Health Admin Blogs

Harnessing Consumer Engagement for Better Health, Better Care and Lower Cost

Thu, 01 Oct 2015 17:33:59 +0000

Today, ONC joins hundreds of providers, consumers, entrepreneurs, policy makers, and federal and private sector partners to celebrate advancements in consumer engagement through health IT at its premier consumer event: the Fifth Annual Consumer Health IT Summit (#consumersummit15). We have a lot of success to celebrate, a lot of exciting developments to share with one another, and yes, -a lot of work still to do.

Demonstrating Success on Consumer Engagement

We have seen considerable progress in the five short years since the Department of Veteran’s Affairs first unveiled the Blue Button Initiative as a simple solution for veterans to download their own health information. Four years ago, ONC helped nationally launch the Blue Button Initiative to help bring this capability to all Americans. Conceived and run as a public-private partnership, the Initiative has secured commitments from more than 650 organizations to increase consumer access and use of health information and technology. These efforts, combined with Federal policy changes, have led to tremendous progress on the goal to equip individuals and their families with their own health information.

In 2014, over half of individuals who were offered online access to their medical record viewed their record at least once within the last year.
In 2014, almost half of individuals nationwide engaged in at least one of the following activities: sending or receiving a text message or an email from their health care provider; using a smart phone health application; or looking at their test results online.

Access to individual health information online is only a starting point. As a community, we have more work to do to ensure that individuals and their families can fully digest and understand their health information. We need to remove artificial barriers of entry, meaning difficult in-person authentication processes, poor user design platforms or costs for online access so that individuals can receive their data in a digestible format of their choosing and can share their data whenever and with whomever they trust.

Fortunately, our community is already rising to meet these challenges. At the Summit, we’ll spotlight the ways in which our supporters have responded to the needs of consumers, their families, and caregivers by providing innovative technology solutions that bridge communication gaps, and foster greater collaboration with care teams. These critical advancements support consumer wellness and improve health outcomes. We will also highlight industry innovation that welcomes — and encourages — consumer participation in healthcare through patient-generated health data.

Progress Continues but Work Remains

The combination of advocacy and policy drivers like Meaningful Use and the Blue Button Initiative has begun to yield substantive results. Over the last few years, we’ve seen a significant increase in individuals’ online access to their health information and individual use of that access. We are particularly encouraged by prtaovider progress.

In a new data brief we describe a six-fold increase in the percentage of hospitals giving consumers the ability to view, download and transmit their health information online; from 10 percent in 2013 to 64 percent of hospitals offering access today. In parallel, our 2014 national consumer survey reveals that four-in-ten individuals report having electronic access to their health information from health care providers or insurers, and eight-in-ten who accessed their online medical record found it useful.

Still, not all consumers experience the benefits of health IT. In fact, our data show significantly lower health IT use among individuals with less than a 4-year college degree. This may reflect gaps in health literacy. Health literacy is often overlooked and is neither a new challenge nor simply a technology challenge. It existed in the paper-based world and may persist in the electronic world if more isn’t done to address it now. Together, we can work to find solutions that improve health literacy for all Americans.

In addition to gaps in health literacy, awareness of their right to access their health information electronically and how to go about doing so may be limited. Our survey has found individuals who are aware of their right to access their health information electronically get offered access at higher rates than those unaware. Additionally, a recent Xerox survey found that more than a third of US adults are unaware of patient portals. It is critical that this community continue to educate patients to help remedy this problem. While patient portals do not equal patient engagement, they can be a powerful tool to activating consumers and their care teams to coordinate care and improve health outcomes.

New Tools & Resources for Consumers and Providers

Today, I am pleased to share a new educational video for patients about their right to access health information. Please use and share this video to encourage consumers to learn more about their right and benefits of accessing personal health information and how to get that access.

We also want to enlist your help to support our awareness efforts, like the Nationwide Blue Button Campaign, which launched last year with 18 leading national organizations. Together, we pushed public service videos, published blogs at numerous consumer sites, and ran other activities to introduce more Americans to the Blue Button Initiative. On July 4^thof this year, many of you coalesced together to launch the Get My Health Data Campaign, focused on educating consumers about the availability of online access to health information and how they can take advantage of that access.

We also want to support providers in their efforts to market online health information to patients. Today, we are unveiling “Strategies for Improving Patient Engagement through Health IT ,” a new tool outlining tangible steps you can take to educate your patients about your online capabilities through patient portals. We hope this tool will contribute to your efforts to increase patient use of these resources.

Join the conversation online

Join me for this exciting conversation and pivotal call to action to use technology to help Americans manage their health. Follow us on Twitter @ONC_HealthIT and use the hashtag #consumersummit15 to share your thoughts, reactions, and questions about the Summit.

The post Harnessing Consumer Engagement for Better Health, Better Care and Lower Cost appeared first on Health IT Buzz.

Two books

noreply@blogger.com (Paul Levy) — Thu, 01 Oct 2015 13:54:00 +0000

I'm often asked to read books and post reviews here, and I thus find my bookshelf overly full. I just can't get to them all. (Indeed, I just donated a few dozen books--some read and some never opened--to one of our local hospital management degree programs!)

I recently received two requests, and frankly, I was hesitant. For one thing, I am friendly (in the internet virtual kind of way) with the authors, and when friendship is involved little good can come of an honest review. For another, the topics were troublesome and likely to be a bit timeworn--yet another book styled as a guide to personal health and yet another autobiography about the trials and tribulations of being a doctor.

Well, what a relief! They are both very good, and I am pleased to recommend them to you.

An Illustrated Guide to Personal Health

Tom Emerick and Robert Woods, with some important help from illustrator Madi Schmidt, offer 40 common sense steps to improving your health. Don't worry. You don't have to adopt all 40, but you might like to. As the authors note:

Alas, medical care can really only deal with about 20 to 25 percent of the things that cause you to die before your time. The remaining 75 to 80 percent [other than genetics] of health risks come from . . . factors . . . you alone can control.

With good humor the authors warn:

As you read this book, you will see a lot of repetitive redundancy, over and over. Why? We are trying to inculcate you with certain principles.

Much of what we have written here is documented science.

Some of what we wrote here is less science than a merger of philosophy and personal observations.

And then the final disclosure:

Some people do almost everything wrong their entire lives, and we mean everything, and live to be age ninety.

I'll let some of the chapter headings titillate your interest. To find out more, buy the book. Don't worry. It's short.

Avoid Hand Dryers in Public Restrooms

Avoid Antibacterial Soaps and Gels

Let Kids Play in Dirt

Don't Take Multivitamins

Envy is a Killer

Brush and Floss Your Teeth Regularly

Retirement Can be Bad for Your Health

Medicine Man, Memoir of a Cancer Physician

As first glance, Peter Kennedy is the stereotypical overly intelligent young man who dives into his medical school textbooks to learn everything so he will never face the possibility of not knowing something important that he might face in the classroom or the clinic. There not much hint of emotional intelligence as we read that chapter. Later, too, we see his impatience with colleagues, administrators, and regulations, and we are set on believing that he is just an arrogant twit.

Why on earth would we consider his life to be interesting? Simply, because we watch him grow as a human being and as a doctor.

It turns out that this fellow is deeply dedicated to his patients. We like to talk about patient-centeredness today, as though it is a new concept. Decades ago, Peter walked the walk, sometimes literally. Here are some excerpts from his fellowship period:

The work [of taking care of indigent patient's in the Ben Taub cancer service] was long and rarely exciting. On those occasions where I couldn't quite understand a patient's difficulty with immediate family or home issues, I ventured into the Fifth Ward (Houston's ghetto district) to visit patients at night in their homes. It was plain stupid to go alone. I had seen hundreds of the wounded from that region, more than enough to make me wary, but I was never approached or threatened on those visits. It was at those times that the total impact of a patient's journey to improvement or death upon his family became reality to me.

As I talked with patient and family . . . I felt something in the room change. And as I explained a mother's medical status, her husband, her children, and any extended family present would calm down and give me all their attention. Some of the free-floating anxiety, and the suspicion and wariness about a physician in their home at nine p.m. began to dissipate.

I pushed past my own hesitation a little further. Patient and family were presented with a gentle reboot of sorts, a statement of data rather than information mixed with hysteria or bias. . . . They became active participants in their own disease and its treatment.

[He'd say:]

"When I am sure you understand all of this, and you must try very hard to do so, we'll talk about what can be done to reverse, stop, or cure this cancer. I'll tell you about treatment, warts and all. Nothing will be held back"

"Then we'll use this information to decide what we as a team think is best."

And then Peter offers this confession to the reader:

As I became more deeply involved in it, I began to impart a quality I did not know I had--true empathy.

I had been trained originally to use evasion and misdirection as tools to maintain hope.

It is unusual for an author to display the vulnerability that Peter offers, not just on these clinical matters, but with regard to his personal life. (I'll leave those sections to you.) His story is a compelling one. It is a privilege to be asked to read it. I am pleased to recommend the book to medical students, clinicians, administrators, and patients.

Building resiliency

noreply@blogger.com (Paul Levy) — Wed, 30 Sep 2015 14:32:00 +0000

What's the secret of building resiliency, the ability to withstand unexpected challenges, into your organization? Lots of leaders I know take this attitude: "When the crunch comes, we'll deal with it. I'll explain that we have a burning platform, and the team will respond."

Well, yes, they will, but to the extent that you succeed in handling the crisis? If so, will the team respond in a way that creates the potential for future success, or will the effort just get you through the crisis?

A recent story [subscription required] in the UK Health Service Journal shows what happens when an administrative fiat is issued to deal with a budget shortfall. Excerpts:

The financial ‘stretch targets’ and emergency measures imposed by NHS regulators will fail to make significant inroads into the total provider sector deficit, analysis by HSJ reveals.

Providers had forecast a combined year-end deficit of £2.1bn at the start of 2015-16, which prompted Monitor and the NHS Trust Development Authority to order them to revisit their financial plans for the year in August.

Emergency measures were announced, such as a recruitment freeze for non-clinical roles, while many trusts were asked to work to new stretch targets or control totals.

[HSJ[ findings revealed that at least 13 of these organisations were not given stretch targets, while at least seven have declined to alter their plans. For three organisations, their positions deteriorated.

Contrast that experience with the one at my former hospital when we faced a budget crunch in 2008-9 because of the financial crisis. For several years, we had built a culture to support a learning organization, one in which the staff felt empowered and engaged and encouraged to redesign work flows. When the bad numbers hit, we asked people to consider whether they would be willing to make sacrifices to save the jobs of others. They did, willingly and enthusiastically.

Brian, from finance, said:

Obviously, I want to keep this job. I’m sure I echo most people’s thoughts when I say that no one wants anyone else to be laid off, and we are all willing to do whatever is necessary to make sure that as few as possible actually lose their jobs.

Catherine, a nurse, offered:

I would be more than happy to forgo a pay raise and reduce my earned time if that would mean another person in the hospital could keep their job. I think this is a great idea and I hope my colleagues feel the same.

And Bernice, an MRI technician, agreed:

I would rather take the loss of my yearly raise than see a fellow employee laid off.

And another:

I know the next few months will be extremely difficult for all of us. But it is so comforting to know that the people I work with are not just sitting back and letting things happen.

After this afternoon’s meeting, we had our own “post-town meeting meeting” to review what you had said, and to toss around suggestions. I know those little meetings are happening all over the medical center. I have never been prouder of the people I work with and the hospital I work for.

The challenge also enhanced our internal sense of community.

Lois, a manager in our Department of Medicine, said, “I think we will learn much from the process. I even dare to believe that we will become a community of healing for one another, just as we are for our patients.”

The end result of this entire process was that we were able to balance the budget with hardly any layoffs. And much to our amazement, we achieved national renown for our hospital. Readers emailed a Boston Globe story by Kevin Cullen detailing the events to over 14,000 other people around the world.The story was also posted on the Yahoo home page for an entire day, viewed there by hundreds of thousands of people. ABC news, NBC news, and PBS all came to do feature stories, seen by millions of viewers.

The pride among our staff was palpable. Patients, too, felt a part of the story and helped spread the word. Here’s a note from Bob, who had had cardiac surgery at our hospital:

I just watched the NBC clip about the employees of BI. I must tell you how much I appreciated the care that I received from all of the folks who attended to me while I was recovering from my surgery. This is most true of the ‘low-level’ employees. The folks who helped me wash, brought me my meals and took me for my x-rays were all professional and courteous. For this reason alone, I am so glad to hear of the efforts all of the BIDMC employees to ensure that everyone can keep their jobs.

About a year and a half later, we were able to restore the salary and benefits to our staff, and even pay a small bonus when our business improved. Jerry wrote a typical response:

I’m sure you were inundated with thank you emails for this bonus, but I felt the need to add mine to the list. I also wanted to mention that when I told my wife about this she said, “What a wonderful place to work. That would have never happened at my company.”

I’m sure the five hundred dollars will come in handy, but the fact that our leadership even thought of this is what makes BIDMC such a great place to work. We came together when times were tough, and now we are sharing the wealth as finances improve. To me this sounds more like a family than a workplace.

In appreciation: Vivian Li

noreply@blogger.com (Paul Levy) — Tue, 29 Sep 2015 12:10:00 +0000

The worth of a city can be measured in part by the caliber of the people who devote themselves to its improvement. By that measure, Boston has much to credit from the engagement of Vivian Li as long-time head of the Boston Harbor Association, created to promote a clean, alive and accessible Boston Harbor. Many have considered her the unofficial mayor of Boston's waterfront for the last quarter century, and that would not be a bad summary.

She's now off to new adventures in Pittsburgh, and there is a farewell celebration for her tonight. For today, I'll skip her many accomplishments but rather focus on her approach and demeanor.

I don't know of anyone in this city who has worked with Vivian who doesn't admire her and consider her a friend and colleague. Those of us who worked at the Massachusetts Water Resources Authority certainly viewed her in that light. Invariably pleasant and respectful in her dealings--even in the most contentious disputes--she has approached her job with intelligence, judgment, and good humor. Her objective has always been to achieve the public good. But her other objective has been to achieve a coalition for the public good, to build the institutional and community infrastructure to support the wise use of the waterfont resource. In that regard, her legacy will outlast her tenure at TBHA.

I join thousands who know her in wishing her well and happiness. Pittsburgh, you've landed a gem!

Will no one rid me of this priest?

noreply@blogger.com (Paul Levy) — Sun, 27 Sep 2015 15:57:00 +0000

As we consider the leadership failures that led to the current debacle at Volkswagen, we can take a lesson from English history.

Henry II, facing a disagreement with Archbishop of Canterbury Thomas Beckett in 1164, is reported to have shouted out in frustration, “Will no one rid me of this troublesome priest?” Four knights heard what Henry had shouted and interpreted it to mean that the king wanted Beckett dead. They rode to Canterbury and did the deed.

This story exemplifies the term myrmidon. From this source, we get the following definition: "A loyal follower; especially: a subordinate who executes orders unquestioningly or unscrupulously."

One of the dangers for a CEO is the tendency for your subordinates to take what you say and execute it to a degree you never intended.

Now, let's take a quick look at the VW story, courtesy of the New York Times:

Martin Winterkorn, Volkswagen’s chief executive, took the stage four years ago at the automaker’s new plant in Chattanooga, Tenn., and outlined a bold strategy. The company, he said, was in the midst of a plan to more than triple its sales in the United States in just a decade — setting it on a course to sweep by Toyota to become the world’s largest automaker.

“By 2018, we want to take our group to the very top of the global car industry,” he told the two United States senators, the governor of Tennessee and the other dignitaries gathered for the opening of Volkswagen’s first American factory in decades.

One way Volkswagen aimed to achieve its lofty goal was by betting on diesel-powered cars — instead of hybrid-electric vehicles like the Toyota Prius — promising high mileage and low emissions without sacrificing performance.

The determination by Mr. Winterkorn, the company’s hard-charging chief executive, to surpass Toyota put enormous strain on his managers to deliver growth in America.

Volkswagen officials now state that Mr. Wintrerkorn knew nothing of the regulatory cheating that his engineers had designed into the company's engines. Some are skeptical:

“For something of this magnitude, one would expect that the CEO would know, and if he doesn’t know, then he’s willfully ignorant,” said Jeffrey A. Thinnes, a former Daimler executive who works as a consultant for European companies on compliance and ethics issues.

We may never know. But what we can be sure of is that the myrmidons at VW thought they were carrying out the intent of the CEO.

A Presidential Innovation Fellow’s View on APIs, Patient Empowerment, and Improving Health Outcomes

Fri, 25 Sep 2015 18:23:35 +0000

For the past year, I have been honored to serve my country as a Presidential Innovation Fellow (PIF) with the Office of the National Coordinator for Health IT (ONC). As my PIF journey comes to an end, I wanted to provide a brief recap of my work and its potential for the future.

At a high-level, my work this year has focused on three components:

Demonstrating how Application Programming Interface (APIs) can be leveraged to improve data access;
Creating a prototype personal health record (PHR) powered by data obtained from APIs for patient engagement and empowerment; and
Demonstrating how patient-mediated health data sharing and donation could take place, especially in the context of precision medicine.

The following three segments break down my work and its relevance to the future.

Health Data: Transform, Access and Transport

Right now, health data access is not seamless for patients or providers. In my experience, electronic health record (EHR) systems have been built around documentation, not collaboration. Patient access to their own health data is mainly available through patient portals and most of the patient portals are not configured to make it easy for patients to download their data in electronic standardized format. On the other hand, providers face a similar situation, with patient health data scattered across multiple provider systems that can’t always talk with one another.

Health data access can be simplified using APIs. APIs are the means by which all our apps communicate and exchange information across systems. We can and should embrace what works in other industries. While health data may be “different” than any other industry, the technical means by which we can access and use data is not.

Health data is currently stored in its own respective health system database. Before the information can be exchanged, one way to “standardize” it is to transform it into Fast Healthcare Interoperability Resources (FHIR), open, HL7 standards, and transported via HTTPS a secure internet protocol for APIs.

For me to try out solutions, I built a FHIR server. The FHIR server transforms the data into FHIR specifications and reads/writes the information from the source and destination database.

There are two important use cases for this FHIR server:

Health system to patients – Business-to-Consumer (B2C).
Health system to health system – Business-to-Business (B2B).

With B2C, health systems can implement Blue Button functionality in their patient portals enabling access to patients’ data via FHIR APIs or allowing them to download it themselves. FHIR API access provides seamless transmission of health data from a health system to consumers or the app that the consumer chooses. This ensures patients will be in full control of how information flows to the destination or desired apps in a way that typically doesn’t exist with most patient portals today.

FHIR standards that apply to APIs also can be leveraged by business-to-business. FHIR API’s support read and write, which is great for interoperability. Health systems can leverage this simple API to exchange information with other approved provider systems.

My source code for the FHIR server, which provides data transformation, access and transport, is available in GitHub.

Patient engagement & empowerment using Personal Health Record (PHR)

Blue Button is all about enabling patients online access to their data. Once the patient is able to access and download their data, s/he still needs a platform or third party app to keep them engaged, help them understand and visualize the data, and become empowered to take action and improve their own health. The huge ecosystem of innovative health applications in the market will play an important role in this engagement and empowerment.

As a patient myself, I would like to see my Patient-Generated Health Data (PGHD) and my customized travel alerts (based on allergies) be proactively provided to me in a single app. PGHD can be gathered from wearable devices such as Fitbit and Apple Watch, and when combined with visuals from my lab results, medications, reminders, schedule, allergies, care team, care plan, immunizations, genomics as well as other types of health data (you get the idea), it becomes an incredibly powerful platform to create a more complete picture of an individual’s health. Combining all these disparate datasets is typically not possible today. To test out how the industry might address this challenge, I created a prototype app called “myHealth”.

An important product feature of this prototype is called “myHealth API” which enables patients to keep track of patient health systems data access points (aka FHIR API endpoints). For a single patient with multiple providers, their care might span across multiple health systems, especially patients with more serious and chronic conditions. This means these patients have multiple patient portals they have to sign into if they want to try and keep track of all their data. The burden of keeping up with multiple portals leads to drop-off in use of the portals and frustration for many patients today. In addition, any new, updated clinical data are not sent out automatically to the patient’s preferred destinations, whether to their caregiver or a mobile app. myHealth API can collect and aggregate patient’s data via API’s and gather data intelligently behind the scenes to create a dynamic dashboard for patients to review and understand a comprehensive snapshot of their health.

myHealth API also supports outbound data sharing capabilities via APIs, where patients would be able to share their own data with 3^rd party applications. Imagine if a Type 1 diabetes patient on Continuous Glucose Monitoring (CGM) device tracked their glucose and, similarly, that their provider wanted to monitor their patient population. An app could be created to get patient data in an API format with patient consent and authorization and also enable patient’s to have full control to share the data and discontinue anytime.

Patient-mediated health data sharing / donation

The myHealth prototype I created also provides functionality for the patient to collect health data from multiple health systems. It allows users to simply drag and drop to keep them in one place and have full control over their data and privacy.

As a patient, I might switch providers, or I might want to contribute my data to research and science. myHealth also provides functionality for the patient to not only share their data with each provider, but also share data and genomics information for research initiatives under the Precision Medicine Initiative (PMI). This wealth of data can then be utilized for research purposes.

Imagine one open source PHR app platform for patients, which can connect to any health system via FHIR standards, securely exchange health data with APIs, connect to mHealth applications/sensors, and provide genomics data. This PHR can offer widgets/apps like ecosystem, where patients can control apps created by range of different stakeholders from health systems to tech companies. This scenario, which I hope isn’t too far into the future, will help make personalized medicine a reality for many patients with the help of the open source community.

Patients should be at the center of the health care system. We have one of the most sophisticated data-driven health care systems in the world. As we shifted focus from a, piece meal, fragmented, Fee-for-Service model, to a value-based, data driven pay for performance and outcomes model, bigger and better quality data will become increasingly important. These data provide us with expanded tools to educate and empower patients to become actively involved in managing their health.

In order to improve outcomes and cut costs across the system (better health and smarter spending) we need to provide tools and the proper platform to free the data from health systems and help empower patients. Innovative third party apps can help to put patients in the driver’s seat, giving patients full control over their health information flow, help them engage with dynamically changing PGHD, and share health data for research and science to improve the lives of themselves and others.

The post A Presidential Innovation Fellow’s View on APIs, Patient Empowerment, and Improving Health Outcomes appeared first on Health IT Buzz.

Part of the school day

noreply@blogger.com (Paul Levy) — Fri, 25 Sep 2015 12:19:00 +0000

For several years, I've had the pleasure of expanding my role as referee of youth league soccer games to officiate in high school games. Although covering some of the same age groups, there is a different feel to these school games. School loyalties are different from town team loyalties. Coaches are more often professional and paid rather than being volunteer parents.

One of the things drilled into the referees is that the matches are "part of the school day." We're told that the main value of the athletic endeavors is that they are part of the curriculum. The coaches, we are advised, have a teaching role, just like in the classroom. Indeed, many of the coaches are classroom teachers, too, during the previous hours in the day. Our job is to defer to these teachers in matters of deportment and discipline (while of course officiating the game in a fair manner and one which helps ensure the safety of the teenagers.)

So, what happens to all that when the coach loses it? When, in the excitement and stress of the match, he or she feels that calls are not going their way and when he or she loudly and persistently dissents from the calls made by the referees.

In youth soccer matches, the established ethic is that the coach shall not dissent, in word or deed, from the calls made by the referee. Indeed, a coach can be disciplined--and even ejected--for doing so to excess. Not so in the high school matches (except in very extreme cases.) When the yelling begins, you maintain your composure as a referee and just continue to do your best.

I don't have a problem with that. I personally have taken a lot more heat as a public official and CEO than I get from the sidelines of a soccer match. I've had hundreds of people screaming at me in public meetings, death threats from aggrieved parties, not to mention really nasty commentators in the media. I've learned to breathe deeply and go on.

No, the problem I have relates to the setting: The game is supposed to be part of the school day. The coach's role is that of a teacher. What possible lesson is being taught to the students when the coach engages in obnoxious and disrespectful behavior to uniformed officials who main job is to use their judgment to maintain a fair and safe environment? Who is there to remind the coaches that the circumstances of the game should not overtake their roles as mentors and role models for the children?

Shining a Light on Secure Health Big Data and Digital Privacy

Thu, 24 Sep 2015 16:00:17 +0000

Through the proliferation of software applications and mobile technology, the amount of identifiable health information being collected, analyzed, and used is growing exponentially. As the volume, velocity, and variety of such information activities continue to grow, ONC is looking at how to protect that information from potential risks that may arise from unknown and inappropriate use.

The shared draft interoperability roadmap, Connecting Health and Care for the Nation, supports research and big data analyses within a trusted environment as an important component on the path to achieving a nationwide learning health system.

On August 11th, the Health IT Policy Committee (HITPC) approved the privacy and security health big data report of the Privacy and Security Workgroup (PSWG). The PSWG focused its efforts on identifying potential gaps in privacy and security protections given prevailing frameworks. The workgroup also examined the degree to which existing laws and regulations facilitate an environment that enables information to be “leveraged for good” while still protecting individual’s privacy interests or protecting against discrimination. ONC appreciates the time and dedication of the HITPC on this important topic and is taking the report under consideration.

HITPC Health Big Data Recommendations

The report recommends that ONC and other federal stakeholders, including the HHS Office for Civil Rights (OCR), take several actions to support privacy and security related to health big data. These actions include:

Address Harm, Including Discrimination Concerns

Promote more public discussion to understand the risks from gaps in privacy and security protections for health information, both the harm to individuals and communities.
Focus on identifying gaps in legal protections against what are likely to be an evolving set of harms from big data analytics.
Adopt measures that increase transparency about actual uses of health information.
Explore how to increase transparency around use of the algorithms used in big health analytics, perhaps with an approach similar to that used in the Fair Credit Reporting Act (FCRA).

Address Uneven Policy Environment

Promote Fair Information Practice Principles (FIPPs)-based protections for data outside the protections of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules.
Evaluate rules (existing laws, regulations, and local policies) governing uses of data that contribute to a learning health system to ensure they promote responsible re-uses of the data that contribute to generalizable knowledge.
Modify rules around research uses of data to incentivize entities to use more privacy protecting architectures, for example by providing safe harbors for certain behaviors and levels of security.
Create an individual “right of access” to the information in entities not covered by HIPAA as part of voluntary codes of conduct; also revise HIPAA over time to enable its continued effectiveness at protecting health information in the digital age.
Educate individuals, healthcare providers, technology vendors, and other stakeholders about the limits of current legal protection; reinforce previous PSWG recommendations.

Protect Health Information by Improving Trust in De-Identification Methodologies and Reducing the Risk of Re-Identification

Be a more active “steward” of the HIPAA Privacy Rule de-identification standards.
Develop initiatives or programs to objectively evaluate statistical methodologies to vet their capacity for reducing risk of re-identification to “very low” in particular contexts.
Grant safe harbor status to methodologies that are proven to be effective at de-identification in certain contexts to encourage use of proven methodologies.
Establish risk-based de-identification requirements in circumstances where re-identification risk is very low.

Support Secure Use of Data for Learning

Develop voluntary codes of conduct that also address robust security provisions.
Provide incentives for entities to use privacy-enhancing technologies and privacy-protecting technical architectures.
Educate stakeholders about cybersecurity risks and recommended precautions.
Leverage HITPC’s Privacy and Security Tiger Team 2011 recommendations to ONC with respect to the HIPAA Security Rule

Rapidly evolving informatics techniques have the potential of yielding significant information that will help improve health, lower costs, and deliver a better health care experience. The recommendations further advance the dialog about how these techniques can contribute to building a learning health system while maintaining fair information practice principles and securing big health data and digital privacy. The report, however, is not comprehensive. That is why ONC looks forward to working with federal partners, industry, and the health IT community to make sure progress continues toward achieving the goals of an interoperable learning health system.

The post Shining a Light on Secure Health Big Data and Digital Privacy appeared first on Health IT Buzz.

Blindfolds on? Good, let's lead.

noreply@blogger.com (Paul Levy) — Thu, 24 Sep 2015 00:23:00 +0000

My Australian friend Marie Bismark and colleagues published an article a couple of years ago about the role of boards in clinical governance in over 80 health service boards in the state of Victoria. There was one remarkably revealing quote about the 233 board members who answered the survey:

Almost every respondent believed the overall quality of care their service delivered was as good as, or better than, the typical Victorian health service.

In an earlier article, Ashish Jha and Arnold Epstein found similar results:

When asked about their current level of performance, respondents from 66 percent of U.S. hospitals rated their institution’s performance on the Joint Commission core measures or HQA measures as better or much better than that of the typical U.S. hospital. Only 1 percent reported that their institution’s performance was worse or much worse than the typical hospital. Among the low-performing hospitals, no respondent reported that their performance was worse or much worse than that of the typical U.S. hospital, while 58 percent reported their performance to be better or much better.

Hospital Board Chairs’ Perceptions Of Hospital Performance, Compared With A Typical U.S. Hospital, On The Joint Commission Core Measures, 2007–08

Marie and her co-authors suggest:

A recognised cause of these so-called "Lake Wobegon effects" named after Garrison Keillor's fictional community in which all the women are strong, all the men are good looking, all the children are above average, is unavailability or underuse of reliable information on peer performance.

I'd go a step further. A couple of months ago, I recalled

a wonderful story from Amitai Ziv, the director of MSR, the Israel Center for Medical Simulation at Sheba Medical Center on the outskirts of Tel Aviv. He relates how Israeli fighter pilots would return from their missions and debrief how things went. The self-reported reviews of performance were very good. Then, the air force installed recording devices on the planes, and it turns out that the actual performance was not nearly as good as had previously been reported. The conclusion: It's not that people are poorly intentioned or attempt to mislead about their performance. It's just that we tend to think we are doing better than we actually are.

I think the issue is not the unavailability of reliable information on peer performance. I think the issue is a failure, in the first instance, to even measure one's own performance and to share that with one's own team. After all, the issue is not so much benchmarking. That only goes so far. As I've often said, there is no virture in benchmarking to a substandard norm.

So, the first step is to accurately collect one's own data and make it transparent to your own team. It is that transparency--more than benchmarking--that will establish the creative tension in an organization that will drive people to meet their own stated standard of clinical excellence. A smart board does not have to apply pressure on its staff by drawing comparisons with others. Rather, they take governance steps to demand transparency, so that the deep sense of purpose that is inherent in the clinical staff is employed to stimulate the team to do better on their own.

ONC Publishes Final Federal Health IT Strategic Plan 2015-2020

Mon, 21 Sep 2015 16:31:27 +0000

Most people that use GPS navigation apps aren’t concerned with the backend development, the standards used, or whether the app is interoperable with other data sources – people just want to arrive at their destination quickly and safely. Similarly, when faced with critical health care choices, having the information and tools to help individuals, providers, and communities safely arrive at their health destinations should be as efficient and accessible as a GPS. Health information technology (IT) is the key to getting us where we want to go – allowing for seamless use of information and technology to overcome challenges and make decisions.

One pathway to help us achieve those goals is the Federal Health IT Strategic Plan 2015 – 2020, which was issued today. This Plan outlines the commitments of all the agencies that use or influence the use of health IT across the nation for the next five years. The Plan is an action plan for federal partners, as they work to expedite high-quality, accurate, secure, and relevant electronic health information for stakeholders across the nation. The Plan’s strategies for achieving this aim focus on making electronic information available so individuals can manage their health, providers can deliver high-quality care to their patients, public health entities and long-term services and supports can improve community health, and scientists and innovators can advance cutting-edge research and solutions.

We released a draft Plan in December 2014 for public comment and received thoughtful feedback from over 400 individuals and organizations, including their suggestions about how best to achieve the seamless flow of health information. The Health IT Policy Committee gave us valuable recommendations, and the nearly two dozen listening sessions with stakeholders last year let us know what matters most to people managing and utilizing information and technology.

The final Federal Health IT Strategic Plan reflects commenters’ recommendations that federal efforts, including government programs and policies, assist stakeholders as they use electronic information to improve health and support innovations that make health, care delivery, and research more effective. The Plan is a broad document that condenses the detailed work and strategic direction of many federal initiatives and plans. Its strategies and objectives support the use of health IT to accomplish these ongoing initiatives, such as precision medicine and delivery system reform.

With the release of the Plan, we now turn our attention toward achieving the Plan’s goals, while following the principles that guide our core vision. Where the Plan has a broad scope, its implementation has a singular focus: improving the health and well-being of this nation through responsive, collective engagement on health IT and information use.

We will continue to work with stakeholders to evaluate progress as the health IT infrastructure advances and new health, information, and technology needs arise. This engagement will help us prioritize health IT efforts and identify strategic gaps, and will help stakeholders better understand the federal intent of various policies and actions. Together, we will use the Plan’s principles to help direct us to our final shared destination of high-quality care, lower costs, healthy population and engaged people.

To read the final Plan, please visit: http://www.healthit.gov/policy-researchers-implementers/health-it-strategic-planning

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