Tag Archives: ONC2015

After #ONC2015 it is back to working on #BlueButton

This week I attended the #ONC2015 Annual meeting. It was a great event with a lot of buzz and plenty of people passionate to make health care better through the application of technology. Interoperability was at the top of the agenda and infused every aspect of the meeting. After an intense two days it is time to get back to work at CMS and focus on the “coal face” of interoperability: Updating BlueButton for Medicare beneficiaries.

BlueButton Claims Data

I am taking a look at Medicare BlueButton data as it is formatted in plain ASCIII text files. I have also been looking at Consolidated Clinical Document Architecture (C-CDA) Standards Documents which are the basis of BlueButton Plus structured text documents. After delving in to the intricacies of the standard and of NIST test documents I feel the need to confirm my understanding with the BlueButton community at large. The clarification I am looking for originates from the very name of the core document – Consolidated CLINICAL Document Architecture. The CMS BlueButton data also includes CLAIMS data and if you search the CCDA standards there appears to be no mention of Claims information in the document. After looking through some of the parsing libraries that have been built my suspicion seems to be confirmed. Amida-tech’s CMS Parser for Blue Button identifies sections that do not have a data model. it also identifies self-entered data sections that can be mapped to existing clinical sections. However many of those sections are generated from self-entered data and should not be allocated the same level of provenance as data entered from clinical sources. An example here might be self-reported implantable devices or self-reported immunizations.

The HL7 standards do have documentation for a Claims Attachment XML Package. However, these are not part of the core standard.

Josh Mandel has a repository of sample C-CDA documents. These typically cover EHR vendors and not payer organizations and their claims data.

As I look to creating a Data-as-a-Service for BlueButton data at CMS I need to adopt a structured data format. In doing this I want to minimize re-work out in the community. I also want to avoid getting bogged down in protracted standards definition work. I am therefore reaching out to the BlueButton and FHIR development community to gather your views, guidance and sage advice.

My thinking is this…

In upgrading from text and pdf file formats to offer XML and JSON as additional formats I should do the following:

  1. Where sections of the CMS BlueButton data directly map to established data models in the CCDA standard the CMS structure will adopt the same coding standard and naming conventions.
    Examples of these sections include:

– demographics
– providers

  1. Where data can be directly mapped to established clinical sections we should use the same coding and naming conventions, as per item 1. However, where those sections identify a source we will add a “source” identifier to the section. Eg. Self-entered. This should help to maintain data provenance.
    Examples of these sections include:

– implantable devices mapped to medical devices with a source of “self-entered”

  1. Where sections are not mapped to an established CCDA section we will:

– identify the data source. Eg. Medicare Part A etc.
– use fields names that carry through the grammar, simplifying and avoid internal acronyms wherever possible based on the original source field names. Eg. Cost, Allowed, Paid, Diagnostic Code 1 etc.

  1. Once we have an XML format we will take the format and use it as a basis for a JSON data format.

My questions to the community:

  • is this a sensible approach?
  • am I missing any critical document standards that I should be applying?
  • is there a better way to do this?

You can submit a comment to this post, or email me at mscrimshire AT gmail DOT com.

Mark Scrimshire

Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
Stay up-to-date: Twitter @ekivemark

Disclosure:

I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.

Medyear: Less hassle. Better care.

 

 

#ONC2015 Michael McCoy (new CIO at ONC) introduces the final session

Fireside Chat with Drs. Mark McClellan and Elliott Fisher (International Ballroom)

Elliott Fisher was thwarted by the New England Snow Storm and was unable to make it to Washington.

What does the future look like?

Comments from Elliott Fisher delivered by Mark McClellan:

Payment Reform and Technology changes are a means to an end: Better Care.

Has HIT evolved as expected over the last 10 years.

American Health information Collaborative – Started moving forward. Interoperability needs to keep a focus on practical things standards can do in the short term.

Quality-based payments is further along.

Brookings ACO Learning Network looks at developments in the ACO Sector.

Medicare ACO Payments are currently around shared savings. Fee for Service is the base payment. This is supplemented on benchmark payments based on quality performance.

Proposed regulations are looking to move further away from Fee for Service. Better support systems that rely on better data which drives more confidence in moving to performance based payment. This also encourages innovation since you are no longer tied to fee for service. ie. Per Beneficiary Per Month.

Health IT is helping organizations get to better results. We don’t have true interoperability but we have workarounds to move in the right direction.

Quality Measurements – what are the right ones?

199 Measures of care. Are they enough?

ONC is working to understand the fundamental building blocks to support those measures. Better quality measurement that is built in to workflow.

Two biggest complaints:
1. Measures don’t capture what is important for patients and provider. No reliable systems to provide this.
2. Measurements aren’t built in to workflow so drives additional work.

CMS is working on making it easier for measures to come out of the systems that ACOs use.

Only 25% of ACOs have systems that generate quality data directly. 75% are working with analytic partners to generate quality data.

“Collect Once and use multiple times.”

What are the opportunities if we get the data model right?

  • Drug Surveillance data allowing automatic queries. Health Insurance claims are the best source currently. Automated Lab data collection can lead to more real time data analysis.

Opportunities in Medical Device Surveillance.

Currently require creation of separate registries and manual data entry. With standardization there is the opportunity to do better comparative effectiveness studies and reduce workload.

Does ACO Data model need to be institutionally focused?
Will some parts of the country not move to ACO and value-based models?

We will move to more personalized medicine but not sure how the institutional makeup will shake out.
Some of the fastest growing ACOs are small physician groups. They are not integrating with the full range of services but instead are managing patients whole health. This may lead to more ambulatory care delivery instead of Hospital-based.

May be the ACO of the future will be a virtual, cloud-based entity.

Questions

Advice for making path to transformation more understandable for providers?

Congress has got the message that providers feel there is an alphabet soup of standards that are confusing. Congress is looking at how to align payment and other models that are clearly aligned.

One of the uses of Interoperability that will matter for providers will be where it reduces the burden of reporting for quality and payments. The reduction of administrative burdens for providers.

Sec. Burwell pushed for definitive targets on value-based payments in order to provide some market certainty for those on the front-line of care.

States are very innovative. Can we capitalize on that innovation?

A lot of initiatives looking to help rural doctors.

Sec Burwell is aggressive in working with Governors to capitalize on work being done in the states.

Do you envision emergence of an ACO-type Medicaid Model?

A lot of activity in Medicaid ACO programs. Successful ACOs are looking beyond health care. ie. Attacking the other social determinants of health. eg. Housing, jobs etc.

Governance has more changes. Patients will become more involved in defining and guiding Governance.

Consumers have a vote and not just a voice in their care.

Little Data is not so small anymore. When will we see algorithmic support for data analysis?

The number of data points that need to be monitored keeps growing.

Providers typically don’t have data analytics, particularly predictive analytics. This needs patient confidence in sharing and using data.

[category News, Health]

[tag health cloud, blue button, ONC2015]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
email: mark@ekivemark.com
Stay up-to-date: Twitter @ekivemark

Disclosure:
I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less hassle. Better care.

#ONC2015 Advancing Consumer Mediated Exchange

Advancing Consumer Mediated Exchange (Jefferson East)

This session will highlight real examples of consumer-mediated exchange occurring across the country including implementation approaches and tactics. You will learn what systems need to be in place to support consumer mediated exchange or the implementation of new technologies. Learn the benefits that have emerged from successful consumer mediated exchange. This session will also delve into the challenges and opportunities that will enable a future with more robust consumer mediated exchange activities.

  • Ryan Bosch, M.D. FACP M.B.A. CPHIMS, Vice President of Informatics, Chief Medical Information Officer, Inova Health System (@InovaHealthWeb Site Disclaimers)
  • Janet Campbell, Senior Architect, Epic
  • Dave Meyers, CTO – Health & Human Services, Microsoft Health & Life Sciences (@Health_ITWeb Site Disclaimers)
  • Dina Passman, Lieutenant Commander, US Public Health Service and Public Health Advisor for Health IT, SAMHSA (@notjustanepiWeb Site Disclaimers)
  • Eileen Rivera, Consumer Representative
  • Lee Stevens, Director, State Health Policy, ONC
  • Jim Younkin, Director, Keystone Health Information Exchange

New Community of Practice from ONC for HIE systems offering PHR services. Caroline Coy is leading the initiative.

What has ONC done around C-ME? What is the next step?

Interoperability is a big issue. You have to be able to get your records.

Will people actually use their Personal Health Records?

What are the business cases for C-ME?
Why do providers want to do it?
Why should hospitals go to the next level of connection?

Questions

Eileen Rivera: What have been the gaps in care when moving between providers?

In the summer was reflecting on arrival at 2nd hip replacement.
As a teenager had a collision with a car and an un-diagnosed hip fracture that stayed un-diagnosed for over 30 years..

If she had access to her medical records she could have had a better conversation with specialists. She had confused hip pain with back pain.
Unable to share information with each doctor.

We have to be our own advocates.

Dr Bosch, Innova: What is important about engaging patients in their care?

11 Hospitals and 400 ambulatory clinics. Uses MyChart for blocking and tackling. Excited to move medications, allergies with the patient. Built in to the portal the ability for patients to submit information prior to major surgery and treat that as structured data.

Consumer supplied data creates an opportunity for transformation to relationship-based care.

Janet Campbell, EPIC: what was important in creating LUCY

15 years ago when MyChart was introduced. MyChart is a portal and the data lives in the source organization. Patients ended up with multiple MyCharts.

LUCY extended the capacity of MyChart and store information separate from the source organization and then share with others. Any downloadable data is uploadable to LUCY. LUCY provides a Direct Address.

EPIC sees LUCY as an extension of MyChart.
50 Organizations can exchange data with LUCY. Utilization is low. Because People may just use MyChart.
About 200,000 patients use LUCY.

LUCY was extended to support upload of non-standard documents. If third party portals enable Direct email then they can send data to LUCY.

No Transmit function in LUCY – that is through MyChart.

Jim Younkin – Keystone HIE: Why did they offer a C-ME?

Keystone established in 2005. 38 participant organizations including Geisinger. Now is a community-based exchange.
Participated in the Beacon Community initiative. Looking to engage patients to improve critical illness care.

Lots of care took place outside Geisinger system. Patients needed a tool to engage in their care. So they wanted a PHR that sat on top of HIE. MyKeyCare.

Needed to be able to scan in paper records. Work with an outside vendor to scan their 3-ring binders.
Today about 4M patients in HIE. Having the PHR helped providers meet MU2 measures. Access to underlying record and provide messaging features.

Providers are conscientious about meeting MU incentives. Any health care provider can get MU Reports from the HIE.

When a patient looks at their record any provider gets credit for VDT Measures if they were involved during the period in providing service.

SHINY in NY creates a view for patients across all providers.

Dina Passman – SAMSHA: Behavioral Health is important to share. How do Consumers feel about sharing that data?

Consumers have concerns.

Consent to Share is compliant with CFR42 part 2.
Piloting in Prince George’s County

Dave Myers – Microsoft: PHR Ignite – what is Microsoft’s role in supporting access?

Children’s hospital in Dallas wanted to see how kids with sickle cell disease would use an untethered PHR. These kids say about 32 different providers.

The population fell into category of people that were felt unlikely to use the technology. Lower income, younger mothers. The response to access was astounding with high adoption.

Couple of things for data exchange:
1. HIPAA compliance
2. trustworthy system/cloud (scalability, manageability etc)

Healthvault is free to consumers. Developers can write apps to integrate with healthvault.

Microsoft health announced in October to capture fitness and wellness data. Eg. Microsoft band ( battery only lasts about 2 days).

Dade county, FL is using healthvault and smartphone to manage diabetes.

Eileen Rivera: using wearables

Uses yoga to help in hip replacement recovery.
Until physicians will accept the data it is of limited value.

Consumers are asking for integration.

Questions/comments

Why can’t I get my data? What standards

Actually asking for BlueButton.

Can we consolidate records from multiple sources?
Do we understand the business drivers to drive interoperability?

biggest challenge is data is seen as a competitive advantage

It’s the patient’s data! Providers have to give the information. We need to work on tools to make this easier.

Consumer choice is important. Plenty of patients get care from multiple places. They should have choice about how they store their data.

Data hoarding precludes other advantages of interoperability.

Don’t be shy in offering comments back to the ONC. Eg. “Standardize the fields in the CCD”
Send in your feedback!

[category News, Health]

[tag health cloud, blue button, ONC2015, CME, Medyear]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
email: mark@ekivemark.com
Stay up-to-date: Twitter @ekivemark

Disclosure:
I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less hassle. Better care.

#ONC2015 Chris Muir introduces Direct Project Update with David Kibbe @DirectTrustOrg and @Aaron_M_Seib, John Hall, @Greg_Meyer93

Direct: Industry Update (Lincoln West) This session will provide an industry update on Direct, a standards-based means of secure messaging and a health information exchange protocol required in certified products used by health care providers participating in the CMS EHR Incentive Program. Session participants will hear from Direct Community leaders about the current challenges and opportunities facing the industry, and hear from leaders of nationwide trust communities about scaling trust when using Direct.

Chris Muir: There is a lot happening with “Direct.”

John Hall Project Coordinator for Direct for last 3 years.

Direct Project Goal: “To create a set of standards and services that within a policy framework enable simple directed, push-based and secure transactions over the internet obetween known and trusted participants.”

2014: Year of the Edge. Securing the edge protocols by encryption and encrypted SMTP between HISPs. The last mile from the HISP to the EHR. Implementation Guides do not go so far as stating plug and play methods.

Left open to interpretation. Delivery Assurance. MU2 requires counting for delivery assurance. Manual tracking is not scalable. But EHR Vendors have developed one-off custom solutions. The community asked for Direct Project Edge Protocol Guide. – Guidance on HOW to accomplish implementation. Implementation Guide for Direct Edge Protocols were developed 1.1 from June 2014 is the latest version.

Guides are available on http://wiki.directproject.org

ONC EHR Certification Criteria 2014 edition Release 2 gives technology solutions the ability to certify to the Implementation Guide. This makes it easier for HISPs and Edge organizations to link up. ## What is coming in 2015? Clear up lack of clarity in Applicability Statement.

Addressing challenge areas: – MIME Headers – Certificate Discovery – Message Disposition Notifications (MDNs) Approach is to clarify and NOT add new capabilities.

Greg Meyer, Cerner

Direct Project Reference Implementation 4.0

From June 2010 and the initial bakeoff to v3.0 in 2013. Now working on v4.0 for Winter 2015 release. ## What is new in 4.0? Complete Configuration re-implemented as Config Service Restful API Pluggable authentication model to a service API: – Basic Auth is default – Certificate Private Keys are now encrypted by default. This supports pluggable key access to decrpyt private keys. New RDBMS Audit Store: – Replace log file based auditing and writes audit events to configurable RDBMS – Supports pluggable auditor implementation via James configuration file. PKCS11 Support (crypto Key) – Tested with safenet eTokenPro for USB Modules and SafeNet 1700 & 7000 for network appliances – Adds FIPS 140-2 key protection support (to level 3) Future iteration will support cryptographic functions on HSMs (not for 4.0)

Last Mile Encryption: – Default James 3 config will support SSL for client apps over SMTP, IMAP, POP3. Bug Fixes: – MU2 NIST Testing fixes – XDR/XDM concurrency issues. Release of 4.0 will take place in Q1 2015. Now documenting the reference implementation. Release package by end of Feb 2015.

David Kibbe – DirectTrust.org

160 Organizations as members DirectTrust network provides service to 300 EHRs, >35,000 HCOs and over 650,000 email addresses.

Direct is not as sexy as FHIR. It works and is working. DirectTrust uses accreditation and Audit to avoid the need for on-on-one arrangements between organizations.

Organizations newly attesting to MU2 in 2015: – approx 4,000 hospitals – approx 232,000 providers. DirectTrust charge from ONC: – Launch national accreditation program for HISPs and achieve widesprad participation – Align policies and procedures for accreditation – Implement a Trust anchor bundle for efficient distribution of HISP trust anchor certificates – Develop and implementation a Federation Agreement for DirectTrust community members (Lightweight). One important aspect of Federation Agreement is that it prevents HISPS charging each other for message handling. 38 HISPS are in DirectTrust trust anchor bundles covering all 50 states 29 HISPS 13 CA/RAs have completed EHNAC DirectTrust accreditation. 19 are in candidate status. 6 have applied. Includes all HISPS from Federal Agencies. Certificate Policy and HISP policy is aligned with ONC.

By End of 2014 over 35,000 Health Care Organizations have contracted with DirectTrust HISPs. (650,000 Provider direct addresses, 60,000 patient direct addresses) 10M transactions in last 6 months of 2014.

Aaron Seib – NATE

BlueButton for Consumers Trust Bundle (NBB4C)

NATE = National Association for Trusted Exchange

Not-for profit association enabling trusted exchange between organizations AND individuals. with differing regulatory environments

NBB4C

A trust mechanism for provides HIPAA covered Entities that use Direct an easy method of exchange with Customer Facing Applications.

Do we need another bundle?

There are distinctions between Provider sharing ABOUT a patient. To Covered Entities sharing WITH a patient. Different from DirectTrust that is focused on the health care industry inter-organziation interoperability.

Why does this matter?

Improve outcomes Communicate and coordinate with providers

NBB4C application is available

Application is available today http://nate-trust.org/trustbundles

Launch the bundle on March 1st Simplifying Patient Sharing for providers

Greg Meyer does a live demo of NBB4C.

View Download and Transmit in MU2: A consumer has the ability to take information from an EMR and send to any destination that they direct. As a Consumer accesses HealthEClinic Cerner portal select Send. Enter any direct address. (add phone number) BlueButton via NBB4C is outbound, uni-drectional only. A provider can send a direct email from their EMR. Clinicians could use BlueButton trust bundle to send a record (CCDA) you exceed the requirements for MU2. No longer a passive participant in the transaction. and sends to iBlueButton.

Automated BlueButton Plus Defines a trigger event that will send data to Patient’s default Direct Address.

This has not yet been implemented. Patients need to push EMRs to implement.

Questions

Last mile encryption START/TLS is recommended for last mile encryption negotiation. Recommend 1.1 or 1.2

How do we find direct addresses?

See the David Kibbe Session after lunch. Addresses have to be in the Trust network.

 

Mark Scrimshire Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk. Blog: http://blog.ekivemark.com email: mark@ekivemark.com Stay up-to-date: Twitter @ekivemark

Disclosure: I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries.

The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today. Medyear: Less hassle. Better care.

#ONC2015 S&I Standards Deep Dive

Deep Dive on the Standards & Interoperability Initiatives (Georgetown West)This session will provide a general overview of the S&I Framework and processes as well as provide a deep dive technical discussion on four different S&I framework initiatives: Data Access Framework, Structured Data Capture, electronic Long Term Services and Supports and Data Provenance. During this session, each presenter will provide an overview of the initiative, the use cases, a discussion on the technical standards, and an update on the pilots.

  • Nagesh “Dragon” Bashyam (@contact_dragonWeb Site Disclaimers)
  • Johnathan Coleman, S&I Initiative Coordinator, ONC
  • Evelyn Gallego, SDC and eLTSS Initiative Coordinator, ONC

FHIR and Heart initiatives.

HEART focused on Oauth/OpenID

Data Provenance Standards are coming.
Data will be atomized. Going from whole documents to individual fields and sections.

This will help Patints share their data as they become responsible for generating more data (Wearables)

Use Case for Data Provenance:

  1. Start Point to End Point
  2. Start Point via Transmitter to End Point
  3. Start Point to Assembler/Composer to End Point

Data Provenance is in implementation stage. Applying candidate standards.
Focusing on simple EHR to EHR transfers.

Plenty of standards to choose from…

Structured Data Capture Initiative

Partnering with various federal agencies.
Identify standards for collection of structured data from EHRs

Work has focused on Syntax.

  • Definition
  • Structure or Design for container
  • Interaction
  • Pre/Auto-population of data

Focused on data collected during episodes of Care.

Three Transactions:
1. Request for Form/Template and Response without Patient Data
2. Request pre-populated with relevant patient data
3. Send completed form to external repository.

Implementation Guide: Phase 1 – established standards

Phase 2: Emerging Standards (FHIR)

Data Set Grouping
Data Element Semantics
Data Element Attributes (Syntax)

Check out SIFramework.org

[category News, Health]

[tag health cloud, blue button, ONC2015]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
email: mark@ekivemark.com
Stay up-to-date: Twitter @ekivemark

Disclosure:
I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less hassle. Better care.

#ONC2015 Voice of the Caregiver and disruptive consumer: Angela Kennedy. Data is critical for the patient.

Angela Kennedy talking about her journey after one of her daughters was diagnosed with Cystic Fibrosis.

“The Consumer is the center of care”

How do you get access to the right care? Lie or beg… should it have to be this way?

Doctor’s office was reluctant to release information (Pulminary Function Tests), despite signing a release.

Records were faxed to the wrong number. Asked for another copy. Faxed again but did not arrive at the hotel.

In contacting rural hospitals she found that records had been destroyed. Forced them to go back through claims data. A pain staking reconstruction.

“Why didn’t I ask for copy of a record after each visit.”

Records created using copy/paste copied errors forward.

As a family they focus on wellness. Trying not to be a helicopter mom. Encouraging Gracie to be in charge of her own health.

Interoperability is important. Data is critical.

Gracie is an informed and empowered patient.

HIPAA is standing in the way of our health.

How long do we have to put up with businesses standing in the way of our health?

[category News, Health]

[tag health cloud, blue button, ONC2015]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
email: mark@ekivemark.com
Stay up-to-date: Twitter @ekivemark

Disclosure:
I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less hassle. Better care.

#ONC2015 @SecBurwell Sylvia Matthews Burwell address the ONC Meeting

Remarks from HHS Secretary Sylvia Matthews Burwell (International Ballroom) (@SecBurwellWeb Site Disclaimers)

Committed to supporting the Health IT community.

We have a common interest in building a Health Care System that is smarter and more efficient.

Unanimous agreement that current system under delivers on Access, Affordability and Quality.

We have started to make progress.

How do we better:
– Deliver Better Care
– Reward better care
– Share information

Achieving a better system, more efficient with better/healthier patients.

Now it is the time to free up the data so patients and providers can access their health information across the continuum of care.

The Strategic Roadmap: By defining the rules of engagement around privacy and use of data will support trust and confidence.

Announcing $28M grant funding to advance interoperability. Two year grant funding to demonstrate movement of information across vendors and geographic boundaries.

Better coordination for the patient. slow the growth of health care costs to invest in higher quality care.
Friends and Neighbors will have access to cost and quality data to support their health decisions.

[category News, Health]

[tag health cloud, blue button, ONC2015]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
email: mark@ekivemark.com
Stay up-to-date: Twitter @ekivemark

Disclosure:
I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less hassle. Better care.

#ONC2015 Day 2 starts with a panel of National Coordinators past and present inc @Farzad_MD @DavidBlumenthal @KBDeSalvo

A Conversation with ONC’s National Coordinators – Past and Present (International Ballroom)

Janet Marchibroda moderates a panel of ONC National Coordinators

David Brailer

“We stumbled in to the Health IT Movement”
A passion and sense of purpose and creativity in the Health IT community. It is remarkable that this passion has been maintained over 10 years.
Initially it was about resolve to get action in legislators and in congress. Now it needs to evolve. What has changed is that the health care industry has caught up with Health IT. HIT is very real and an essential part of care delivery.

Health Care is now demanding more from Health IT.

David Blumenthal

February 2009 and the HITECH Act became law. The great recession and the ARR Act. This was about economic recovery. It laid the groundwork for the reforms in the Affordable Care Act. Policy development and implementation in a 12 month period. Setting direction in face of uncertainty.

What has changed most is that this was a top down effort to alert the Health Care community to the potential of HIT.

Rob Kolodner

Taking over from the entrepreneurial phase under David Brailer and the challenge was to use scarce resources to lay a foundation while people had high expectations and wanted to see real progress. Now we have resources in place we can now make a real impact on health.

The challenge is now to use the resources in place and deliver real impacts on person-centered health. Now we need to build towards the learning health system.

Farzad Mostashari

Things weren’t as smooth as it appears now in hindsight.

Meaningful Use Phase 1 had been put in place. Top of mind was execution. Also need to help the people on the front line deliver and implement. Time lines were incredibly compressed.
Now it is time to iterate and improve. People need to optimize policy and implementation.

Karen DeSalvo

Building on a strong foundation. The last year has been moving off the era of HITECH funding. Data is available and can be shared. There are promising models in operation. Also a great environment where the culture has changed. Health is more than just health care.

Payment reform is driving the realization that sharing health information is critical to delivery of better care and aligned rewards.

What is next beyond just interoperability?

Brailer: We can’t support population health management and payment reform without interoperability. The industry won’t get a breathing space. There are 2 worlds of interoperability:
1. The heavily architected, non-scalable architecture for data sharing.
2. Lighter, less mediated and peripherally managed policies

Hope that the comment period on the roadmap will bring clarity in this area

Mostashari: Remember feeling the impatience but docs couldnt get lab interfaces, couldn’t e-prescribe and couldn’t e-bill. Simple transactional issues.

e-prescribing has gone from 1% to 80% plus.

Small practices can’t get their own data out. Not because of technical standards but because of their business practices. Vendors don’t have same incentives as providers. This is a market failure. Standards reduce the cost of interfacing. Will they reduce the price?

Bluementhal: Information exchange is a team sport.

We want competition yet we want people to collaborate and share their most valuable information and if they do then the FCC will target them for Anti-trust activities.

Kolodner: For the ONC the issue is Transparency. Who is doing a good job? We need to understand how organizations are performing.

DeSalvo: Three areas are critical pathway to the Learning Health System:

  • Change way we pay for care
  • Change way we deliver care
  • Share information

Use existing payment structures and link to quality results.

Kolodner: What can other agencies do to drive change? VA and DoD use Private Sector to deliver care. This will drive information exchange.
Medicare and Medicaid hit one part of the market. DoD and VA can help in helping the nation’s veterans.

Mostashari: VA, DoD and CMS did and is doing great things with BlueButton

How will congress influence

Brailer: Didn’t have a great relationship with congress since they reduced ONC budget to zero. Level of HIT IQ has gone up on the hill. Hard to imagine this congress acting on Health IT or on Healthcare. Wish they would rethink HIPAA. It stands in the way of interoperability.

A simple business model question: “Health Information Sharing is a Covered Benefit”

Bluementhal: ONC had to maintain confidence around the industry to avoid resistance to change. MU3 may see some push back from Congress. Toughest legislative challenge is around security and privacy. HIPAA has gaps and flaws that jeopardize interoperability. Don’t expect change in the current congress.

Words of Advice for ONC and HIT?

Brailer: Be very aware of the tremendous world that has been created by innovators and entrepreneurs to change Health IT.

Kolodner: Environment keeps changing. Recognize the different forces and be ready for change. Keep focused on the interests of the population. Keep listening.

Blumenthal: The time is right for a real push on interoperability. The culture of change is in alignment. Keep pushing and go for it.

Mostashari: The role of the National Coordinator is a dual role. Leader of an agency of committed civil servants. Also a representative of a passionate community that have different perspectives. Represent and synthesize these voices.

Questions

Q: Market Failure. Vendors using barriers to interoperability will be de-certified (proposed in budget)

Kolodner: having the noose in place may dissuade the market

Q: @FredTrotter: Epic hasn’t have a reputation for interoperability. How can we know a vendor is friendly to interoperability? How can we get clarity?

Brailer: If a vendor has significant market share they do not prioritize Interoperability. This is because Vendors have been asked to solve an enterprise integration problem.

DeSalvo: Encouraging signs since October with things like project Argonaut http://www.hl7.org/documentcenter/public_temp_1E9AEAC0-1C23-BA17-0C0AACB5924115DE/pressreleases/HL7_PRESS_20141204.pdf This is encouraging.

Q: Could selection of Dod/VA EHR impact interoperability.

Kolodner: Interoperability is a big part of EHR requirements since VA/DoD needs to share with private sector providers. VA has been a leader in interoperability. Also disruptive effects of mobile apps. Consumers must demand our information. Not just flat but rich types of data.

DeSalvo: An incredibly important decision. It is a catalytic investment opportunity in the healthcare marketplace.

Q: Why are we not taking more advantage of health care dollar savings?

DeSalvo: Coalesce around a core set of standards that support interoperability. We have to recognize trusted entities.

[category News, Health]

[tag health cloud, blue button, ONC2015]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
email: mark@ekivemark.com
Stay up-to-date: Twitter @ekivemark

Disclosure:
I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less hassle. Better care.

#ONC2015 finish the day with a Fireside chat by @KBDeSalvo with Tom Daschle and #BFrist

Fireside Chat with Former Senate Majority Leaders Tom Daschle and Bill Frist (International Ballroom)

How can we support Information Exchange across the care continuum?

Tom Daschle and Bill Frist have been involved in Health Policy since before it was topical.

Tom Daschle:

Technology may be the biggest impact on the Health Care sector. Policy and Technology have to work hand in hand. The ONC Roadmap is indicative of the importance of policy. Governance, Privacy and Security are all required.

Wide recognition that value-based payments are needed but technology is needed to support this.

Bill Frist

At an inflexion point that comes from the history from the Hitech and ACA acts and other legislation. How does congress create legislation that is flexible and agile enough to adapt to rapidly changing technologies.

Technology has the potential to bring us back to patient-centered care.

True innovation comes from Government setting the framework while the private sector drives innovation.

History

ONCHIT was created in the Bush Administration of 2004.

The HITECH Act was a classic example of how legislation was created (it rarely happens today). Three converging issues in 2009:

  1. Rapid acceleration to technological advancement
  2. Application of innovative new policy
  3. Need for economic stimulus

Policy and technology could create new opportunities.

Bill Frist agreed with Tom on the confluence of events and added that the understanding of science isn’t what it should be in congress. Prior to Bill’s arrival in the Senate the last physician in the Senate was in 1928.

The US has been innovator in many medical areas: Pharma, Imaging etc. But has been woeful in improving medical services. Very few people in congress had any understanding of the demands of caring for a patient.

It also takes Presidential leadership, part symbolic and part real. It establishes national priorities.

Strategic Plan to enhance interoperability. But what comes next?

TD: Integration of payment and delivery reform we will see new opportunities but We will need better data management. Enable Value driven factors to be applied in analytics. We need transparency because you can’t improve what you can’t see.

TD: Telehealth has a lot of potential to improve service in rural areas. However, we need broadband access. We also need payments for telemedicine and we need to simplify state-based legislation and harmonization.

BF: “Love the shift to patient-centered approach. That is smart. It is where the action is”

BF: Many determinants of health are not medical. We need to embrace the power of the consumer.

BF: Empower the consumer. Consumers are the big lever. Not everyone has to be a smart shopper but a small percentage can change the market.

TD: Government has a role in policy by setting standards. Medicare is by far the largest consumer and so can drive change. Still al ong way to go in measuring quality and performance.
Help to build the infrastructure. Always worried about siloization of health. We need more collaboration.

BF: 2005 to 2009. Big lesson was to listen to the outside world – outside the beltway. Standards have to be set at the national/federal level but need to reflect the reality from the field. Government sets standards but allows innovation from the Private Sector.

80% of ER visits do not result in referral visit. Many of those can be dealt with via telemedicine. State-based prohibitions are an impediment to adoption. Privacy issues need to be addressed when online transactions take place.

VA is using Telehealth and these lessons can be learned and applied elsewhere.

Q: Most of the nation don’t have a clue about the innovation that is going on.

TD: Polarization in politics is worrying. There is however a lot of quiet conversation that goes on by politicians that want to find a way out of this challenge. There is a lot of consensus about achieving the Triple Aim.

BF: “We have to get out of Washington” There is a disconnect with the real world. Listening tours are important. Reach outside Washington is hard but necessary.

Q: Three industries working against health care improvements (Food industry, Pharma, Medical Devices)

BF: FDA – regulates 25% of all consumable goods in USA. It needs to be modernized.
How do you reach people when the power has shifted to the consumer. These big entities know how to reach the consumer. That means embracing social media. Also how do we reach out on the non-medical aspects of social determinants of health.

TD: Two pieces of Advice: 1. Ask yourself if you will be a constructor or destructor in politics. Be a C. 2. Don’t be a spectator. Be Involved. Get engaged. Your voice matters.

Q: States have created Innovation Zones. Can we pass laws for to enable legislative exemptions.

BF: Innovation is hard in Health when stripping away legislation related to health. Focus on safety and efficacy.

2.3% of healthcare spend on drawing blood. affects 8 out of 10 decisions. Use technology to reduce 20% of errors.
Use It to monitor and reduce variation. This allows you to detect minor changes in glucose allowing diabetes to be diagnosed years sooner.

TD: As we go through Transofrmation. We need to value:
1. Resiliency
2. Engagement
3. Collaboration
4. Innovation – How do we create the environment for innovation.

Risk Adversity is something we have to contend with. we need better balance and reduce risk adversity.

Q: What is ONC Role in Precision Medicine?

BF: Shout out to Tom Daschle and the start of the Human Genome Project. Projected to cost $8M and only took $3M but it has created the platform for analysis of the data. Big data focused on the diversity of the individual patient.

Transforming the billions of bits of genetic information not something that improves the health of the individual.

TD: Leadership is needed to drive the Precision Medicine initiative forward. We need a lot more done than said.

[category News, Health]

[tag health cloud, blue button, ONC2015]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
email: mark@ekivemark.com
Stay up-to-date: Twitter @ekivemark

Disclosure:
I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less hassle. Better care.

#ONC2015 Interoperability Roadmap and Standards Moderated by @KBDeSalvo

Nationwide Interoperability Roadmap and Standards Advisory (International Ballroom)

Karen DeSalvo

We can’t get there in one step. Sometimes we have to build pathways.

Erica Galvez

People need access ot the right information at the right time in a format they can use.

The Average Medicare Beneficiary sees 2 Primary Care Providers and 5 specialists in a year.
Only 10-20% of health outcomes are attributable to health care.

Beneficiaries should be able to send, receive and view health care information.

Five core building blocks:

  1. Core technical Standards and functions
  2. Certification to support adoption and optimization of Health IT product and services
  3. Privacy and Security protections for health information
  4. Supportive business, clinical, cultural and regulatory environments
  5. Rules of engagement and governance.

Restful APIs get another shout out for scalable delivery of information. Certification also includes testing tools.

Tracking progress includes measuring the capability of both consumers and providers to securely exchange data.

The public comment period on the Interoperability Roadmap (on www.healthit.gov) closes on Friday April 3rd, 2015.

Lucia Savage

Roadmap definition of Interoperability:

“Ability of a system to exchange information wth and use information from, other systems, without special effort on behalf of the customer.”

Representation of Permission to Collect Information is a patchwork across states. This makes it hard to work at a nationwide level.

Patient Choice Strategy: Move from Consent Management to “Computable Privacy”.

Computable Privacy starts with Permitted Uses. These are background rules that support information exchange.
People have a basic choice. They may then have granular choices.

Steve Posnack Interoperability Standards Advisory

What is the purpose of Interoperability. GET SPECIFIC!

Different combinations of standards may be needed to achieve objectives.

Provide a single point for standards discussion.
Promote discussion and comment on standards

Don’t be a bystander in the Standards Discussion

ISA – Is a non-regulatory document. All hands on deck experience.

How will this be used?
The vision is that it will be a widely vetted resource developed in one place. Put the work in early to gain common momentum.

Four Sections:
– Vocabulary
– Syntax
– Content Standards
– Transport Standards

These work together in tandem and cumulatively.

This will be an annual publication that culminates from an ongoing series of publication and review and comment.

Christopher Miller

More than half of care in the DoD/VA is carried out by Private Organizations.
Delivery of care is very similar but the situation for the delivery of care may be very different.

Giving a fascinating insight in to the delivery of car in a war situation. Saving lives where previously soldiers would have died.

At the beginning of the war patients were given printed copies of medical records.

Lt Cpl Kyle Carpenter threw himself on a grnade to save his comrades. He died three times before he received his first care. Now after 40 surgeries he is able to run marathons and skydive. cbsn.ws/1pnXnFe

DoD and VA share 8.4M Patient records. 3.2M records accessed daily.
1.5M data elements exchanged every day

Implemented a Legacy Viewer that allowed both systems to be viewed. Browser access to 25 data domains and 5.9M Patients. Data is pulled in real time. Working on integrating Private Sector data too.

How can industry help us serve our members and veterans better?
– Interoperability and data sharing is critical. We need the same level of sharing with the private sector.

Questions and Answers

CCDA

The CCDA is not the greatest or complete format. However, it is something that can be iterated upon to improve.

Patient Identification

Language in recent legislation gives more flexibility. ONC have some initiatives with HIMSS in the arena of patient matching.

Aligning policies with HIPAA.

Basic choice is more than opt-in/opt-out. This is an attempt to capture information that is already manfiest. In other words people have consented or prohibited the sharing of their information.

Granular Choice: reflects the variations in state-based legislation.

Can the VA/DoD give insight on what they are looking for in their next EMR

DoD/VA is working with ONC to communicate better in this area.

[category News, Health]

[tag health cloud, blue button, ONC2015]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
email: mark@ekivemark.com
Stay up-to-date: Twitter @ekivemark

Disclosure:
I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less hassle. Better care.