Friday, November 18, 2011

Videos: 2011 ONC Annual Meeting

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:
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?

Wednesday, November 9, 2011

Encryption and Electronic Health Records

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.

Sunday, November 6, 2011

Health Reform and the Supreme Court

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.

Wednesday, November 2, 2011

Supreme Court and Healthcare Reform

"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.