Tuesday, January 28, 2014

Health IT State of the Union

I appeared on the Fed Tech Talk radio program on Federal News Radio which aired on WFED 1500 AM in Washington, DC on January 28, 2014. It was a fun discussion with host John Gilroy (check out his blog here) where we discussed the Office of the National Coordinator for Health Information Technology (ONC) Annual Meeting, the historic signing of an MOU between the United States and Great Britain on sharing health IT tools, health information exchange, EHR adoption, the Direct Project, mobile health, and the current state of health IT in the nation.

I gave some background on my involvement in health information technology and an overview of the landscape in health IT and how we are building out an infrastructure to improve our healthcare system. This was a lot of fun, and hopefully helped get the word out that the state of health IT in this country is strong, and we are looking at the best year ever ahead. The bottom line is that it is time to drag the US healthcare system (albeit kicking and screaming) into the 21st century of technology.

Healthcare Analytics Gets a Major Funding Boost and Kaiser Chooses a Vendor

healthcare analytics ROI
Data warehousing and analytics company Health Catalyst has raised $41 million in a series C funding round led by existing investor Sequoia Capital reports the Wall Street Journal. The investment enables Health Catalyst to further build out its healthcare analytics platform and assist its clients in systematically and permanently improving efficiency and effectiveness in care delivery. The company plans to invest $50 million in product development over the next two years, including production of the next 200 advanced content-driven clinical applications on its roadmap. This $50 million will be money well spent if Health Catalyst is going to continue to take on giants like IBM, Oracle, other analytics vendors, and also the large EHR vendors that would like to keep big slices of the health data analytics pie.

"We are thrilled that our existing investors chose to continue their strategic relationships with us, leading the way to major innovations for US healthcare,” said Health Catalyst CEO Dan Burton. "As more healthcare organizations are coming to understand, data warehousing and analytics are foundational to their success under new payment and risk models." This latest round brings the total amount raised by Health Catalyst to nearly $100 million. Last year, the company was one of the top digital health investments, according to Rock Health's 2013 Midyear Digital Health Funding Update.

Introductory Video to Health Catalyst

A year ago Health Catalyst increased its Series B round by $8 million, with participation from Kaiser Permanente Ventures, the corporate venture capital arm of Kaiser Permanente, and CHV Capital, a venture capital fund guided by the strategic objectives of Indiana University Health, Indiana’s largest healthcare system. Indiana University Health had chosen Health Catalyst reporting and advanced analytics solutions and built out an enterprise data warehouse in just 90 days. Regarding the investment last year Kyle Salyers, Managing Director at CHV Capital, said, "Healthcare data warehousing and analytics is a necessity in order to succeed in the future of healthcare. It will bring actionable information to the point of care and to administrative leadership. We and our colleagues at IU Health see Health Catalyst as the market leader in delivering a data warehousing platform and analytic accelerators with scale, flexibility, speed to deployment, and ultimately a tangible return on investment."

Now Health Catalyst has also announced that Kaiser Permanente, the nation’s largest healthcare delivery system, operating 38 hospitals and employing more than 17,000 physicians serving 9.1 million members, is also adopting the Health Catalyst technology platform improve quality, eliminate waste and lower costs. This brings the total of company’s clients now operating over 135 hospitals and 1,700 clinics that account for over $130 billion in healthcare delivered annually. This is a substantial piece of the health data analytics market and Health Catalyst is certainly one to watch. Last year Chilmark Research named Health Catalyst the highest-rated overall solution in the Chilmark 2013 Clinical Analytics for Population Health Market Trends Report, calling the company a "clear standout." Also research firm KLAS claimed that Health Catalyst’s platform is a "newer and more effective way to approach EDW" in the report Healthcare Analytics: Making Sense of the Puzzle Pieces. KLAS gave Health Catalyst the highest performance rating (90) in the category of healthcare analytics companies, which also included Deloitte, Explorys, Healthcare Data Works, IBM, Oracle, Microsoft, SAP, and Teradata.

Todd Cozzens, venture partner at Sequoia Capital, told Healthcare IT News in an interview last year that Health Catalyst is better than "the IBMs and Oracles of the world."

"It's much more intuitive, much more clinically focused," Cozzens said. "The other piece is this incredible content they have around waste reduction, LEAN process, Six Sigma. You take these two core competencies, and it goes way beyond an electronic data warehouse. It's a performance management and care transformation system all in one."

As Zina Moukheiber points out in Forbes, Health Catalyst is muscling its way into Oracle and IBM territory. But Health Catalyst is developing data management tools that are uniquely suited for health care with laser focus on this industry. “Clinical data is so much more complicated that managing bank accounts or shoe sizes,” she quotes Dan Burton as saying. She also points out that Oracle typically captures data and converts it into a specific format, whereas the Health Catalyst late-binding architecture allows for more flexible manipulation of data aggregated from electronic health records, thus making its system faster to implement, and easier to query.

I have called 2014 the Year of Health Data Analytics and said that I believe that we are moving through three phases: data capture, data sharing, and data analytics. Data capture and sharing have been driven primarily by meaningful use incentives, while analytics will provide the ROI from these investments. It is the ability to do interesting and useful things with these data that will build out the infrastructure to support new payment and care delivery models. Business intelligence and analytics tools will be critical in order to thrive in the new healthcare marketplace. Much of the success of these analytics platforms will depend on the underlying architecture and the late-binding data warehouse model used by Health Catalyst holds the most promise today.

(full disclosure, I have provided strategic advising services to Health Catalyst).

Saturday, January 25, 2014

ONC Annual Meeting 2014

The Office of the National Coordinator for Health Information Technology (ONC) held it’s Annual Meeting in Washington, DC, on January 23, 2014. This marked the 10th year of the ONC, and the fifth since the passage of the HITECH Act. The ONC was created in April 2004 through an executive order by President George W. Bush, and was legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. The HITECH legislation also created the HIT Standards Committee and the HIT Policy Committee under the auspices of the Federal Advisory Committee Act (FACA).

After 10 years of activity we are entering a new era in health IT policy, and the industry is at a major crossroads.

The ONC Annual Meeting is a gathering of health IT and policy geeks made up primarily of grantees to various ONC programs. Many of these were funded through the HITECH Act, such as the State Health Information (State HIE) Exchange Cooperative Agreement Program and the Health IT Regional Extension Center (REC) Program. The HIE cooperative agreements are ending, along with the funding streams to many statewide HIE efforts, while the REC program is extended for another year.

In some cases the entity receiving the funding for these two programs is the same, and I think it is likely that those states where the REC and HIE are closely aligned are ones where we will see the most success. In any event, I expect to see up to one third of the state HIEs fold as the funding dries up. But those that have put good sustainability plans in place and ultimately succeed by providing value to stakeholders will be that much stronger a year from now. We will have to see how well the RECs can help providers over this next year in achieving meaningful use.

We now also have a newly minted National Coordinator for Health IT. In an email sent to staff at HHS on December 19, 2013, Secretary Kathleen Sebelius announced that physician Karen DeSalvo, who served as the City of New Orleans Health Commissioner and Senior Health Policy Advisor to Mayor Mitch Landrieu, will be the National Coordinator and begin the job January 13, 2014. She was preceded by physician and ONC Chief Medical Officer Jacob Reider (interim 2013 – 2014), physician and public health expert Farzad Mostashari (2011 – 2013), physician and Harvard Medical School Professor David Blumenthal (2009 – 2011), psychiatrist Robert Kolodner (interim 2006, permanent 2007 – 2009), and physician and venture capitalist David Brailer, (2004 – 2007).

The ONC Annual Meeting was Dr. DeSalvo’s first public introduction to the health IT community and her keynote was very interesting (playing off many of the themes she shared with the HIT Policy Committee earlier this month).

She spoke of her upbringing and discussed her work as New Orleans’ health commissioner. She talked about how the use of health IT has became critical in public health initiatives and emergency preparedness. She described how health IT was key in New Orleans’ recovery after Hurricane Katrina and rebuilding the region’s health system. She was also on the Steering Committee for the Crescent City Beacon Community in Louisiana.

“When asked to be a part of ONC’s leadership, I said ‘Absolutely yes’ because this is a critical period where we need to do in this nation to reform the healthcare delivery system,” DeSalvo said in her keynote talk. “We are making strides in expanding coverage and getting everybody in the tent. Our challenge now is to see that when everybody is in the tent that the care is as effective and efficient and safe as possible.”

Perhaps responding to HIT Policy Committee member John Halamka’s blog post in which he said she is a cheerleader for health IT, not an informatics expert, she stated “I’m more than a cheerleader for health information technology. I am actively engaged in the space as a doctor, as a leader, and a public health official.” Although when speaking to her privately later she readily admitted that she is not a technologist and she will lean on the expertise of the leadership assembled at the ONC and within the health IT community.

One of the more under-reported stories, and a very important milestone that occurred at the meeting was the signing of an historic memorandum of understanding (MOU) between the United States and the UK. Originally identified at the June 5, 2013, bilateral summit meeting between the US and UK, the collaboration focuses on four key areas for health IT and innovation:
  • Sharing quality indicators
  • Making better use of health data
  • Adopting digital systems
  • Working towards a more robust health IT marketplace

HHS Secretary Kathleen Sebelius attended the meeting. Bryan Sivak, Chief Technology Officer at HHS also joined Sebelius onstage while she gave some brief remarks. The Secretary said that because of the work of the people in the room, patients are more empowered to access and manage their own health information.

Then Secretary Sebelius and the U.K. Secretary of State for Health Jeremy Hunt, who was participating in the meeting remotely, signed the historic memorandum of understanding allowing the countries to share health IT tools. Bryan Sivak and Tim Kelsey, National Director for Patients and Information at NHS, also countersigned the MOU. Secretary Sebelius discussed how health IT is an important platform for healthcare delivery and stressed its role in shaping lower costs and improved quality. She expressed hope that the MOU will help to address the challenges and ultimately improve the healthcare system and the lives of patients.

Bryan Sivak moderated a fascinating panel discussion, “Spurring Innovation for Health IT Transformation” with Jacob Reider, MD, Bijan Salehizadeh of NaviMed Capital, and Polina Hanin, community director at StartUp Health. Some of the themes were taking advantage of government resources while still knowing your customers and their real world needs.

“Startups are trying to understand how they can help physicians, hospitals and organizations become more efficient, with an emphasis on quality of care,” said Ms. Hanin. Entrepreneurs interested in health IT should consider shadowing clinicians in practice or else “they will develop technology that sounds right but doesn’t actually work within the organizations,” she said.
With patients well being and very lives sometimes at stake, Dr. Reider urged providers to be measured about the way health IT is implemented in order to minimize risk. “You don’t have to do the Big Bang. You can do iterations of risk, starting in places where there is less patient risk.”

Businesses often don’t know what ONC resources are available that could help accelerate development. “They are surprised we are so helpful, and we are surprised that they didn’t know what was buried in a 2,000-page regulation,” Reider said to laughter. “They can leverage the standards instead of creating a new way of doing things.”

Taking time to get things right was a key stressed by Bijan Salehizadeh. “I think it’s important for entrepreneurs to realize that things take a little bit longer in healthcare. Often a lot longer,” he said.

At a Town Hall meeting Thursday afternoon, in which 11 senior leaders at ONC participated, Dr. DeSalvo spoke of the importance of maintaining constant progress for health IT as ONC enters a new decade and what she referred to as a “pivot” stage.

The panel was asked what is being done to help pharmacists and other providers who are not eligible for the Meaningful Use program. “We are looking at how we can leverage the certification program to be broader than just for those participating in Meaningful Use,” said Jodi Daniel, JD, MPH, director of ONC’s Office of Policy and Planning. Behavioral health and long-term care providers are high priorities, she added. A team is working on ways to best include more providers.

Kelly Cronin, health reform coordinator, said ONC is figuring out how to accelerate interoperability and support adoption of health IT by long-term care and behavioral health providers. Also, “We want to make sure that, as accountable care organizations mature, we’re thinking critically about how we weave health IT into that. How do we advance exchange as a series of applications including those that reach patients and make sure this all fits together.”

Lygeia Ricciardi, director of ONC’s Office of Consumer eHealth, said her office’s strategy for consumer engagement encompasses the three As: access, action and attitude. With access to data comes action, or the ability to enable patients to utilize tools to meet health goals. Holding this all together is attitude, the perspective that patients should be an active and core member of the team. “It’s about being a smart and thoughtful consumer and being engaged in all aspects of thinking about your health and well-being, including your privacy,” she said.

Rear Admiral Boris D. Lushniak, M.D., M.P.H., the Acting Surgeon General gave and inspiring talk and spoke about the 50th anniversary for the 1964 Sugeon General’s Report on Smoking and Health and gave a call to arms to create a tobacco-free generation. It is a laudable goal. We are half way through the first generation of the ONC, and the next decade is full of promise to improve care and lower costs using health information technology in innovative and effective ways.

Friday, January 3, 2014

Health IT in 2013

We have made some great progress in 2013 on EHR adoption, which is really all about data capture and the digitization of health data. Technologically speaking, we are finally beginning to drag the healthcare industry kicking and screaming into the 21st Century. And we’re making strides in interoperability, or data sharing. HIE infrastructure is in place and the policy framework will continue to drive adoption – the business case for sharing data is even more pressing as new payment and care delivery models continue to spring up.

The third piece that has started to emerge this year is health data analytics. This will enable healthcare organizations to realize some significant returns on their IT investments and thrive in the healthcare marketplace of the future.

Whatever your vision for health reform (and I think we can all agree that our system is broken), there is little doubt that the smart use of technology tools are what is going to make us successful. Todd Park, the U.S. CTO, once said that, “”There’s no problem America has we can’t invent our way out of, if we really try.” However, it is claimed that Winston Churchill once opined “The United States can always be relied upon to do the right thing — having first exhausted all possible alternatives.”

There is at least a grain of truth in each of these sayings, and we may have reached a point where they collide.

continue reading on HL7 Standards blog to see 2013 Year in Review on the following topics:
  • EHR Adoption
  • Meaningful Use Changes
  • Health Information Exchange 
  • Patient Engagement 
  • Changing of the Guard at ONC
Karen DeSalvo, MD, the new National Coordinator for Health Information Technology at the ONC
Karen DeSalvo, MD, the new National Coordinator for Health Information Technology at the ONC