(via oversight.house.gov)

...

New HIE Survey Shows Increased Privacy Controls, Concerns with Systems Integration and Participation in Accountable Care

2011-07-14T06:00:00.000-07:00

The eHealth Initiative (eHI) annual survey of health information exchange (HIE) "2011 Report on Health Information Exchange: The Changing Landscape," released July 14, 2011, documents the growing pains 255 HIE initiatives are experiencing today as they grapple with competing timelines to meet federal requirements, complex systems integration and the uncertain future of Accountable Care Organizations (ACOs). Despite privacy concerns that patients have over the safety and security of their personal information, the survey demonstrates an unprecedented amount of patient health information exchanged between physician offices, laboratories and hospitals.

The survey shows the number of States with advanced HIE initiatives increasing with New York leading the way:

“Some exchanges have solved their technical issues and are offering more advanced services, such as analytics, quality reporting, wellness programs and education to providers and hospitals. As a result, they are in a much stronger position than those that have not expanded services,” said Jennifer Covich Bordenick, Chief Executive Officer. “HIE initiatives that cannot adapt quickly may not last long in a transformed healthcare system. The HIE marketplace is very competitive today, but the momentum seems to be with private sector HIEs,” added Covich Bordenick.

Some key findings from the 2011 survey include:

There has been net growth of 9% in the number of initiatives, which total 255 in 2011. At least 10 HIE initiatives have closed or consolidated, and 46 new initiatives responded to the survey. Twenty-four initiatives report that they have sustainable business models, up from 18 in 2010.
Initiatives are developing complex privacy controls for patients, even in the absence of new federal requirements.
An increased number of behavioral or mental health providers report providing and viewing more data through exchanges.
Despite uncertainty about accountable care organizations (ACOs), a quarter of the respondents indicated that they will support an ACO.
In addition to struggling with business models and value, groups are facing new challenges related to technical aspects and systems integration.
A majority of initiatives (113) plan to incorporate the federal Nationwide Health Information Network’s (NwHIN) Direct Project into their service offerings.
The majority of advanced initiatives (85) are offering at least one service that supports Meaningful Use requirements.

Of the 113 HIEs who plan to incorporate the Direct Project protocols, the most popular use case is for transitions of care. And while only 1 HIE has currently implemented Public Health reporting using Direct, 46 are planning to and 35 are considering it. The breakdown of Direct Project use cases is:

“The number of initiatives offering services that improve patient care has increased in 2011. As more HIE initiatives provide services such as ePrescribing, alerts to providers on drug interactions, clinical decision support, and medication reconciliation, the quality of care for patients will improve,” Covich Bordenick said. “When providers have access to vital patient information and consequently receive important alerts, patients benefit.”

As HIEs continue to move forward, eHI recommends the following:

HIEs must move quickly to help providers with meaningful use, Medicare Shared Savings Program rules and privacy recommendations. Hesitancy about moving forward until changes to the healthcare system are complete will only diminish growth.
Privacy will continue to be an important issue for patients. If patients are to be engaged in their care, they have to trust that their information can be securely exchanged. One way of many to build this trust framework: initiatives can offer patients more than a global consent model.
Groups need to “work with what they have.” Since initiatives need to rapidly innovate and move through the stages of development quickly, they need to consider working with the existing infrastructure in their geography. Where there are well-developed IDNs or health systems, the community-based or state initiatives should try to work with them. While competition can be good for innovation, in the current rapidly changing healthcare market, competition may not be the best option for sustainability.

Oregon Launches Direct Project Pilot

2011-07-13T16:20:00.000-07:00

We are launching a Direct Project pilot in Oregon. Working with Medicity, who are providing HISP services for the pilot as they continue to widely support Direct Project protocols; Krysora LLC, who are providing project management and using their deep experience and expertise in health information exchange to drive this pilot forward; Gorge Health Connect, Inc. (GHC) a health information exchange service provider in the Columbia River Gorge area of Oregon will work through the summer with the goal of going live before the end of August.

Two years ago a group of stakeholders in the Columbia River Gorge gathered together to find ways to provide health information exchange services in our area. Starting with a Network Planning Grant from HRSA, we formed a 501c3 corporation and I am serving as President. We have also been working on health IT workforce development. Members of GHC include Columbia Gorge Community College, Mid-Columbia Medical Center, Providence Hood River Hospital, Columbia River Women's Clinic, La Clinica Del Carino, Mid-Columbia Surgical Specialists, North Central Public Health District (Wasco, Sherman, Gilliam Counties), and Hood River County Public Health Department, altogether covering most of the healthcare services in a four-county area. The Oregon Direct Project Pilot is focused on providing secure transport of health information to members and non-members based on existing referral patterns. This pilot is focused on supporting the following Direct Project User Stories:

Primary care provider refers patient to specialist including summary care record
Primary care provider refers patient to hospital including summary care record
Specialist sends summary care information back to referring provider
Hospital sends discharge information to primary care provider

I have worked hard over the last couple years with Oregon's Health Information Technology Oversight Council to help develop our strategic and operational plans for health information exchange. After helping to write the strategic and operational plans, I have served on the HIO Executive Panel, chaired the Technology Workgroup, and served on the eRx ad hoc Group and Labs ad hoc Group. During this time I also have been working on the Direct Project, right from the beginning of this incredible community, and I have been looking forward to when we can announce our own pilot in Oregon.

In November of last year NHIN Direct was rebranded to become the Direct Project. In February the ONC announced the launch of real world implementations of the Direct Project. I recently worked with the ONC to bring states up to speed on the Direct Project. Today I am happy to announce that we are launching our pilot project in Oregon with plans to go live in our pilot in August :-)

Total Number of Live HIEs Exchanging Data More Than Doubles in Past Year

2011-07-08T13:11:00.000-07:00

Health Information Exchanges (HIE) enable hospitals, physicians, and clinicians to improve the quality and efficiency of the care a medical community is able to provide to its patients through the electronic sharing of patient records. Thanks in part to Meaningful Use and other elements of healthcare reform in the United States, HIEs are now being formed, whether through a government-backed initiative or as private ventures.

Mark Allphin

In last year's HIE performance study, KLAS found that, although the market was full of vendors offering an HIE solution, only a few HIEs were actually up and running. The new KLAS report, "Health Information Exchanges: Rapid Growth in an Evolving Market," looks more deeply into the adoption level of HIEs, as well as the state of each vendor's HIE activity, and how well that vendor is responding to provider needs.

Among the highlights of the report:

THE MARKET IS STILL A MILE WIDE, BUT SLOWLY GETTING DEEPER.
The HIE market still has a wide array of vendors, and the total number of HIEs that KLAS has validated as live and exchanging data has more than doubled from 2009 to 2010. Several hundred other HIEs are in some stage of development.
THE CREAM IS SLOWLY RISING TO THE TOP AMONG VENDORS.
Determining which are the most viable players among the myriad of HIE vendors is becoming easier as some vendors continue to bring new HIEs live, while others are seeing little growth.
THE BULK OF HIE MARKET GROWTH IS IN PRIVATE HIES.
While the number of live public HIEs KLAS was able to validate increased from 37 last year to 67 this year, the number of live private HIEs KLAS validated exploded from 52 to 160.
MOST PHYSICIANS STILL HAVE TO LEAVE THEIR WORKFLOW.
Although physician adoption was cited most often as a key indicator of HIE success, most HIEs still have work to do in making the system physician friendly. Among the live HIEs that KLAS validated, only 43% were delivering patient data directly into physicians’ EMRs.
FUTURE FUNDING IS STILL A MAJOR CONCERN IN PUBLIC HIES.
Of public HIEs interviewed, 54% expressed concern about future funding. Only 35% of private HIEs had the same worry.

"The HIE market continues to mature since last year's report, and a number of vendors are beginning to stand out from the crowd," said Mark Allphin, author of the report. "But, most HIEs still have a long way to go before they will be able to start making the positive impact on healthcare that providers and regulators are hoping for. Interestingly, the number of live private HIEs has increased more rapidly than the number of live public HIEs."

Public vs Private HIEs--why is one gaining more traction than the other?

Since 2010 the number of live public HIEs rose from 37 last year to just 67 this year, while the number of live private HIEs mushroomed from 52 last year to 161 this year. Data collected for this report revealed two main reasons public HIEs are not going live as quickly as private HIEs:

1) Governance - between the complications inherent in government-sponsored initiatives and the difficulty of getting competing healthcare organizations to agree on what to share, public HIEs have had a hard time earning physician acceptance, whereas private HIEs need not depend on public funds and/or government oversight.

2) Funding - at this time there are numerous grants and funding options available, but providers are very concerned that given normal economic and political upheavals monies may dry up at any time, leaving them without the means to continue functioning.

One director at a public HIE commented, "The fact that our funding is dependent on political support in difficult economic times is worrisome. . . With new faces in the federal and state legislatures, there are no guarantees." Private HIEs, however, are typically funded by the stakeholders themselves, so future funds are less of a worry.

Physician reticence--doctors may be exacerbating the hold-up

According to respondents, physicians may be contributing to the lag in deployment of public HIEs. Providers reported that doctors are interested in HIEs, but not if they cause them to lose time searching for or wading through too much patient information. Concerns over data integrity and having outside providers push data into physician's EMRs were also voiced as contributing to the low adoption of public HIEs in the United States.

One provider related, "The doctors were interested in this to start out, but once they realized that they were going to have to do things in two different places, they lost interest. It is just too cumbersome." With that challenge in mind, more HIEs are striving for ways to deliver useful data to physicians without requiring them to leave their normal workflow, but so far progress has been slow.

More than 230 HIE customers were interviewed for this study. Together they evaluated a total of 35 HIE vendors. In the case of private HIEs, Medicity, RelayHealth, and Cerner ranked highest in performance scores. Although Epic Care Everywhere scored higher than all three, Epic was not ranked in this report because nearly all of the Epic exchanges KLAS was able to validate were between Epic hospitals. One Epic HIE was with a non-Epic EMR system. In the case of public HIEs, both Axolotl and Orion scored 83.8 and 85.5, respectively. However, neither solution was ranked in the report because they did not meet the minimum KLAS Konfidence levels.

"While HIEs have made substantial progress over the last 12 months, the market is clearly still in the early stages," added Allphin. "The majority of HIEs are building the foundation for what they hope will become robust and meaningful exchange models. Meaningful Use will continue to put pressure on providers to make patient information accessible across the continuum of care, and with the rapid evolution of healthcare in the United States. HIEs will only increase in importance going forward."

For more information about the health information exchange market, as well as the strengths and weaknesses of measured vendors, "Health Information Exchanges: Rapid Growth in an Evolving Market" is available to healthcare providers online for a significant discount off the standard retail price.

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Small, isolated, rural hospitals show poorer results on measures of quality of care, patient outcomes

2011-07-05T13:11:00.000-07:00

In the first national study to examine care at critical access hospitals (CAHs) in rural areas of the U.S., Harvard School of Public Health (HSPH) researchers found that CAHs have fewer clinical capabilities, lower quality of care, and worse patient outcomes compared with other hospitals. The researchers found that patients admitted to a CAH for heart attack, congestive heart failure, or pneumonia were at greater risk of dying within 30 days than those at other hospitals. The study shows that despite more than a decade of policy efforts to improve rural health care, substantial challenges remain.

In an analysis of data from more than 4,500 hospitals that serve Medicare beneficiaries, critical access hospitals (CAHs; no more than 25 acute care beds, located more than 35 miles from the nearest hospital) had fewer clinical capabilities, worse measured processes of care and higher rates of death for patients with heart attack, congestive heart failure or pneumonia, compared to non-CAHs, according to a study in the July 6 issue of JAMA.

"Critical access hospitals play an important and unique role in the U.S. health care system, caring for individuals who live in rural areas and who might otherwise have no accessible inpatient care," according to background information in the article. "The CAH designation was created with the goal of ensuring 'proximate access' to basic inpatient and emergency care close to home for approximately 20 percent of the U.S. population that still lives in rural communities. Despite broad policy interest in helping CAHs provide access to inpatient, care, little is known about the quality of care they provide.

Karen E. Joynt, M.D., M.P.H., of the Harvard School of Public Health, Boston, and colleagues conducted a study to examine CAHs' clinical and personnel resources, the quality of care they deliver, and their patients' outcomes. The analysis included 4,738 U.S. hospitals of Medicare fee-for-service beneficiaries with acute myocardial infarction (AMI) (10,703 for CAHs vs. 469,695 for non-CAHs), congestive heart failure (CHF) (52,927 for CAHs vs. 958,790 for non-CAHs), and pneumonia (86,359 for CAHs vs. 773,227 for non-CAHs) who were discharged in 2008-2009.

The researchers found that compared with other hospitals (n = 3,470), 1,268 CAHs (26.8 percent) were less likely to have intensive care units (380 [30.0 percent] vs. 2,581 [74.4 percent], cardiac catheterization capabilities (6 [0.5 percent] vs. 1,654 [47.7 percent], and at least basic electronic health records (80 [6.5 percent] vs. 445 [13.9 percent]).

For patients admitted with AMI, CAHs provided care that was concordant with Hospital Quality Alliance process measures 91.0 percent of the time compared with 97.8 percent of the time for non-CAHs. The difference was larger for CHF (80.6 percent vs. 93.5 percent) and smaller but still significant for pneumonia (89.3 percent vs. 93.7 percent).

Patients admitted to CAHs had higher 30-day risk-adjusted mortality rates for all 3 conditions than patients admitted to non-CAHs. Patients admitted to CAHs had 7.3 percent higher absolute 30-day mortality rates for AMI (23.5 percent vs. 16.2 percent; 2.5 percent higher mortality rates for CHF (13.4 percent vs. 10.9 percent; and 2 percent higher mortality rates for pneumonia (14.1 percent vs. 12.1 percent) than those admitted elsewhere.

"Despite more than a decade of concerted policy efforts to improve rural health care, our findings suggest that substantial challenges remain. Although CAHs provide much-needed access to care for many of the nation's rural citizens, we found that these hospitals, with their fewer clinical and technological resources, less often provided care consistent with standard quality metrics and generally had worse outcomes than non-CAHs," the authors write.

"… these findings should be seen as a call to focus on helping these hospitals improve the quality of care they provide so that all individuals in the United States have access to high-quality inpatient care regardless of where they live.

"Critical access hospitals face a unique set of obstacles to providing high quality care, and our findings suggest that their needs are not being met by current health policy efforts," said Karen Joynt, a research fellow in HSPH's Department of Health Policy and Management and the lead author of the paper.

The government defines CAHs as geographically isolated facilities with no more than 25 acute care beds. More than a quarter of acute care hospitals in the United States have been designated CAHs by the Medicare Rural Hospital Flexibility Program of the 1997 Balanced Budget Act. The program created payment reform that has kept small rural hospitals financially solvent, preserving access to care for rural Americans who might otherwise have no accessible inpatient provider.

Joynt and her colleagues analyzed the records of 2,351,701 Medicare fee-for-service beneficiaries at 4,738 hospitals (26.8 percent of which were CAHs) diagnosed with acute myocardial infarction (heart attack), congestive heart failure, and pneumonia in 2008-2009. Compared with other hospitals, CAHs were less likely to have intensive care facilities, advanced cardiac care capabilities, or even basic electronic health records. These hospitals were less likely to provide appropriate evidence-based care, as measured by the Hospital Quality Alliance metrics.

Patients admitted to CAHs had 30 to 70 percent higher odds of dying within 30 days after being admitted for heart attack, congestive heart failure or pneumonia. "We were surprised at the magnitude of these findings," said Ashish Jha, senior author on the study and an associate professor in HSPH's Department of Health Policy and Management. "These findings suggest that we need to redouble our efforts to help these hospitals improve."

"To improve the quality of care patients receive at CAHs, policy makers could explore partnerships with larger hospitals, increasing use of telemedicine, or inclusion of these hospitals in national quality improvement efforts," said Joynt. "Helping these hospitals improve is essential to ensuring that all Americans receive high-quality care, regardless of where they live."

###
Study authors included Yael Harris, director of the Office of Health IT & Quality at the U.S. Department of Health and Human Services and E. John Orav, associate professor in the Department of Biostatistics at HSPH.

"Quality of Care and Patient Outcomes in Critical Access Rural Hospitals," Karen E. Joynt, Yael Harris, E. John Orav, Ashish K. Jha, Journal of the American Medical Association, July 6, 2011.

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What Lies Ahead for ONC: Meaningful Use and Beyond

2011-06-29T13:11:00.000-07:00

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...

What Lies Ahead for ONC: Meaningful Use and Beyond

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.

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New Top Level Domains and Healthcare Implications

2011-06-28T19:11:00.000-07:00

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.

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Statewide Health Information Exchange: Becoming Operational

2011-06-28T07:11:00.000-07:00

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

Metadata Power Team Recommendations

2011-06-23T08:00:00.000-07:00

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:

Cancer Death Rates Decline, But Disparities Remain

2011-06-20T06:00:00.000-07:00

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:

POVERTY IS A CARCINOGEN

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Marty Coopers Big Idea Has Transformed Our Lives

2011-06-16T07:00:00.000-07:00

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 Health Data Initiative Forum 2011

2011-06-09T07:00:00.000-07:00

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.

Download HERE

These are the morning presenters:

Healthagen (iTriage)
Co-founded by two emergency physicians, Healthagen is the software development company for iTriage, a free, consumer-based healthcare application that is a game-changer in healthcare. The comprehensive iTriage database includes information on thousands of symptoms, diseases, procedures and medications and combines that knowledge with a nationwide directory of every hospital, urgent care, retail clinic, physician, pharmacy and government health center. The proprietary Symptom-to-Provider™ pathway allows users to search symptoms, find possible causes, and be led to the most appropriate provider for a specific condition. Once the end-user selects a provider, the user can find information on ER Wait Times, pre-register for an ER visit (being piloted in select facilities), and access detailed information about that provider’s specialties and credentials. iTriage is truly a one-stop shop for consumer healthcare information.

Aetna / Medicity
Aetna is one of the nation’s largest healthcare companies with over 3,000 nurses, social workers, and behavioral health specialists, and covers over 18 million medical members across the United States. Aetna is focused on delivering technology and care management solutions that provide greater value to our customers and meet the needs of the emerging ACO market. Working with our subsidiary, Medicity, and accessing HHS data, we created several new applications that showcase how information can be used to build a more personalized experience that can lead to improved health outcomes. Our use cases highlight both clinicians working from a call center to provide disease management and other services, and primary care/specialty physicians that see and treat patients on a daily basis.

Ozioma
Ozioma, www.localhealthdata.org, is a new online tool designed to increase the amount of locally-relevant health information in communities through media. Ozioma allows users to search for health data from HHS (e.g., National Cancer Institute and Centers for Disease Control and Prevention) and more than 60 other reliable sources—all in one place. Search results are presented as easy-to-understand sentences crafted by a team of communication and public health experts, which can be immediately included in press releases, news stories, blogs, reports, grants or policy briefs. Greater access to locally relevant data will help in building healthier communities.

Healthline SPG - Surgical Procedure Guide
Healthline Networks has created comprehensive, data-rich online learning environments to help consumers research and make informed decisions about serious surgical procedures. Leveraging Healthline’s Medically Guided™ semantic search, we have incorporated CMS and FDA data to enhance Healthline’s rich information resources and present consumers with the most comprehensive online surgical procedure resource available today. Healthline Surgical Procedure Guides (SPG) analyze and interpret MedPar data to help consumers understand what events and incurred charges they can expect throughout each stage of the patient pathway—from preparation, to surgery, through recovery and rehabilitation. To personalize this experience, the data is immediately localized based on the user’s zip code. SPG also applies algorithms that process and summarize Hospital Compare data to provide consumers with “quick scores” that rank performance and charge trends for their hospitals against local, state, and national averages. FDA news and alerts for contextually relevant procedure data complement Healthline’s reference and education materials. SPG is the newest offering in Healthline’s suite of products that reach more than 100M consumers each month when they are searching for credible health information.

PatientsLikeMe – Clinical Trials
PatientsLikeMe will present a new feature that helps patients find clinical trials that are right for them and helps companies find patients who are right for their trial. The feature, which updates daily with all of information reported on ClinicalTrial.gov, allows members of the website to see every clinical trial they are interested in or eligible for based on the conditions and location they report. Investigators can also find their trial listed on PatientsLikeMe and see eligible patients, or search for patients that match their criteria. Companies, nonprofits, and academics that use PatientsLikeMe for trial recruitment can now also purchase enhanced listings that message eligible patients anonymously through the site’s private system. PatientsLikeMe aims to make trial enrollment faster, more efficient, and ensure patients know and have access to the opportunity to contribute to research.

Maestro (Lumeris)
The Essence Group, through Lumeris, is the nation’s first full-service enabler of next-generation accountable health care delivery systems. Maestro, from Lumeris, is powerful software that allows health plans, hospitals, medical groups, and individual physicians to find and confidently act on opportunities to improve the quality and lower the cost of health care. In addition to lending credible context to clinical and financial data, this web-based software supports greater collaboration between the payers and providers of health care.

MAYA Food Oasis
Initially developed at a Health 2.0 Code-a-thon, MAYA Food Oasis is an SMS-based virtual grocery marketplace intended to expand access to healthy, affordable food. To order food, consumers send a simple text message to the central system requesting specific items. Suppliers can review the individual orders, aggregate them into economically viable groups, and negotiate with buyers about price and quantity. Then, suppliers deliver the grouped orders to existing community locations like libraries, schools, or churches. The system provides an easy-to-use and dynamic marketplace that improves access for consumers and expands the market for suppliers. While the system is purposefully designed to have a positive impact on consumers trapped in a food desert, it could also improve access to healthy food for a wide section of the community.

Asthmapolis
Asthmapolis has developed a set of tools to capture data about the real time burden of asthma in communities. Visitors to our exhibit in the Data and Apps Expo can explore some of the medication sensors we’ve built to track the time and location where asthma inhalers are used. In addition, we will highlight the interfaces and mobile applications we’ve developed to help patients, physicians, and public health officials put this information to work to improve the management and control of asthma. We will also provide several case studies to illustrate how the technology is being applied in different settings to help identify patients with uncontrolled asthma, to wirelessly monitor and encourage adherence with preventive medications, and to track the health effects of specific environmental exposures.

Multistate Foodborne Disease Outbreak Investigation System
The Multistate Foodborne Disease Outbreak Investigation System (FDOIS) is a collaboration between the CDC and Palantir Technologies that enables the CDC and its state, local and partner agencies to work together on investigations of disease outbreaks. The CDC facilitated the initial pilot program to address a major gap in multistate foodborne disease outbreak investigation methods: the lack of an electronic system to integrate key data sources and facilitate secure information sharing between public health partners while maintaining patient privacy. The FDOIS rapidly joins disparate data sets, including epidemiologic and laboratory data, into a single environment for partners across organizations to collaboratively analyze. The result is more rapid hypothesis generation and testing that translates into actions to reduce the public’s risk. A “proof of concept” system is currently deployed at the CDC as well as six state health departments with plans to roll out further to federal partners in the next several months. Broadly, the system represents an “all hazards” solution, meaning the systems developed in this framework are applicable and adaptable to programs across CDC.

ElizaLIVE
ElizaLIVE is a multi-modal engagement platform that brings understanding of healthcare data to a whole new level. ElizaLIVE combines data from proprietary outreach on hundreds of millions of individual conversations about health care, taking in interactions from web click streams, email, and automated phone conversations powered by Eliza’s proprietary speech recognition engine. ElizaLIVE weaves this data with clinical data, third-party, and publically-available data to better understand healthcare consumers and create multi-dimensional profiles including socio-demographic, clinical, and behavioral inputs. ElizaLIVE’s proprietary score predicts how people will behave, specifically assigning individuals a number on a 10 point scale that predicts how they will respond to attempted interventions that would improve care and lower costs. It is not enough to stratify a population by how much they are likely to cost; ElizaLIVE shows whether individual members are likely to respond to an intervention, while creating meaningful interventions, communications strategies, and programs that increase compliance and lower costs.

Below are the slides (in Flash format) from the Apps Demonstration Session A.

Download HERE

These are the session A presenters:

Doximity
Doximity is a physician network that links medical professionals over mobile devices and the web, enabling them to deliver faster, smarter treatment. Its secure platform enables the physicians to find fax numbers, phone numbers, insurance information, clinical interests, and languages spoken; exchange private phone lists, back lines, and pagers, as well as send HIPAA-compliant messages to colleagues; connect with former classmates and residents; and access phone numbers of pharmacies, hospitals, and labs. To help medical professionals find the information they need quickly, Doximity pre-populates its national directory with practice information from the National Provider Identifier, Medicare, PubMed and other HHS databases.

Castlight Health
Castlight Health’s application enables true health care consumerism by integrating and personalizing the critical information for value-based health care decision making. Castlight users see out-of-pocket, service-level costs combined with the best available information on clinical quality and patient satisfaction. Castlight’s data is created from a variety of commercial and public sources, including CMS, HCAHPS, and AHRQ. Castlight’s proprietary educational program provides consumer-friendly guidance on health care costs, provider selection, and evidence-based care. Castlight Health was founded in 2008 and is based in San Francisco, CA.

Daily Challenge
MeYou Health’s Daily Challenge emails you one small thing to do each day to improve your well-being. In just nine months, this Facebook-enabled web application has enrolled over 105,000 users who have completed over 1 million challenges. In the course of exploring well-being, members are invited to get their well-being score using the Well-Being Tracker (an assessment tool derived from the Gallup-Healthways Well-Being Index). To date, over 50,000 people have completed the Tracker to get their personal well-being score. By combining well-being scores with social relationship data, MeYou Health enables its users to compare their score to the average score of their friends. Working with our partner, MedNetworks (founded by “Connected” author Nicholas Christakis, MD, PhD), we are mapping this unique social well-being data set to ultimately understand if well-being is contagious and how we might promote its diffusion across social systems.

Treatment Pathways – Thomson Reuters
Thomson Reuters MarketScan® Treatment Pathways facilitates faster and smarter healthcare research by overlaying an analytic interface onto robust patient level databases. This online research tool supports cross-sectional and longitudinal analyses, descriptive reporting, iterative exploratory research, and quick querying, so studies or portions of study work can be quickly and easily completed without the need for data intake, software, or custom programming. Data are hosted on a Thomson Reuters cloud, which users access through a web-interface. For more information, please e-mailmarketscan@thomsonreuters.com.

Practice Fusion Practice Fusion provides a free, web-based Electronic Medical Record (EMR) system to physicians. With charting, scheduling, e-prescribing, billing, lab integrations, unlimited support, and a Personal Health Record for patients, Practice Fusion’s EMR addresses the complex needs of today’s healthcare providers and disrupts the health IT status quo. Practice Fusion is the fastest growing EMR community in the country with more than 90,000 users serving 13 million patients. When pairing our structured, clinical data with the vast number of patient records in our system, the possibilities for research and development are endless. That is why Practice Fusion is opening our API to allow developers to utilize the data across our web-based platform. Practice Fusion’s API for EMR is a first step toward future medical record interoperability, creating opportunities for seamless communication with hospitals, medical groups, patient platforms, and more.

Global Health Data Exchange
The Global Health Data Exchange (GHDx) is a new data catalog for demographic, public health, and global health data. It was developed by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to address a key issue for global and public health analysis, which is a lack of knowledge about data and access to data. The GHDx is the first—and currently the only—data catalog that focuses on health-related data on a global scale. We will make every effort to build the broadest and most in-depth data catalog, and aim to be the go-to source for information about data for researchers, analysts, policy makers, and others in the global health space. The GHDx improves data discoverability by providing a user-friendly, validated, and searchable data catalog for global health, demographic, and other health-related datasets, including censuses, surveys, health records, vital statistics, and administrative data. The GHDx also aims at improving access to data by serving as a platform for data owners to share their data with the public. All of IHME’s search results are available for download, and IHME invites others to distribute their data through the GHDx.

Directrelief.org
Direct Relief International is a California-based, nonprofit organization founded in 1948 to improve the quality of life for people affected by poverty, disaster, and civil unrest at home and throughout the world. Direct Relief provides essential material resources—medicine, supplies, and equipment—to over 70 countries globally and throughout the United States. Direct Relief receives medicines and medical products from more than 100 healthcare manufacturers, who collectively donate approximately $250 million (wholesale) worth of pharmaceuticals and supplies annually. Direct Relief launched data.directrelief.org to empower people by providing access to important health data through an intuitive and powerful web-based interface. Users can search, analyze, and understand a variety of federal, state, and local government data, as well as Direct Relief’s own data. Key variables have been hyperlinked to facilitate search and analysis across datasets. The goal of the site is to deepen insight, improve efficiencies, and facilitate interaction to improve health.

MedVentive Population Manager and Risk Manager
Through our early roots combined with our work with Provider and Payer clients today, MedVentive brings unparalleled experience and expertise built from the physician perspective to support population and risk management. We provide two core products that support interrelated business requirements for Clinical Integration, Medical Home, and Accountable Care initiatives. MedVentive Population Manager is an enterprise population management platform. MedVentive Risk Manager provides the capabilities providers need to be successful under risk or value-based contracts with payers and/or employers. Most importantly, we take data beyond generalized reporting and identify actionable opportunities, then provide the tools, workflows, and detail to empower clinicians to improve the coordination and quality of care in our clients’ networks.

Community Commons / Advancing the Movement
Via www.communitycommons.org, registered users will have free access to over 7,000 GIS data layers at state, county, zip code, block group, tract, and point-levels; contextualized mapping, visualization, analytic, impact and communication tools and apps; searchable profiles of over 1,000 place-based community initiatives working toward healthy/sustainable/livable communities—funded by government and private philanthropy—complete with text and video narratives on "what’s working." Peer learning forums in the “interactive commons” with colleagues exploring similar interests and challenges—hosted by leading national TA providers. Inspired by Advancing the Movement, www.communitycommons.org is a democratized learning and innovation platform for enhancing the reach and impact of distributed action for a healthier, more equitable, and prosperous United States of America.

Below are the slides (in Flash format) from the Apps Demonstration Session B.

Download HERE

These are the Session B presenters:

Network of Care for Healthy Communities
Brought to you through the National Association of County Officers and the National Association of County Health Officers, the Network of Care for Healthy Communities is a delivery platform for community stakeholders and citizens. For stakeholders, the platform consolidates and presents data from open.gov and other sources tied to actionable content, including promising practices, local resources, progress trackers, and collaboration centers. By adopting the platform locally, communities can meet PHAB accreditation requirements, track progress to Healthy People 2020 goals, conduct needs assessments, and collaborate to promote change. For citizens, the platform provides a health encyclopedia, directories of services and supports care coordination, distance learning, and includes a secure health record that is compliant with open standards. This demonstration will showcase the power of making centrally provided health data locally relevant while providing individuals with the tools they need to improve both their health.

MedWatcher
Nearly half of all Americans currently take a prescription drug, yet the public remains largely unaware of medication safety concerns. While the Food and Drug Administration (FDA) regularly issues alerts on drug problems, many consumers become aware of problems with drugs from unofficial sources. The present structure highlights an important information gap between government and the public that has persisted for decades. We attempt to improve the drug safety process through the MedWatcher application for mobile phones (currently available for the iPhone and iPad). The app is designed to engage users (both the public and healthcare practitioners) in issues of drug safety, providing both current safety advisories and a reporting tool for direct submission of adverse drug events by the user. Developed in collaboration with the FDA, the system will be designed to generate intelligence about candidate medication risks, especially for widely prescribed medicines. These data have the potential to have tremendous public health value by augmenting traditional drug surveillance efforts while also being of major interest to pharmaceutical companies, medical device makers, pharmacies and benefit payers.

TheForce.com application platform
Force.com is the leading cloud platform for business apps. With security, reliability, and privacy that enable HIPAA compliant applications, it also excels at health apps. Every business needs apps: HR apps, inventory apps, iPhone, iPad, Android, and BlackBerry apps. Some require aggregating data from other systems, some generate their own data. Force.com enables both.
Now you can use the Force.com platform to build all of your apps—and websites—quickly and easily. Over 200,000 apps have already been built. And with a robust program to help partners to be successful, our Technical Enablement and Independent Software Vendor teams make it easier than ever.

Improvement Portal – Press Ganey
The Improvement Portal, Press Ganey’s innovative online performance dashboard, provides an integrated view of a provider organization's total performance so they can target their improvement efforts and get results faster. The Improvement Portal enables provider organizations to gain real-time insight into current performance, provides immediate access to improvement resources and networking and aligns your organization around performance priorities in the areas of clinical, financial, operational and patient experience performance. And the Improvement Portal can work in two modes—it can utilize a provider’s own institutional data, or it can utilize public data such as MEDPAR and HospitalCompare.gov data to produce the improvement opportunities. Whether leveraging the intuitive performance chart or the more comprehensive performance dashboards, it takes only a matter of seconds to pinpoint where the provider stands against other practices or facilities on key performance measures, all with one goal in mind: becoming a High Performance organization.

Humedica
Humedica is a next-generation clinical informatics company that provides novel analytics solutions to the health care industry. Humedica integrates clinical, financial, and administrative data from disparate IT systems and then applies advanced analytics to define appropriate patient cohorts, treatment pathways, outcomes, and associated costs. Humedica MinedShare® can transform a provider organization’s immense reservoir of data into valuable, actionable knowledge, all within a state-of-the-art, HIPAA-compliant, and highly secure environment.

SAP and Digital Infuzion
This demonstration will leverage SAP Business Objects to make health and disease related information more accessible and interactive for community and resource planners. In addition, our solutions will provide the health consumer with a greater understanding of health resources in their area. The long-term goal is to allow doctors and patients with the capability to view health, service, and disease-related data and make comparisons across different doctors and providers. We envision public data sources like the Area Resource File from HRSA to provide the framework for additional visibility for each person in need of greater health transparency.

MedlinePlus Connect
MedlinePlus Connect, medlineplus.gov/connect, is an award-winning, free service of the National Library of Medicine (NLM) and the National Institutes of Health (NIH) that easily links patient portals and EHR systems to MedlinePlus.gov, an authoritative, up-to-date health information resource for patients, families, and health care providers. MedlinePlus Connect provides context-relevant responses for problems and diagnoses, medications, and lab tests. MedlinePlus Connect supports the HL7 Context-Aware Knowledge Retrieval (Infobutton) standard and accepts requests containing standardized code sets already used by EHRs. It is available as a web application and as a web service.

Pillbox
Some of the health care challenges this country faces cannot be solved by opening existing data. They require entirely new data sets. The National Library of Medicine (NLM), Food and Drug Administration (FDA), and pharmaceutical industry are meeting this challenge by creating the largest, highest-quality data set of medication images that has ever been available. The NLM and FDA’s ground-breaking Pillbox Initiative already gives developers direct access via API to previously hard-to-reach government drug identification and reference data in drug labels. Now it will add standardized high-quality drug images for prescription, over-the-counter, homeopathic, and veterinary medications. More than a single application, the Pillbox Initiative is a platform for innovation, giving developers an all-access pass to federal pharmaceutical data and creating a sustainable ecosystem of high-quality medication images. Pillbox’s project manager will outline the recently-announced government/industry partnership, highlight the data, images, and services created and exposed through this patient-safety initiative, demonstrate the API, and showcase mobile, tablet, and web applications developed with this resource.

Below are the slides (in Flash format) from the Apps Demonstration Session C.

Download HERE

These are the Session C presenters:

Esri / Community Analyst
Community Analyst is a cloud-based application that provides seamless access to detailed data about communities, including socio-demographics (Census), lifestyle segmentation (Esri), business data (Esri) and health status indicators such as access to care, use of preventive health services, and premature death risk factors (HHS). These data about community demographics, health behaviors and outcomes can be quickly analyzed, visualized, and shared as stunning, smart maps! Community Analyst provides neighborhood-level views and generates detailed reports and interactive color-coded maps. Integration of additional datasets from ArcGIS.com, a free data and map exchange provides access to thousands of additional data and maps providing insights about communities. HDI Forum attendees will be able to sign up for a free trial subscription of Community Analyst as well as download other free health relevant smart phone applications such as My Place History (environmental health) and Business Analyst (lifestyle behavior) smart phone applications at the Data and Apps Expo.

Robert Wood Johnson Foundation Childhood Obesity GIS
ChildhoodObesityGIS.org is an online, place-based information and collaboration system sponsored by the Robert Wood Johnson Foundation (RWJF) to provide interactive tools for RWJF grantees, Major Program Offices, and community partners working toward preventing childhood obesity. The Center for Applied Research and Environmental Systems (CARES) at the University of Missouri developed and implemented this unique multi-dimensional system by combining highly intuitive interactive maps and custom dynamic reports, with the ability to upload and overlay local and regional data with over 7,000 of national-source data sets. The system also provides peer-learning spaces for grantees to learn from each other about how they are reversing childhood obesity in their communities.

PolicyMap
As a national leader in financing neighborhood revitalization, The Reinvestment Fund has long recognized that information drives change in all sectors: public, private, and civic—and that getting that information has not always been simple or efficient. With that in mind, TRF developed a national data warehouse and mapping tool—www.policymap.com—to provide users with simple, online access to data, tables, charts, reports and maps in a sophisticated, user-friendly web platform. PolicyMap users can not only view data and maps online, they can also download and export from our platform, as well as upload their own data to share with others. Development of this tool is rooted in TRF’s belief that good data drives good investment decisions.

...

Office of the National Coordinator for Health Information Technology introduces new Investing in Innovations (i2) Initiative

2011-06-08T11:00:00.000-07:00

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.

For more information please visit ONC's home page at http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__onc/1200

via hhs.gov

Not What the Doctor Ordered: Health IT Barriers for Small Medical Practices

2011-06-08T06:30:00.000-07:00

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:

Updated section

Other testimony was provided by:

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 full video of the hearing is available HERE

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Meaningful Use Workgroup Recommendation to Delay Stage 2

2011-06-08T06:00:00.000-07:00

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.

Meaningful Use Workgroup Recommendations:

Draft recommendation letter:

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Health IT in an Era of Accountable Care: Update from the Beacon Communities

2011-05-27T14:22:00.000-07:00

The Engelberg Center hosted a forum highlighting the Beacon Community Program, a major project of the U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology. Panelists focused on health IT implementation strategies to accelerate clinical transformation, and discussed how various Beacon communities are advancing broader healthcare reform efforts. The event featured keynote remarks from Aneesh Chopra, U.S. Chief Technology Officer at the White House Office of Science and Technology Policy; Farzad Mostashari, National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services; and Joseph McCannon, Senior Advisor to the Administrator and Group Director, Learning and Diffusion, Innovation Center, Centers for Medicare & Medicaid Services. In addition, the event highlighted various Beacon Community accomplishments and plans for upcoming years, shared health IT implementation strategies to accelerate clinical transformation, and communicated how various communities are advancing broader healthcare reform efforts. Presenters focused on how health IT and related delivery system improvements are being utilized to increase care coordination and accountability in order to demonstrate feasible paths to higher-quality and lower-cost healthcare.

Panel I: U.S. Chief Technology Officer Aneesh Chopra, National Coordinator for Health IT Farzad Mostashari, and CMS Senior Advisor Joe McCannon discuss the federal health IT strategy.

Panel II: Beacon Community Program Director Aaron McKethan moderates a session on priorities for health system improvement.

Panel III: Mark McClellan moderates a session on harnessing health IT for payment reform

Closing remarks: from Mark McClellan and Farzad Mostashari

...

Moving Providers from AIU to Meaningful Use

2011-05-27T12:00:00.000-07:00

Below is a wonderful presentation from Joshua J. Seidman, PhD at the recent 3rd Annual CMS Multi-State Medicaid HITECH Conference entitled "Moving Providers from AIU to Meaningful Use."

New Report: The Social Life of Health Information

2011-05-11T15:06:00.000-07:00

"Data will help you make better decisions. Data will chart your course. Data will show you what really works." Data makes all the difference in the world...

Susannah Fox, Associate Director at Pew Research Center’s Internet & American Life Project has published a new report "The Social Life of Health Information, 2011," which is an update on her excellent "The Social Life of Health Information, 2009." This latest report is even better and I highly recommend it to anyone interested in the intersection of healthcare and technology. This new report posits that online conversation about health is being driven forward by two forces: 1) the availability of social tools and 2) the motivation, especially among people living with chronic conditions, to connect with each other.

Susannah is the former editor of the website for U.S. News & World Report, winner of the 2001 National Magazine Award for General Excellence in New Media. She has also worked as a researcher for RealNetworks and for The Harwood Group. Her research is consistently wonderful and I also encourage all of you to immediately follow her on Twitter @SusannahFox ~ I promise you won't be disappointed. Her tweets and blog posts along with her research are a national treasure.
One of the best summaries of Fox's research can be found in the video when Susannah spoke in September 2010 at Mayo Transform 2010 : Thinking Differently About Health Care:

This new report shows that doctors, nurses, and other health professionals continue to be the first choice for most people with health concerns, but online resources, including advice from peers, are a significant and growing source of health information. One interesting new data point this survey collects for the first time is that 25% of internet users have watched an online video about health or medical issues. And the statistics for Internet users with one or more chronic conditions are even higher.

The report notes that 1 in 4 Internet users (1 in 5 adults) is a self-tracker:

Carol Torgan, a health science strategist, points out that anyone who makes note of their blood pressure, weight, or menstrual cycle could be categorized as a "self-tracker." Add an online component, and you have the ingredients for a social health application or an electronic health record. Our survey finds that 15% of internet users have tracked their weight, diet, or exercise routine online. In addition, 17% of internet users have tracked any other health indicators or symptoms online. Fully 27% of adult internet users say yes to either question.

In the earlier published report "Health Topics" it was revealed that fully 80% of Internet users reported looking online for health information. This can be broken down into the following topics:

There is a much larger number of users on the Internet since the last report, but the percentage of those accessing health information online is also growing. And the typical search for health information online is on behalf of someone else so the reach is even further extended. The report states:

Half of internet users (48%) who go online for health information say their last search was on behalf of another person, 36% say their last search was on behalf of themselves, and 11% say it was both for themselves and someone else. Thus, while eight in ten internet users go online for health information, the impact of their inquiries may be even broader. And while some groups, such as the chronically ill and those living with disability, are less likely to be online and searching for health information, it does not mean that this information does not reach them through a surrogate of some kind.

Social network sites are popular, but used only sparingly for health updates and queries. But it is interesting to note that people caring for loved ones are more likely than other adults to use social network sites to gather and share health information and support. Also people living with one or more chronic conditions and those living with disability are significantly more likely than other social network site users to gather health information. Social network sites lend themselves well to building community, so I expect we will see this type of trending continue.

Mobile is becoming another area with significant increase in activity. Looking just at the 85% of adults who own a cell phone, 9% say they have software applications or "apps" on their phones that help them track or manage their health. But there is a large gap between rural users at 4% and urban users at 12%. There are also disparities in mobile use of healthcare apps based on race, age and education.

But even with these increases in mobile and online access to health information most people still turn to a professional, friend or family member when they have a health question. The majority of these interactions happen offline: just 5% of adults say they received online information, care, or support from a health professional, 13% say they had online contact with friends and family, and 5% say they interacted online with fellow patients. But people turn to different sources for different kinds of information. As the chart below shows, when seeking emotional support in dealing with a health issue fellow patients, friends, and family win by a landslide.

The Internet is a very powerful tool and it is becoming even more useful in healthcare. Whether searching for a quick answer, taking a deeper dive into research, or joining a community of patients for support and to share information, the Internet will continue to be a growing part of the healthcare landscape.

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Health IT Could Help Reduce Impact of Staff Shortages

2011-05-06T07:00:00.000-07:00

More fragmented and uncoordinated healthcare may be on the horizon thanks to a growing shortage of U.S. healthcare workers. That’s the message from a new poll of healthcare quality experts conducted by ASQ, the world’s largest network of quality resources and experts.
Poll respondents indicate the biggest quality issues patients will face in light of a staffing shortage are:

Spotty care.
Longer waits for primary care physician appointments.
Medical errors.

The online poll was conducted with 475 U.S. healthcare quality professionals who are part of the ASQ quality community. Respondents say healthcare quality will be most impacted by the following shortages:

Primary care physicians – (44 percent of respondents).
Nurses and nursing assistants (27 percent of respondents).
Laboratory professional shortages were also mentioned as an area of concern.

The U.S. Department of Health and Human Services predicts that healthcare staffing shortages will increase significantly after 2014. That’s when approximately 32 million more people will be insured, as mandated by the healthcare reform law, and as baby boomers become Medicare-aged.

“This trend is real and could have a negative impact on a patient’s experience as heavier demands are placed on the system,” said Joe Fortuna, chair of ASQ’s Healthcare Division. “That’s why it is imperative that healthcare organizations focus on enhancing their ability to prevent errors, remove waste and improve the clinical and operational quality of the services they provide.”

Prevention Tips

How can healthcare organizations prevent these shortage-related quality issues? Respondents ranked the following solutions in order of priority:

Create fast track units. These units allow patients with less serious needs to be seen, assessed and treated faster and released in a timely manner. This frees emergency room staff to focus on urgent cases and improves a patient’s access to emergency services overall.
Install and use healthcare IT systems.
Implement checklists in the ER and other hospital departments.
Establish more care teams of doctors, nurses, physician assistants and disease educators.
Implement a scribe program to improve productivity. Hospital scribes trail doctors from bed to bed, taking detailed notes for a patient’s electronic medical record.

Fortuna believes that healthcare IT systems can be helpful in a number of ways to reduce errors, improve care coordination and enhance access to needed medical information. “Innovations like fast track units and scribe programs are also useful.” He adds, “Process redesign coupled with culture change, however, can have a huge impact on cost and quality while at the same time ensuring the sustainability of the changes once made.”

Impact of Healthcare Technology

Poll respondents identified patient electronic medical records as the IT system that will provide the most value in reducing the impact of staff shortages. Respondents ranked other useful IT methods by priority:

Computerized order entry system for medications.
Clinical decision support systems. DSS is a computer-based information system that supports an organization’s decision-making activities.
Telemedicine or remote monitoring systems.
Automated dose dispensing.
Disease registries. Registries are collections of secondary data related to patients with a specific diagnosis, condition or procedure.

Cost-cutting Measures

Respondents said that increased use of quality and process engineers should be the top priority for hospitals to reduce costs in light of shortages. Other methods identified by the ASQ poll include:

Implement mandatory process improvement training for healthcare.
Create financial incentives to deliver more efficient care.
Redesign hospital care spaces to be more efficient.
Changes in malpractice laws.

ASQ quality improvement experts work in a diverse range of healthcare organizations from hospitals to public health departments. Quality improvement methods have proven increasingly successful in healthcare organizations. For example, lean emphasizes removal of wasteful processes and focuses on delivering more value to patients.

ASQ is a global community of people dedicated to quality who share the ideas and tools that make our world work better. With millions of individual and organizational members of the community in 150 countries, ASQ has the reputation and reach to bring together the diverse quality champions who are transforming the world’s corporations, organizations and communities to meet tomorrow’s critical challenges. ASQ is headquartered in Milwaukee, Wis., with national service centers in China, India and Mexico. Learn more about ASQ’s members, mission, technologies and training at www.asq.org.

Getting Direct with State Health Information Exchange

2011-04-15T16:20:00.000-07:00

I have been working on a contract to help the Office of the National Coordinator (ONC) State HIE Program host a Direct Boot Camp in Chicago, IL on April 12 – 14, 2011. So I spent a few days this week working at the Boot Camp helping the ONC bring states up to speed on the Direct Project. But the Boot Camp went well beyond Direct basics to focus on implementation details to help States who are planning on implementing Direct learn from experiences in the field and take their next implementation steps. The Boot Camp was geared explicitly toward states that are implementing Direct as part of their strategic and operational plans under their cooperative agreement with the ONC. I was pleased to be part of the excellent team of ONC staff and consultants that organized and facilitated the event. The meeting agenda and materials are now posted on the Direct Project wiki and there was some good discussion using the #ONCDirect hashtag on Twitter. There was also some rich discussion during the Q&A portions of each session and I encourage you to read through the session notes available on the wiki.

Much of the impetus for incorporating the Direct Project into their state plans was the result of the Program Information Notice (Document Number: ONC-HIE-PIN-001), known as the PIN, sent to the states on July 6, 2010. One section of the PIN requires the states to:

Set Strategy to Meet Gaps in HIE Capabilities for Meaningful Use — Develop and implement a strategy and work plan to address the gaps in HIE capabilities as identified in the environmental scan with a focus on delivery of structured lab results, e-prescribing and sharing patient care summaries across unaffiliated organizations. Gap-filling strategies might include:
Policy, purchasing and regulatory actions, such as requiring e-prescribing or electronic sharing of lab results in state or Medicaid contracts with pharmacies and clinical labs.
Core services to reduce the cost and complexity of exchange including authoritative provider and plan directories and authentication services that would support both simplified and comprehensive interoperability.
Targeted infrastructure for gap areas such as shared services for small labs or pharmacies, or to serve rural providers, which could utilize both simplified and comprehensive interoperability solutions.
In filling these gaps, the state is not required to directly provide or construct technology infrastructure or services. A key role for states can be to provide leadership and direction to public and private stakeholders. States may also use policy and purchasing levers to extend and enhance existing HIE activities in the state so as to encourage key trading partners such as pharmacies and clinical laboratories to participate in electronic service delivery and to enable providers to meet meaningful use requirements.

States shall also establish a strategy and immediate next steps to address the following over the course of the project:
Building capacity of public health systems to accept electronic reporting of immunizations, notifiable diseases and syndromic surveillance reporting from providers.
Enabling clinical quality reporting to Medicaid and Medicare.

To meet these requirements many states have plans to use direct messaging in a phased approach as an onramp towards more robust HIE services. But due to the flexible nature of a cooperative agreement, as opposed to being a straight grant, the states have been working with the ONC to fine tune their plans. Many of these states had their plans approved before the Direct Project was able to provide working code. As the Direct Project has developed, some of the states thinking around deploying direct messaging services has evolved. And there is also continuing maturity in the marketplace, with vendors offering services that have allowed the states to back away from providing centralized services themselves and moving towards a more market based approach.

Therefore, many states that were originally planning to to act as a Health Information Service Provider (HISP) themselves are now moving towards creating a preferred vendor list for HISPSs and monitoring the market to ensure coverage for all the providers in their state. A HISP is an entity that provides services that are required for Direct Project exchange, such as the management of trust between senders and receivers. Using the HISP model, offerings are emerging that provide some of these services:

Provisioning of health domain addresses
Certification issuance and management
Global routing services

The Best Practices for HISPs posted on the wiki is an excellent document for those interested in knowing more about organization structures that will allow these services to be provided.

There are also states planning to use Direct to help with interstate exchange. This is an area that will need further development, as we weave through the spaghetti of various consent laws around the country, but ultimately getting exchange happening at a broad scale will obviously include interstate exchange. Some of the nation networks being launched, such as AAFP/Surescripts and Verizon presented during the boot camp and helped the states to shape some of their thinking in this area. There was a lot of discussion about Provider Directories as well, which I will leave to a future post. It was a very interesting experience to work with the ONC and the various states to further integrate the Direct Project into their plans and I expect we will see this help to drive further adoption and use of these standards and specifications.

The list below shows the currently approved state specific strategic and operational plans for creating health information exchange capacity. Not all of these states are incorporating Direct Project into their plans.

State	Strategic /Operational Plans and State Summaries	Entity Responsible for Grant	Plan Approval Date
Alabama	Strategic and Operational Plans State HIE Plan Summary	Alabama Medicaid Agency	02/12/2011
Arizona	Strategic and Operational Plans	Arizona Governor’s Office of Economic Recovery	03/18/2011
Arkansas	Strategic and Operational Plans	Arkansas Department of Finance and Administration	02/24/2011
California	Strategic and Operational Plans To view the documents separately click here (easier download)	California Health and Human Services Agency	06/16/2010
Colorado	Strategic and Operational Plans	Colorado Regional Health Information Organization	12/3/2010
Connecticut	Strategic and Operational Plans	State of Connecticut Department of Public Health	03/18/2011
Delaware	State Summary	Delaware Health Information Network	05/17/2010
Florida	Strategic and Operational Plans	Florida Agency of Health Care Administration	02/04/2011
Georgia	Strategic and Operational Plans	Georgia Department of Community Health	03/23/2011
Hawai’i	State Summary	Hawaii Health Information Exchange	02/02/2011
Idaho	Strategic and Operational Plans	Idaho Health Data Exchange	12/07/2010
Illinois	Strategic and Operational Plans	Illinois Department of Healthcare and Family Services	12/10/2010
Indiana	Strategic and Operational Plans State Summary	Indiana Health Information Technology, Inc	01/21/2011
Iowa	Strategic and Operational Plans	Iowa Department of Public Health	01/25/2011
Kentucky	State Summary	Cabinet for Health and Family Services	02/17/2011
Maine	State Summary	State of Maine/Governor’s Office of Health Policy & Finance	08/16/2010
Maryland	Strategic and Operational Plans	The Maryland Department of Health and Mental Hygiene	05/14/2010
Massachusetts	Strategic and Operational Plans	Massachusetts Technology Park Corporation	11/03/2010
Michigan	Strategic and Operational Plans State Summary	Michigan Department of Health	11/29/2010
Minnesota	Strategic and Operational Plans	Minnesota Department of Health	02/24/2011
Mississippi	Strategic and Operational Plans	State of Mississippi	02/24/2011
Missouri	Strategic and Operational Plans	Missouri Department of Social Services	01/25/2011
Nebraska	Strategic and Operational Plans State Summary	Nebraska Department of Administrative Services	11/05/2010
New Hampshire	Strategic and Operational Plans State Summary	New Hampshire Department of Health and Human Services	12/10/2010
New Jersey	State Summary	New Jersey Health Care Facilities Financing Authority	01/13/2011
New Mexico	Strategic and Operational Plans State Summary	LCF Research, New Mexico	01/25/2010
New York	Strategic and Operational Plans	New York eHealth Collaborative	11/22/2010
North Carolina	Strategic and Operational Plans State Summary	North Carolina Department of State Treasurer	11/03/2010
Ohio	Strategic and Operational Plans State Summary	Ohio Health Information Partnership	01/25/2011
Oregon	Strategic and Operational Plans	State of Oregon	12/10/2010
Pennsylvania	Strategic and Operational Plans	Commonwealth of Pennsylvania	3/23/2011
Rhode Island	Strategic and Operational Plans	Rhode Island Quality Institute	12/06/2010
South Carolina	Strategic and Operational Plans	South Carolina Department of Health & Human Services	08/30/2010
South Dakota	Strategic and Opeational Plans	South Dakota Department of Health	02/24/2011
Tennessee	Strategic and Operational Plans State Summary	State of Tennessee	09/17/2010
Texas	Strategic and Operational Plans State Summary	Texas Health and Human Services Commission	11/03/2010
Utah	Strategic and Operational Plans	Utah Department of Health	05/12/2010
Vermont	Strategic and Operational Plans State Summary	Vermont Department of Human Services	10/26/2010
Virginia	Strategic and Opeational Plans	Virginia Department of Health	03/17/2011
Washington	Strategic and Operational Plans State Summary	Washington Health Care Authority	12/10/2010
West Virgina	Coming Soon	West Virgina Department of Health and Human Services	02/12/2011
Wisconsin	Strategic and Operational Plans State Summary	Wisconsin Department of Health and Family Services	12/10/2010
Wyoming	Coming Soon	State of Wyoming Office of the Governor	03/18/2011

Direct Project Boot Camp

2011-04-12T11:11:00.000-07:00

As most of you may already know, the State Health Information Exchange Cooperative Agreements Program is designed to promote health information exchange (HIE) that will advance mechanisms for information sharing across the health care system. I've said many times that simply digitizing disparate silos of health information will not move us toward the goals of lower costs, higher quality, and improved clinical outcomes. The appropriate and secure electronic exchange and consequent use of health information to improve quality and coordination of care is a critical enabler of a high performance health care system. The program aims to ensure that every eligible health care provider has at least one option for health information exchange that meets the requirements of the Medicare and Medicaid EHR Incentive Programs, defined by CMS in a final rule released on July 13, 2010. Program awardees will be using their funding to:

Create and implement up-to-date privacy and security requirements for HIE
Coordinate with Medicaid and state public health programs to establish an integrated approach
Monitor and track meaningful use HIE capabilities in their state
Set strategy to meet gaps in HIE capabilities
Ensure consistency with national standards

The immediate priority of the State HIE program is to ensure that all eligible providers within every state or territory have at least one option available to meet the HIE requirements of meaningful use in 2011. While it is ultimately the responsibility of each Program awardee to determine the specific role and infrastructure of its HIE, this Program Information Notice (PIN) has outlined six key responsibilities for States and SDEs that must be fulfilled for continued funding through the State HIE Program.

One of the resources resources available to assist states and SDEs in their efforts to establish Health Information Exchange capacity for providers is the Direct Project. The Direct Project was created to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. The Direct Project has more than 200 participants from over 50 different organizations. These participants include EHR and PHR vendors, medical organizations, systems integrators, integrated delivery networks, federal organizations, state and regional health information organizations, organizations that provide health information exchange capabilities, and health information technology consultants. To assist states in planning to incorporate using Direct I am helping with a Direct Project boot camp in Chicago, Illinois April 12th through the 14th.

Thirty nine states are attending the boot camp, and thankfully without a government shutdown this week, the ONC can provide them with some great support. The states were presented with a Direct Basics Webinar on March 11, 2011. The Webex recording can be accessed HERE. The boot camp will build upon this to provide real hands on work assisting to incorporate direct messaging into their strategic and operational plans, especially to help fill in the gaps in health information exchange coverage. I'll be sure to provide the relevant information for stakeholders on the Direct Project wiki and may even send out a tweet or two.

...

2011 Budget Deal Details

2011-04-12T04:30:00.000-07:00

Below are the budget cuts that will be voted on this week. The CR that would fund the government through the rest of this fiscal year is posted under the listing of cuts. The bill includes a total of $1.049 trillion in funding, over $38 billion in reductions from last year’s (fiscal year 2010) levels. This includes the $12 billion in reductions previously approved by Congress and signed into law under the previous three continuing resolutions, as well as nearly $28 billion in additional new spending cuts.

Farzad Mostashari named National Coordinator for Health Information Technology

2011-04-08T11:11:00.000-07:00

The Office of the National Coordinator for Health Information Technology has named Farzad Mostashari, MD, ScM to replace David Blumenthal, MD as National Coordinator for Health Information Technology. Dr. Mostashari had been serving as Deputy National Coordinator for Programs and Policy within the ONC since July 2009, while Dr. Blumenthal has been national coordinator since March of 2009.

It is no surprise that Dr. Blumenthal as gone back to academia, since he would have lost his tenure at Harvard had he stayed on at the ONC. Blumenthal has done an outstanding job at launching the many health IT initiatives at the ONC over the past two years, and moving us into the "Era of Meaningful Use." But I actually think that this is a great time for transition to Dr. Mostashari as we move from planning these programs to implementation. And I think it is important that this is not a temporary or interim appointment, but we have a permanent replacement. This is no time for doubt or uncertainty, and Farzad will provide the continuity that is so badly needed.

Some have said that the next national coordinator should have more real world experience in implementing an EHR, and Dr. Mostashari will fit this criteria nicely. I have thought for some time (really since my interview with Farzad back in November 2010) that he would be the best choice for this new role. Moving from planning with a strong leader who casts a vision, to implementation with equally strong leadership who has real world implementation experience and great communication skills. As I told Neil Versel for InformationWeek Magazine, "I think you've got the right leader in the right place at the right time."

...

Group Practice Reporting Option (GPRO) Tool and Accountable Care Organizations (ACO)

2011-03-31T16:20:00.000-07:00

The CMS proposed regulations on Accountable Care Organizations (ACO)s was released on March 31, 2011. These rules give a glimpse of how the government is planning to coordinate the electronic health record (EHR) meaningful use incentive program with its plans for ACOs. In an article published in the New England Journal of Medicine, Donald Berwick, MD, administrator of the Centers for Medicare and Medicaid Services, said the creation of ACOs is one of the first delivery-reform initiatives that will be implemented under the health reform passed a year ago. But this program also builds on some existing incentive programs and tools for quality reporting.

The Physician Quality Reporting Initiative (PQRI) established a financial incentive for eligible healthcare professionals to participate in a voluntary quality reporting program. By reporting on a minimum of 3 measures on a specified group of patients, a physician can earn a bonus payment of 1% on all of their Medicare billing for one year. In 2011, CMS renamed PQRI the Physician Quality Reporting System (PQRS). For 2011, there are 194 quality measures and 14 measures groups in the PQRS, which can be reported to CMS by physicians and other caregivers in hospitals or physician practices. Last years rule for the Medicare Physician Fee Schedule had an impact on both PQRI and eRX Incentive programs. The recently released proposed rule on Accountable Care Organizations will make use of the same reporting tools that PQRS uses. The CMS website for the PQRS is here: https://www.cms.gov/PQRS/01_Overview.asp

Beginning with 2011 Physician Quality Reporting, a group practice consisting of a single Taxpayer Identification Number (TIN) with 2-199 individual eligible professionals or individual national provider identifiers (NPIs) can submit data on quality measures to qualify for an incentive payment. If it is determined that the group practice satisfactorily reports data on Physician Quality Reporting measures, the practice will be eligible for an incentive payment equal to one percent of the practice's total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges.

The GPRO II reporting mechanism is via claims. If the group does not have an applicable measures group to report via claims, the practice can report that measures group via a qualified registry. The reporting requirements for GPRO II are determined on a tiered basis depending on the group's size. Groups selected to participate in GPRO II will use the Physician Quality Reporting System Measure Specifications Manual for Claims and Registry Reporting of Individual Measures and the Physician Quality Reporting System Measures Groups Specifications Manual for the respective reporting year.

In the first year of the new ACO program announced by CMS ACOs will use a new ACO GPRO tool based on the data collection tool currently used in the PQRS. In subsequent program years through additional rulemaking, we would expect to refine and expand the ACO measures to enhance our ability to assess the quality of care furnished by ACOs participating in the Shared Savings Program and expand measures reporting mechanisms to include those that are directly EHR-based. The tool would allow ACOs to submit clinical information from EHRs, registries, and administrative data sources required for measurement reporting. One very interesting section of the proposed rule on ACOs is:

In July 2010, HHS published final rules for the EHR Incentive Programs. Included within the final regulations were certain clinical quality measures for which eligible professionals and eligible hospitals are responsible. We have noted in Table 1, the proposed Shared Savings Program quality measures currently included in the EHR Incentive Programs and will continue to further align the measures between the two programs. Given that we have proposed in Section II.E.6 that at least 50 percent of an ACO's PCPs are "meaningful EHR users" as that term is defined in 42 CFR 495.4 by the start of the second Shared Savings Program performance year in order to continue participation in the Shared Savings Program, our intent is to develop the capability of the GPRO web-based tool to interface with EHR technology, such that EHR data could directly populate the ACO GPRO tool with the required quality data. As we intend to further align both the Shared Savings Program and EHR incentive program through subsequent rulemaking, we anticipate that certified EHR technology (including certified EHR modules capable of reporting clinical quality measures) will be an additional measures reporting mechanism used by ACOs under the Shared Savings Program for future program years.

Obviously, there will continue to be alignment, not only between the reporting requirements for ACOs and the EHR Incentive Program requirements for meaningful use, but also the Standards and Certifications Criteria for EHRs in the succeeding phases of the program. I imagine that the interface between the EHR and the ACO GPRO tool will become a very important part of healthcare innovation for the future...

...

Sebelius and Blumenthal HIMSS 2011 Conference Keynotes

2011-03-25T08:00:00.000-07:00

At the annual HIMSS conference, Secretary of Health and Human Services Kathleen Sebelius and National Coordinator of Health IT Dr. David Blumenthal discussed the progress made in healthcare IT.

While much has been accomplished, Sebelius warned the crowd of over 30,000 attendees about the long road ahead. In terms of health IT adoption, “there’s already a gap between large urban hospitals and small rural ones,” she said. As she pointed out, 30% of primary care physicians (PCPs) use an EHR system today. That represents progress since only 20% of PCPs used an EHR system two years ago, but it still means that seven in 10 primary doctors do not have electronic health records.

"The energy and creativity and commitment to improving health are a positive sign," Sebelius said. "Eventually, we'll see hospital after hospital clear out their file cabinets. For future generations, jokes about doctors' handwriting will be a thing of the past."

Moving forward in health IT, Secretary Sebelius stressed the need for engagement in health reform, a push for technological development, adoption of EHRs by small practices, and provision of health IT across all populations regardless of racial background, geographic location, and socioeconomic status.

Dr. Blumenthal delivered a positive message on the progress of health IT stating, "Meaningful use is no longer a hope or a theory -- it is a working, operating program -- as reality." In his keynote address, Dr. Blumenthal also provided an update on the progress of the electronic health record (EHR) incentive programs, regional extension centers (RECs), health IT training programs, and EHR modules.

The main topics of Dr. Blumenthal's keynote include the incentive programs, the national infrastructure designed to support the adoption of EHRs, and patient health information (PHI).

"Meaningful use provides us a way to set expectations and goals, a blueprint for what info should be available, to whom and when, in support of an improved health care system and improved health," Blumenthal said.

Direct Project ~ Specifications and Compliance

2011-03-21T06:30:00.000-07:00

Doug Fridsma, M.D., Ph.D. is the Director of the Office of Standards and Interoperability in the Office of the National Coordinator for Health Information Technology (ONC). He is currently on leave from the Department of Biomedical Informatics at Arizona State University and from his clinical practice at Mayo Clinic Scottsdale. On Monday, March 21, 2011 he announced the Direct Project specifications are achieving widespread adoption and gave a glimpse into what's in store for the future of this project.

Important points in this announcement are:

There are significant commitments by key national players (states and health IT vendors) that bode well for universal adoption for the Direct Project.
The pilot projects and specifications related to IHE profiles and transitions of care demonstrate how the Direct Project is so much more than secure email.
The Direct Project specifications (final) and compliance (draft) documents are now available.

Two key events are also coming up:

On Monday March 21 at 1 PM ET, Arien Malec will be presenting the Direct Project update at the National eHealth Collaborative NHIN University course.
And on March 29, the Direct Project will be on the agenda for the HIT Standards Committee meeting.

The post also pointed out that over 60 healthcare and health IT organizations, including many state based and private sector health information exchanges, leading IT vendors, and several leading integrated delivery systems, have planned support for the Direct Project. The full current and growing list is available here. Dr. Fridsma said:

"This broad swath of support for the Direct Project represents approximately 90% of market share covered by the participating health IT vendors. With over 20 states participating in the project, including many of the largest states in the country, nearly half of the total U.S. population can now benefit from the Direct Project’s growing integration into the national health IT ecosystem. Growing participation with the Direct Project will alleviate a healthcare system awash in a sea of paper and faxes."

...

Healthcare, Technology & Government 2.0

The Role of Health IT in Transforming Healthcare

Get Ready for EHR and NwHIN Rules

Stage 2 Meaningful Use and NwHIN Governance Rules

Stage 2 Meaningful Use will be deferred for an extra year for those who attested in 2011

Stopping Internet Pirates

Further Analysis of Data on Meaningful Use Attestation

Data on Meaningful Use Attestation

Health IT Trends in 2012: Clouds and Mobile Health

Looking back at 2011...

Healthcare Innovation Challenge Materials

The CMS Innovation Center's Health Care Innovation Challenge

Remember the Patient

The Moral Test

Berwick's Vision Will Continue Under Tavenner

Alarming Rise in Healthcare Data Breaches

We need to be guarding our backside with health data...

Videos: 2011 ONC Annual Meeting

Encryption and Electronic Health Records

Your Health and Your Privacy: Protecting Health Information in a Digital World

Health Reform and the Supreme Court

Supreme Court and Healthcare Reform

Putting the 'IT' in Care Transitions

Ada Lovelace 2.0 - Her Head in the Clouds and Feet on the Ground

HIMSS EHR Association Comments NwHIN Power Team Deliberations

Hearing on Healthcare Industry Consolidation

President Proclaims National Health IT Week

Things changed that day...

Health Information Exchange Efforts Heat Up

EHR Incentives Likely to Improve Quality

Federal Investment in Electronic Health Records Likely to Reap Returns in Quality of Care

Sharp Focus Roundup

Mobile Health Whitepaper from Sprint and Frost & Sullivan

EHR Incentive Program Gaining Ground

Secrets of HIE Success Revealed: Lessons from the Leaders

Health IT Provides Tools to Improve Patient Safety

Xerox Survey Shows Impact of Electronic Health Records

Patient education and communication required to ease transition to digital

Reflections from the Federal Chief Information Officer

Transparency and Federal Management IT Systems

EXECUTIVE OFFICE OF THE PRESIDENTOFFICE OF MANAGEMENT AND BUDGET WASHINGTON, D.C. 20503

New HIE Survey Shows Increased Privacy Controls, Concerns with Systems Integration and Participation in Accountable Care

Oregon Launches Direct Project Pilot

Total Number of Live HIEs Exchanging Data More Than Doubles in Past Year

Small, isolated, rural hospitals show poorer results on measures of quality of care, patient outcomes

What Lies Ahead for ONC: Meaningful Use and Beyond

New Top Level Domains and Healthcare Implications

Statewide Health Information Exchange: Becoming Operational

Metadata Power Team Recommendations

Cancer Death Rates Decline, But Disparities Remain

Marty Coopers Big Idea Has Transformed Our Lives

The Health Data Initiative Forum 2011

Office of the National Coordinator for Health Information Technology introduces new Investing in Innovations (i2) Initiative

Not What the Doctor Ordered: Health IT Barriers for Small Medical Practices

Meaningful Use Workgroup Recommendation to Delay Stage 2

Health IT in an Era of Accountable Care: Update from the Beacon Communities

Moving Providers from AIU to Meaningful Use

New Report: The Social Life of Health Information

"Data will help you make better decisions. Data will chart your course. Data will show you what really works." Data makes all the difference in the world...

Health IT Could Help Reduce Impact of Staff Shortages

Getting Direct with State Health Information Exchange

Direct Project Boot Camp

2011 Budget Deal Details

Farzad Mostashari named National Coordinator for Health Information Technology

Group Practice Reporting Option (GPRO) Tool and Accountable Care Organizations (ACO)

Sebelius and Blumenthal HIMSS 2011 Conference Keynotes

Direct Project ~ Specifications and Compliance

EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF MANAGEMENT AND BUDGET WASHINGTON, D.C. 20503