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HHS’ New Health IT Lead Speaks Out on EHR Usability, Interoperability

May 25, 2017
by Rajiv Leventhal
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Health and Human Services (HHS) deputy assistant secretary for health technology reform, John Fleming, M.D., spoke at an event on May 24 where he reaffirmed the government’s two core health IT priorities—better electronic health record (EHR) usability and interoperability.

Dr. Fleming, a former Louisiana Rep. who practices family medicine, was tapped earlier this year to be somewhat of a health IT czar for HHS in a new role that was created for him. Fleming, speaking at the “Better Together Health 2017: All Systems Go! Closing the Gaps in Cancer Care” event yesterday in Washington, D.C., said that his vision for the future of healthcare technology is tied to two core goals: improving the usability of health IT systems and also interoperability, which would be sparked by every American having a single unified health record that resides in the cloud. He noted that federal leaders are “undergoing a re-imagination at HHS,” spending time discussing with staff the innovative ideas they have going forward. I will be giving Sec. [Tom] Price positive feedback,” he said.

Fleming, who spoke publicly for the first time since his appointment at HHS, kicked off his short speech on the progress that’s been made since the creation of the Office of the National Coordinator for Health IT (ONC) years ago. The EHR adoption rate is now at above 85 percent for office-based practices and in the 95 percent rage for U.S. hospitals, he added. “But we cannot rest on that laurel; there’s more work to do,” he said. “If we don’t maintain forward progress, we might see a [decline] in those rates, particularly in ambulatory environments.”

He noted that the next step in clinicians’ EHR journeys is improving usability. He mentioned the well-publicized study from last year that found doctors spend two hours in their EHR for every one hour of patient engagement. “Usability is our immediate, existential problem today. People tell me they only recognize their doctor from the back of his or her neck. We need to change that,” Fleming said.

Interoperability is another growing issue, said Fleming. “Most people [ask] what the big deal is, since we go on the Internet and we’re talking to machines all the time, but in the EHR space you have a number of systems on different platforms speaking different languages. You want detection, early diagnosis and rapid intervention when it comes to cancer, and we want to deliver that for you. We are working with stakeholders to make that happen,” he said.

Fleming, who is a former co-chair of the GOP Doctors Caucus and Freedom Caucus, and was part of a petition last fall to make the MIPS (Merit-Based Incentive Payment System) payment path under MACRA (the Medicare Access and CHIP Reauthorization Act) far less complex for doctors, also touched on alternative payment models during his speech without ever mentioning MIPS. He stated that there was a recognition back in the 1990s that capitated care could be the direction to go towards rather than fee-for-service reimbursement. “If you’re paying for service, you'll get service, whether the outcomes are good or not,” he said. To this end, he asked the question, “How do you pay for outcomes without good data? We need better methods for getting data into the system and delivering it to you, and we’re working on doing that. There is a good marriage between pay-for-value and data,” he said.

Fleming further noted the importance of telemedicine, telling a story in which his daughter sent him an iPhone video of her daughter needing help with a respiratory problem. Fleming said he was able to give his daughter advice, saving her the cost of an ER visit, which he estimated could have cost $2,000 to $3,000. “The iPhone is one of the best methods of telemedicine that I have seen. Where you’re not worried about doing things for reimbursement, you’re doing good things for the patient,” he said.

In the end, Fleming said the core idea is to bring down the time commitment that clinicians and providers spend on using technology. He said the goal is to have them spend less time on data input than they did in the pre-electronic era, and that will save more time in the long run since tasks like calling pharmacies and labs are not needed anymore with EHRs present.

Fleming concluded, “Every American should have a single unified health record that resides in the cloud so that the patient can get his or her information to any provider he or she wishes.” He added that too often still, the discussion amongst doctors is that patients come in with sheets of paper that the clinician can’t read due to note bloat. This results in the doctor turning around and asking the patient what the previous doctor said. “We need to get past that and have a single health record that can be accessed anytime, anywhere in whole world,” he said.

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Epic Plans Meeting for Non-Epic Users on Data Sharing Capabilities

August 16, 2018
by Heather Landi
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Verona, Wis.-based Epic is inviting healthcare provider organizations that don’t use Epic’s electronic health record (EHR) to its “un-Users Group Meeting” at its Verona headquarters to learn how to exchange data with Epic.

The event, planned for September 26, will provide information to healthcare provider organizations about how to exchange charts with providers in their community who use Epic, even if providers use a different EHR— or no EHR at all.

According to Epic’s unUGM website, the event is for “executives and strategic leaders of provider organizations who want to learn and discuss how to exchange with providers in their community who use Epic.”

“Access to a patient’s information, regardless of where he or she has been seen, helps providers deliver the best patient care. The first Un-Users Group Meeting (unUGM) is another way we’re reaching out to the leaders of health systems using other EHRs—or even no EHRs—to help them get connected to the Epic users in their communities,” Dave Fuhrmann, Epic’s vice president of interoperability, said in a prepared statement.

According to the event agenda, topics of discussion include options for exchanging patient data with providers through Carequality, Care Everywhere, health information exchange (HIE) and Direct messaging, as well as patient-directed options, including MyChart, Share Everywhere, Lucy, and Blue Button.

There will also be discussion about interoperability success stories, using both non-Epic and Epic EHRs, and the current state of coordinated care in the U.S. and the use of existing tools to close care gaps, improve communication, and reduce costs.

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Amazon, Google, IBM and Other Tech Giants Pledge to Remove Barriers to Interoperability

August 14, 2018
by Heather Landi
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Six of the world's biggest technology companies, including Microsoft, Google, IBM and Amazon, made a joint pledge at the White House Monday to remove interoperability barriers and to make progress on adoption of health data standards.

The announced came during the Blue Button 2.0 Developer Conference in Washington, D.C. where Microsoft joined with Amazon, Google, IBM, Salesforce and Oracle to jointly commit to support healthcare interoperability by advancing healthcare standards such as HL7 (Health Level Seven International), FHIR (Fast Healthcare Interoperability Resources), and the Argonaut Project. They also pledged to remove interoperability barriers, particularly as it relates to the adoption of technologies enabled through the cloud and artificial intelligence (AI).

Dean Garfield, president and CEO of the Information Technology Industry Council, said in a statement, “Today’s announcement will be a catalyst to creating better health outcomes for patients at a lower cost. As transformative technologies like cloud computing and artificial intelligence continue to advance, it is important that we work towards creating partnerships that embrace open standards and interoperability.

“We commend the White House Office of American Innovation for their leadership in being a catalyst for moving health care beyond siloed systems and varied data standards. As well, we celebrate Amazon, Google, IBM, Microsoft, Oracle, and Salesforce for their commitment to helping to advance open healthcare standard. The opportunity to unleash greater innovation in health care is here and working together we can seize it,” Garfield said.

In a joint statement, the technology companies made a commitment to remove barriers to “frictionless data exchange,” noting that they share “the common quest to unlock the potential in healthcare data, to deliver better outcomes at lower costs.”

The commitment specifically states:

“In engaging in this dialogue, we start from these foundational assumptions: The frictionless exchange of healthcare data, with appropriate permissions and controls, will lead to better patient care, higher user satisfaction, and lower costs across the entire health ecosystem.

Healthcare data interoperability, to be successful, must account for the needs of all global stakeholders, empowering patients, healthcare providers, payers, app developers, device and pharmaceuticals manufacturers, employers, researchers, citizen scientists, and many others who will develop, test, refine, and scale the deployment of new tools and services.

Open standards, open specifications, and open source tools are essential to facilitate frictionless data exchange. This requires a variety of technical strategies and ongoing collaboration for the industry to converge and embrace emerging standards for healthcare data interoperability, such as HL7 FHIR and the Argonaut Project.

We understand that achieving frictionless health data exchange is an ongoing process, and we commit to actively engaging among open source and open standards communities for the development of healthcare standards, and conformity assessment to foster agility to account for the accelerated pace of innovation.”

Gregory J. Moore M.D., Ph.D., vice president of healthcare, Google Cloud, said in a statement, “We are pleased to join others in the technology and healthcare ecosystem in this joint commitment to remove barriers and create solutions for the adoption of technologies for healthcare data interoperability. This will enable the delivery of high quality patient care, higher user satisfaction, and lower costs across the entire healthcare ecosystem.”

Patients should have access to their data, said Mark Dudman, head of global product and AI development, IBM Watson Health, in a statement following the announced commitment. Patients also should have the flexibility to use products and services across different healthcare systems, with confidence that they all are working seamlessly for their care, he said. “We are proud to participate in this pledge and look forward to working with industry and the developer community to ensure appropriate access to data and the use of that data to support vibrant communities and solve health challenges for people everywhere.”

In a blog post, Josh Mandel, chief architect, Microsoft Healthcare, notes that interoperability is an overlapping set of technical and policy challenges, from data access to common data models to information exchange to workflow integration – and these challenges often pose a barrier to healthcare innovation.

Mandel, who previously worked at Google Life Sciences and on the research faculty at Boston Children’s Hospital where he worked on the SMART Health IT Platform, notes that support for the Meaningful Use Common Clinical Data Set grows and it is becoming easier to plug new tools into clinical workflows, analyze clinical histories, collect new data, and coordinate care.” Many of these technical capabilities have been available within small, tight-knit health systems for a long time – but developing these capabilities has required complex, custom engineering and ongoing maintenance and support. Driving toward open architecture makes adoption faster, easier and cheaper,” he wrote.

True interoperability in healthcare requires end-to end solutions, rather than independent pieces, which may not work together, Mandel wrote. “Transforming healthcare means working together with organizations across the ecosystem. Today’s joint interoperability statement reflects the feedback from our healthcare customers and partners, and together we will lay a technical foundation to support value-based care.”


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Industry Stakeholders Urge ONC to Move Forward on Information Blocking Rules

August 8, 2018
by Heather Landi
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In a strongly worded letter to National Coordinator Donald Rucker, M.D., several healthcare and health IT industry groups expressed frustration with the Office of the National Coordinator for Health IT’s lack of progress in publishing information blocking regulations, as required in the 21st Century Cures Act.

“It has been 601 days since the 21st Century Cures Act was signed into law. Every day that the administration delays implementation of these critical provisions places patients at risk of harm,” the letter states. Stakeholders including Health IT Now, Research!America, Oracle, the American Medical Informatics Association (AMIA), the American Academy of Family Physicians, Cambia Health Solutions and Claim Your Health Data Coalition signed the letter dated August 6.

In the letter, addressed to both Dr. Rucker and Daniel Levinson, inspector general of the Department of Health and Human Services (HHS), the stakeholder groups note that the 21st Century Cures Act, which was enacted in December 2016, requires the HHS Secretary to “issue regulations to prevent information blocking and to also identify reasonable and necessary activities that do not constitute information blocking.” Further, the law requires ONC to implement a standardized process for the public to submit reports on claims of health information technology products or developers of such products not being interoperable or resulting in information blocking and actions that result in information blocking. “The Office of the Inspector General (OIG) has enforcement authority over vendors and providers who are found to engage in information blocking,” the letter states.

The stakeholder groups also contend that “information blocking poses a significant risk to patient safety and greatly contributes to increased costs and waste in the health care system.”

According to reporting from Politico, during ONC’s 2nd Interoperability Forum this week in Washington, D.C., Rucker told the form audience that ONC is still working on the rule. The rule’s release has been delayed several times and is not expected to be released in September.

“Rucker emphasized Monday that his goal is to make protocols and standards that would let large amounts of health data flow easily between health providers, not just individual patient charts. He and other officials emphasized that ONC’s work is all being done within the confines of HIPAA,” the Politico article stated. Rucker also noted that properly defining which behaviors do and don’t constitute information blocking is “hard to sort out,” and the rule is a “work in progress,” Politico reported.

In a separate statement regarding ONC's delay in issuing an information blocking proposed rule, Douglas Fridsma, M.D., Ph.D., AMIA president and CEO, said, "Information blocking is the absence of interoperability, and there are numerous reasons why information may not flow as intended. Some of these reasons are technical, others for business or policy reasons. The socio-technical interoperability stack is complex and so too is the task of identifying which among its layers is responsible for information blocking. This rule must be critically calibrated to account for these layers, and it must be part of a larger conversation about how we will address other aspects of the socio-technical interpretability stack. Now is the time to initiate this broad conversation through release of the proposed information blocking rule."

In the letter, the industry groups also cautioned that “information blocking impedes provider access to the most current, accurate or complete information on their patients. As the administration proposes and implements new rules related to open APIs and interoperability in Medicare’s payment rules for hospitals and doctors, the lack of clear rules of the road needlessly creates uncertainty for vendors and providers alike.”

“We understand the nuance required but feel that it is past time for a proposal to be made,” the stakeholder groups wrote in the letter.

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