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Blockchain in Healthcare: Will You Lead or Follow?

September 20, 2017
by Hillary Ross, Witt/Kieffer
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We all know that the financial world typically embraces technology faster than healthcare. The era of Finance 2.0 began several years ago with the advent of blockchain backing up the crypto market. Since then, and with the further development of Cloud and Big Data, the use of blockchain is being examined as a means to revolutionize the way finances are being conducted across the world.

Healthcare has and will continue to look at and learn from other industries about the advantages and lessons learned from the use of blockchain. While blockchain may have originated in the finance world, its attributes have applicability in healthcare.

The use of blockchain in healthcare can reinvent the ecosystem in limitless ways to benefit the patient and advancements in treatments, outcomes, security and costs. Like the introduction of the cloud years ago, everyone is asking what is blockchain and its applicability to healthcare?  Wikipedia defines blockchain, “as a decentralized and distributed digital ledger that is used to record transactions across many computers so that the record cannot be altered retroactively without the altercation of all subsequent blocks and the collusion of networks.” Thus, blockchain is a distributed tamperproof database that can be shared and maintained by multiple parties. Through the use of technology known as “cryptography,” data can be stored in “blocks” in a manner that only the intended users can open and read.

There is definitely a role for blockchain in the future of healthcare. The technology has implications that span a gamut, including patient medical records, conducting clinical trials, master patient index, supply chain, and revenue cycle management, to name a few. The potential to establish a longitudinal health record for patients that is also securely accessible to all of their clinicians could be supported by blockchain. This, of course, would significantly increase patient quality care.

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Blockchain can also be applied in the context of precision medicine and to population health. The importance of population health is a given in healthcare and blockchain can provide the means to aggregate and identify where data are so that organizations can access patient data on a large scale. The advancement of interoperability and security are of paramount importance in healthcare and blockchain technology is being considered as a resource that can significantly increase the efficacy in these two important areas of healthcare.

Clearly, blockchain is a topic and opportunity with many facets and its applicability in healthcare is in an embryonic stage and being examined carefully by organization leadership. Healthcare organizations who are not cognizant of the importance of this digital strategy will find themselves left behind and have difficulty in adapting to what will likely be a relatively rapid transition. It will be important for healthcare providers, including complex health systems, academic medical centers and managed care to take heed of this new technology since it’s not a specific initiative.

IT vendors, consulting firms and pharma are also included in organizations who will be utilizing this digital technology to their advantage. Google and IBM have been developing blockchain tools for some time, and have more recently stepped up their interests in healthcare. Other healthcare giants will likely offer their own versions. There is no denying that blockchain is a new and important strategic resource for healthcare.

Blockchain also has caught the attention of the Office of the National Coordinator for Health IT. ONC hosted a blockchain challenge that solicited creative and transformative ways that it can be applied to healthcare. ONC received more than 70 proposals from a broad spectrum that included organizations, companies and individuals. The final winning 15 papers are posted at HealthIT.gov. ONC also has hosted workshops on blockchain and remains a valuable resource for those looking to educate themselves on its applicability to healthcare.

Who will lead blockchain innovation? Leadership for this new and important strategy is key to the success of its implementation and utilization. Senior level leadership will be tasked with defining the vision and setting the path for achieving benefits within the healthcare ecosystem. Highly strategic, blockchain-related roles either belong in the C-suite or reporting there. Is it part of the CIOs office, senior administration, quality/innovation or its own department? With its relatively complex technical nature, blockchain-related roles will absolutely need a highly skilled team of support. In addition to a specialized team, there also will be a budget to support the initiatives involved.

The background for these leaders will likely emanate from technology-minded professionals who can easily transition into this space. Those with degrees and advanced degrees in computer science, engineering, and IT architecture will meet the learning curve. Also, those coming from cybersecurity and finance could transition into blockchain leadership roles. Other potential backgrounds can include, senior software writer in medical field, CTO/master developer, digital designer and data scientist. Core competencies will include leadership, change management, agility, innovation and an entrepreneurial spirit. The expectation is for the compensation to be commensurate with the high demand for this role.

This is a critical time for healthcare organizations to realize the positive impact that blockchain will have on all aspects of healthcare delivery and to give careful consideration to this transformative model by bringing in the experts who can lead a successful transition. While blockchain is a fairly new concept, a recent Deloitte survey found that 35 percent of healthcare and life sciences respondents plan to deploy blockchain in production within the next calendar year.

Hillary Ross, J.D., is the managing director and leader of the Information Technology practice with the executive search firm Witt/Kieffer. Based in the firm’s Oak Brook, Illinois office, Hillary focuses on identifying CIOs, CISOs, CMIOs and other information technology leaders for hospitals, healthcare delivery systems, academic medical centers, colleges and universities, vendors and consulting firms across the country.
 


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EHR-Compatible Pharmacist Care Plan Standard Opens the Door to Cross-Setting Data Exchange

September 14, 2018
by Zabrina Gonzaga, R.N., Industry Voice
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Pharmacists drive information sharing towards quality improvement

Pharmacists work in multiple environments—community, hospital, long term care, clinics, retail stores, etc.—and consult with other providers to coordinate a patient’s care.  They work with patients and caregivers to identify goals of medication therapy and interventions needed, and to evaluate patient outcomes.  Too often, pharmacy data is trapped in a silo and unavailable to other members of the care team, duplicated manually in disparate systems which increases clinical workloads without adding value.

To address these issues, Lantana Consulting Group and Community Care of North Carolina (CCNC) developed an electronic document standard for pharmacist care plans—the HL7 Pharmacist Care Plan (PhCP). The project was launched by a High Impact Pilot (HIP) grant to Lantana from the Office of the National Coordinator for Health Information Technology (ONC).

Before the PhCP, pharmacists shared information through paper care plans or by duplicative entry into external systems of information related to medication reconciliation and drug therapy problems. This documentation was not aligned with the in-house pharmacy management system (PMS). The integration of the PhCP with the pharmacy software systems allows this data to flow into a shared care plan, allowing pharmacists to use their local PMS to move beyond simple product reimbursement and compile information needed for quality assurance, care coordination, and scalable utilization review.

The PhCP standard addresses high risk patients with co-morbidities and chronic conditions who often take multiple medications that require careful monitoring. Care plans are initiated on patients identified as high risk with complex medication regimes identified in a comprehensive medication review. The PhCP is as a standardized, interoperable document that allows pharmacist to capture shared decisions related to patient priorities, health concerns, goals, interventions, and outcomes. The care plan may also contain information related to individual health and social risks, planned interventions, expected outcomes, and referrals to other providers. Since the PhCP is integrated into the PMS or adopted by a software vendor (e.g. care management, chronic management, or web-based documentation system), pharmacist can pull this information into the PhCP without redundant data entry.

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The PhCP allows pharmacists for the first time to share information with support teams and paves the way for them to support value-based payment. The project goals align with the Center for Medicare & Medicaid Services’ (CMS’) value-based programs, which are part of the Meaningful Measure Framework of improved care team collaboration, better health for individuals and populations, and lower costs.

Scott Brewster, Pharm.D., at Brookside Pharmacy in East Tennessee, described the PhCP as a tool that helps them enhance patient care delivery. “From creating coordinated efforts for smoking cessation and medication utilization in heart failure patients, to follow up on recognized drug therapy problems, the eCare plan gives pharmacists a translatable means to show their value and efforts both in patient-centered dispensing and education that can reduce the total cost of care.” (The eCare plan reference by Scott Brewster is the local term used in their adoption of the PhCP).

The pilot phase of the project increased interest in exchanging PhCPs within CCNC’s pharmacy community and among pharmacy management system (PMS) vendors. The number of vendors seeking training on the standard rose from two to 22 during the pilot. Approximately 34,000 unique care plans have been shared with CCNC since the pilot launch.

This precedent-setting pilot design offered two pharmacy care plan specifications: one specification is based on the Care Plan standard in Clinical Document Architecture (CDA); the other standard is a CDA-on-FHIR (Fast Healthcare Interoperability Resources). The latter specification directly transforms information shared using the FHIR standard into CDA. FHIR is straight forward to implement than CDA, so this is an appealing option for facilities not already using CDA. The dual offerings—CDA and CDA-on-FHIR with lossless transforms—provide choice for implementing vendors while allowing consistent utility to CCNC.

What’s on the horizon for the pharmacy community and vendors? With the support of National Community Pharmacists Association (NCPA), the draft standards will go through the HL7 ballot process for eventual publication for widespread implementation and adoption by vendors. This project will make clinical information available to CCNC and provide a new tool for serving patients with long-term needs in the dual Medicare-Medicaid program and Medicaid-only program.  This is a story about a successful Center for Medicare and Medicaid Innovation (CMMI)funded project that started out as a state-wide pilot and is now rolling out nationwide as Community Pharmacy Enhanced Service Network (CPESN)USA. 

The PhCP is based on a CDA Care Plan standard that is part of ONC’s Certified EHR Technology requirements, so it can be readily implemented into EHRs. This makes the pharmacist’s plan an integral part of a patient’s record wherever they receive care. 

Adoption of the PhCP brings pharmacies into the national health information technology (HIT) framework and electronically integrates pharmacists into the care planning team, a necessary precursor to a new payment model and health care reform. In addition, receiving consistently structured and coded pharmacy care plans can augment data analysis by going beyond product reimbursement to making data available for, utilization review, quality assurance and care coordination.

Troy Trygstad, vice president for Pharmacy Provided Partnerships at CCNC, described the strategic choice now available to pharmacists and PMS vendors. “Fundamentally, pharmacy will need to become a services model to survive. Absent that transformation, it will become a kiosk next door to the candy aisle. The reasons vendors are buying into the PhCP standard for the first time ever is that their clients are demanding it for the first time ever."

The move to value-based payment will continue to drive the need for pharmacists, as part of care teams, to provide enhanced care including personal therapy goals and outcomes. Sharing a medication-related plan of care with other care team members is critical to the successful coordination of care for complex patients.

Zabrina Gonzaga, R.N., is principal nurse informaticist and director of health informatics at Lantana Consulting Group and led the design and development of the PhCP standard. 

Email:  zabrina.gonzaga@lantanagroup.com

Twitter: @lantana_group

 


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Health IT Now Pushes for Information Blocking Regulation, Says Administration “Must Uphold its End of the Bargain”

September 13, 2018
by Rajiv Leventhal, Managing Editor
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The executive director of Health IT Now, a coalition of healthcare and technology companies, is again criticizing the Trump administration for not yet publishing any regulation on information blocking, as required by the 21st Century Cures Act legislation.

In an op-ed published recently in STAT, Health IT Now’s Joel White wrote, “More than 600 days after the enactment of the Cures Act, not a single regulation has been issued on information blocking.” White added in frustration, “Health IT Now has met with countless officials in the Trump administration who share our commitment to combat information blocking. But those sentiments must be met with meaningful action.”

The onus to publish the regulation falls on the Office of the National Coordinator for Health IT (ONC), the health IT branch of the federal government that is tasked with carrying out specific duties that are required under the 21st Century Cures Act, which was signed into law in December 2016. Some of the core health IT components of the Cures legislation include encouraging interoperability of electronic health records (EHRs) and patient access to health data, discouraging information blocking, reducing physician documentation burden, as well as creating a reporting system on EHR usability.

The information blocking part of the law has gotten significant attention since many stakeholders believe that true interoperability will not be achieved if vendors and providers act to impede the flow of health data for proprietary reasons.

But ONC has delayed regulation around information blocking a few times already, though during an Aug. 8 episode of the Pulse Check podcast from Politico, National Coordinator for Health IT Donald Rucker, M.D., said that the rule is "deep in the federal clearance process." And even more recently, a bipartisan amendment to the U.S. Senate's Department of Defense and Labor, Health and Human Services, and Education Appropriations Act for Fiscal Year 2019 includes a requirement for the Trump administration to provide Congress with an update, by September 30.

White, in the STAT piece, noted a June Health Affairs column in which Rucker suggested that implementation of the law’s information blocking provisions would occur “over the next few years.” White wrote that this is “a vague timeline that shows little urgency for combating this pressing threat to consumer safety and stumbling block to interoperability.”

Health IT Now is not alone in its belief that the rule should have been published by now, nor is it the first time the group is bringing it up. Last month

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By the end of this year, ONC’s implementation and interpretation of data blocking will also be published and available for comment, as was the case with the TEFCA proposed rule. The TEFCA final rule is also anticipated by the end of 2018.

HOWEVER…there’s still time to prepare for TEFCA and the data blocking regulation, and final rules for both in the coming months will set concrete timelines, and for TEFCA it will be interesting to see how ONC reacts to stakeholder comments, internal and external.

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