Healthcare Technology News

CommonWell Health Alliance

noreply@blogger.com (Anonymous) — Mon, 18 Mar 2013 12:50:00 +0000

This article was originally posted in The Health Care Blog

Moving Toward An Identity and Patient Records Locator
By RICH ELMORE

Last week, five health IT vendors came together to announce the CommonWell Health Alliance, a nonprofit focused on developing a national secure network and standards that will:

Unambiguously identify patients
Provide a national, secure record locator service. For treatment purposes, providers can know where a patient’s records are located.
Enable peer-to-peer sharing of patient records requested via a targeted (or directed) query
Enable patients and consumers to withhold consent / authorization for participation in the network

Unambiguous patient identity matters

In banking, without certainty about identity, ATM machines would not give out cash. And in healthcare without certainty about identity, physicians are working with one hand tied behind their backs.

This problem will never be solved by the Feds. In fact, Congress has restricted any spending on it by the government at all. Industry working together may be the only practical alternative.

CommonWell doesn’t intend to create a national patient identifier. Instead it will use practical, robust identity mechanisms that a patient or consumer could provide to each physician or caregiver. That might be based on a one-way hash of a cell phone number, an email address or a swipe of a driver’s license. The Alliance members will decide on this as part of its standards.

Locating data is critical to clinical decisions

Imagine a cancer patient with a primary care doc they visit in a family practice, a surgical oncologist in private practice, a plastic surgeon and medical oncologist at one academic medical center and a second opinion oncology team at yet another academic medical center.

Chances are those caregivers all using different EHRs, and they may even be in different geographies. The physicians don’t know where the records are. Yet each physician needs real-time access to ALL of the patient’s information with critical clinical decisions hanging in the balance.

CommonWell intends to address these gaps by delivering a secure national record locator service and standards for peer-to-peer targeted queries. Data that is returned to the physician are not stored on the CommonWell network, nor is the data normalized.

Founding members want every health IT vendor to join CommonWell Health Alliance

Those of us in the Alliance are aligned in our desire to be inclusive and welcoming to all. The founding members are making significant commitments of money and product developer time for the good of each patient and physician.

I have personally worked with the thought leaders of this effort over several years on ONC initiatives, including the Direct Project and Meaningful Use standards for Stage 2, and I can vouch for their integrity, goals and expertise. They’ve thought this approach through carefully, not only technically, but also in connection with governance, policy, privacy and security.

Allscripts and the CommonWell Health Alliance are committed to practical, standards-based solutions that can make healthcare safer and more responsive to the physician and patient. To that end, the Alliance looks forward to working collaboratively with the Office of the National Coordinator for Health IT, other vendors and with standards bodies to achieve these objectives.

Fierce Urgency of Now: Revealing Clinical Insights with Better Health IT Standards

noreply@blogger.com (Anonymous) — Mon, 18 Feb 2013 13:00:00 +0000

First posted in It Takes a Community

This past year, I completed a tour of duty with the Office of the National Coordinator for Health Information Technology (ONC). I served as coordinator for standards related to Consolidated CDA, quality measures (HQMF) and results reporting (QRDA) that are now part of Meaningful Use Stage 2. These standards, along with Direct Project and standardized vocabularies, will contribute to Health Information Exchange that works.

I’m proud of the ONC and the community that delivered these standards. It’s a breakthrough with significant benefit to the United States. But it’s also only a start.

The need for better Health IT solutions hits home

Three days after completing my work with ONC, my wife Julie found out she had breast cancer. We have spent every day since in the struggle for her health and survival.

We had the usual frustrations with coordinating her care with a team spread across organizations — using different electronic health records, having to schlep images on DVDs, courier-ing reports for second opinions, and seeking out lab results that never made it to her patient portal. Of course, Health IT can ultimately help improve these countless operational issues.

But this is all secondary to another issue we confronted: the limitations of clinical knowledge. We were initially excited to learn that Julie’s cancer was HER2 positive. What was a killer 10 years ago was now one of the most treatable kinds of breast cancer.

But our second opinion team came to a different conclusion: it was ambiguous as to whether she was HER2 positive and the alternative outcome would mean that she was “triple negative” – the worst form of breast cancer. Other tests were done and the results remained unclear. We were in uncharted territory with no idea of efficacy of treatment options.

There weren’t any applicable studies. And there was no way to learn from others’ experiences – to understand signals from the experience of others in the same boat.

We desperately wanted to know more, but there was no more to know. There is no targeted or distributed query standard that could ask and answer questions of the electronic health records around the country.

Query Health standard offers new possibilities to share EHR knowledge

In a somewhat cruel twist, I had just led efforts at ONC to establish just such a standard. The Query Health standard, built off of Meaningful Use Stage 2 technologies for quality measures and results reporting, is underway in pilots around the country:

The Primary Care Information Project (PCIP) within the New York City Department of Health and Mental Hygiene (NYCDOHMH) and the New York State Department of Health (NYSDOH) will use the Query Health system to investigate and allocate appropriate resources for chronic and acute disease monitoring.
The FDA Mini-Sentinel project is an ongoing distributed network to support public health surveillance of the safety of medical products and the pilot entails adding a new clinical data source at Beth Israel Deaconess.
The Massachusetts Department of Public Health Network (MDPHnet) pilot includes the creation, operation and management of a distributed health data network for public health surveillance of diabetes, influenza-like illness and ad-hoc menu-driven querying.

MDPHNet’s Query Health pilot is live and in production. New York and FDA pilots are going live shortly. All three will be demoing at HIMSS13 in the Interoperability Suite.

Collective data can better inform individual patient care

Julie and I have seen the very best that the healthcare system has to offer. It’s a profoundly good system in the direct treatment and care for the patient. But it’s also a system restricted by the knowledge of a limited number of clinical studies from a relatively small group of patients, many of which cannot even be reproduced, and none of which were directly applicable to her condition.

There is an urgent and compelling national need to leverage the investment we are making in electronic health records (EHRs) — to make visible, within the constraints of patient privacy and security, the experiences of others to provide signals and knowledge that informs each patient’s care. This is the challenge and opportunity that Health IT must deliver. This is truly the “fierce urgency of now.”

Engage with Grace

noreply@blogger.com (Anonymous) — Thu, 22 Nov 2012 10:45:00 +0000

Written by Alexandra Drane & The Engage with Grace Team

We make choices throughout our lives -- where we want to live, what types of activities will fill our days, with whom we spend our time.

These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones "know exactly" or have a "good idea" of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences.But our end of life experiences are about a lot more than statistics. They're about all of us.

So the first thing we need to do is start talking. Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences.

And we're asking people to share this One Slide - wherever and whenever they can.at a presentation, at dinner, at their book club. Just One Slide, just five questions. Lets start a global discussion that, until now, most of us haven't had.Here is what we are asking you: Download The One Slide and share it at any opportunity - with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them. Just One Slide, just one goal. Think of the enormous difference we can make together.

To learn more please go to www.engagewithgrace.org.

Is it possible for us to imagine a world where that power of data is not brought to bear on life and death, on clinical care, on population health?

noreply@blogger.com (Anonymous) — Tue, 13 Nov 2012 11:32:00 +0000

From Farzad Mostashari's introductory comments to the HIT Policy Committee, November 7, 2012

It's been an eventful time since our last meeting together. Some of you are still struggling with the aftermath of Hurricane Sandy. I know at least one of the members who is still without power and anticipating the Nor'easter bearing down on the east coast again. It demonstrated for all of us the need for us to come together and the impact that working together we can have - - private sector, philanthropies and government working together.

Of course, on everyone's mind is also another event - the elections. I was struggling last night to capture all of the swirl of thoughts and emotions about last night and I summarized it in my own mind... and on twitter... in one word and that word was "data".

It was admiration and appreciation for the role that the power of data have played in the campaign. It was also the appreciation for how that if that power of analysis and data has transformed marketing, campaigning, baseball, how is it possible for us to imagine a world where that power of data is not brought to bear on life and death, on clinical care, on population health? And affirming the path that we're on around health IT and bringing data to life.

The second was the appreciation for truth in data. There was lot of discussion that many of us followed, whatever our political persuasion, around whether the analysis of surveys was going to found to be accurate or whether the journalistic epistemology of "uncertainty equals equality" was going to be shown. There was something of I guess relief that data matters, that science matters, that predictions can be based on evidence. For all those who are following Nate Silver and 538 predictions it's truly remarkable. We sometimes see this in our little corner of the world where the preponderance of the evidence, 92% of studies can be positive and showing the benefits but if there is uncertainty, if there are differences, the journalistic urge to create some sort of narrative of two equally opposing realities can become the narrative of the day. So there was relief in seeing the truth in data.

And finally there was the relief when those probabilities converge to the binary, the zero/one, the data, the fact of the election - that goes either one way or another and resolves itself. Now we are thinking "what does this mean?" Everybody would agree that it gives us in the administration more time to finish the job. We've made incredible progress in the past four years on health IT. In my view it gives us a chance to continue to make strides, to continue the essential thrust of the policies and approaches. But it also, as was pointed out, affirms our responsibility to do the people's work, to come together, Republicans and Democrats, to do the people's work. This committee appointed by Republicans and Democrats with stakeholders from patient advocates, doctors, hospitals, payers, researchers, vendors embodies that coming together for the common work - - the focus on challenges that we can only solve together.

We can disagree sometimes on how to get there. Progress has always been through fits and starts. it hasn't always been straight line. Not always smooth path. But the painstaking work of building consensus -- there 's no substitute for that in health IT, in standards or in the broader policies. And that is what we are commited to - the painstaking work of building consensus.

Now as we look at what the president said -- that the value of citizenship doesn't end with our vote. It's not just about what could be done for us, but about what could be done by us through the hard and frustrating but necessary work of self-government. That's what this Policy Committee, to me, embodies. We need to keep reaching, keep working, keep fighting and take the time to look afresh at what we're doing.

Today we'll go through the next stage request for comments that the meaningful use work group, information exchange work group, privacy and security work group and others have put together. One thing I'd like to challenge us is whether we're pushing hard enough on interoperability. Whether there is more that we can do. Whether it's around query based exchange and all the cluster of identity matching and patient consent issues that come with that. Are we moving fast enough with the privacy and security that must accompany the greater availability and greater flow of information? Whether it's around two factor authentication, or audits and consent management for sensitive information? Whether we are doing enough to make sure as we make progress that safety is addressed as much as it possibly can. And that we're setting the stage for innovation.

So that is going to be the opportunity for us, as we move forward, to step back also. I'd like to ask the policy committee, as we'll go through the request for comment, to at least just ask if there's more. If there's a slightly different take that we could pursue to make these come true. Although we have been given more time -- a week, a month, a year - - and before you know it, the opportunity for that urgency is lost.

Thank you.

Digital Data Improvement Priorities for Continuous Learning in Health and Health Care

noreply@blogger.com (Anonymous) — Mon, 01 Oct 2012 12:30:00 +0000

Digital Data Improvement Priorities for Continuous Learning in Health and Health Care - Workshop Summary - available free from the Institute of Medicine.

"Digital health data are the lifeblood of a continuous learning health system. A steady flow of reliable data is necessary to coordinate and monitor patient care, analyze and improve systems of care, conduct research to develop new products and approaches, assess the effectiveness of medical interventions, and advance population health. The totality of available health data is a crucial resource that should be considered an invaluable public asset in the pursuit of better care, improved health, and lower health care costs."

Dr. Rich Platt, Harvard Medical School's Department of Population Medicine and I co-presented on distributed data networks. Our themes included:

Distributed data queries can provide the foundation of a learning health system.
Advantages of distributed data networks include data accuracy, timeliness, flexibility, and sustainability.
Distributed queries facilitate asking questions of large datasets in ways that are HIPAA-compliant and maintain local context.

2014 Standards & Certification Criteria - Final Rule

noreply@blogger.com (Anonymous) — Fri, 21 Sep 2012 11:25:00 +0000

Presentation by Steve Posnack to the HIT Standards Committee - September 19, 2012

Posnack scc 2014edition_hitsc_091912 from Rich Elmore

Towards a Learning Health System

noreply@blogger.com (Anonymous) — Sun, 02 Sep 2012 12:00:00 +0000

This article was originally published on It Takes a Community, the Allscripts blog

This past year, I took a leave of absence from Allscripts to serve as the Office of the National Coordinator for Health IT (ONC) coordinator for Query Health, an Open Government Initiative that is establishing standards, policies and services for distributed population queries of clinical records. It comes at a unique moment in time – at the confluence of broad deployment of Electronic Health Records, the compelling need for standards for secondary use of that healthcare information, and a Stage 3 Meaningful Use strategy that focuses on a “learning health system.” That is, a system in which the vast array of health data can be aggregated, analyzed, and leveraged using real-time algorithms and functions.

I’m thrilled to be back and sharing what I learned about what we can do to implement a learning health system that benefits patients on a national scale.

Our work began in August 2011 in Washington D.C., with a “Summer Concert Series” environmental scan of the best work on distributed queries happening around the country. I collaborated with some of the top folks in the industry from the more than 100 member organizations. It was energizing to be engaged with colleagues so deeply committed and passionate about improving health care.

My job was to lead the overall initiative representing ONC. Clinical, operations and technical workgroups, each with around 40 members, delivered the functional and operational requirements, the technical approach, the proposed standards and reference implementations. We actively engaged with the National Coordinator, the HIT Standards Committee, the HIT Policy Committee and the Privacy and Security Tiger team to ensure that Query Health aligned with broad national priorities and strategies.

Understanding Population Health

Distributed population queries can be applied to a variety of secondary uses. Distributed population queries enable an understanding of population measures of health, performance, disease and quality, while respecting patient privacy, to improve patient and population health and reduce costs.

Distributed population queries are a central component of ONC’s strategy for a learning health system. These queries “send questions to the data” and return aggregate population measures that keep patient-level information protected at the source.

We use distributed population queries today for a variety of purposes. For example, public health tracks diseases, including flu-like illness, and evaluates optimization of scarce resources. The FDA evaluates signals related to drug safety once drugs are released to the market. Researchers compare the relative effectiveness of drugs and treatments.

Putting It into Practice

There are five Query Health pilots kicking off this Summer and Fall.

The New York City and State public health departments are sending questions to both provider practices and RHIOs related to diabetes and hypertension.
The Food and Drug Administration is sending questions to a clinical data source at Beth Israel Deaconess Medical Center to evaluate which post-market drug surveillance questions can be supported by clinical data.
The Massachusetts Department of Public Health is sending diabetes-related questions to community health centers and provider practices.
The Centers for Disease Control is applying Query Health standards to its BioSense 2 cloud-based distributed data repository for situation awareness and disease syndromes.
Allscripts is testing the applicability of Query Health to dynamically query for clinical quality measures.

Query Health standards are being prepared for standards ballot by HL7 and ONC’s Office of Science and Technology. The standard for Queries is based on an improved, more parsimonious version of the Health Quality Measure Format or HQMF. The standard for Results is the Quality Reporting Document Architecture or QRDA (Categories 2 & 3). The target data is aligned with the S&I Framework Clinical Element Data Dictionary, the National Quality Forum’s Quality Data Model and the HL7 Consolidated CDA.

You can find more information about the project at QueryHealth.org.

What’s your take on how the Query Health initiative can improve how we use health IT for the benefit of patient and patient populations? Do you have new ideas we haven’t yet considered? Share your thoughts below.

Standards Applicability - 2014 Edition

noreply@blogger.com (Anonymous) — Fri, 24 Aug 2012 17:46:00 +0000

From http://www.nationalehealth.org/FinalRules

Meaningful Use Stage 2 and 2014 Edition - Resources

noreply@blogger.com (Anonymous) — Fri, 24 Aug 2012 11:15:00 +0000

ONC Final Rule

ONC Resources

CMS Final Rule

Patient Centered Outcomes Research Institute (PCORI) Data Workshop

noreply@blogger.com (Anonymous) — Tue, 24 Jul 2012 03:17:00 +0000

Series of outstanding presentations from PCORI's electronic data workshop.

Query Health at the HITPC / HITSC Clinical Quality Hearing

noreply@blogger.com (Anonymous) — Thu, 07 Jun 2012 19:13:00 +0000

From testimony at the Health IT Policy Committee and Health IT Standards Committee Clinical Quality Hearing, June 7, 2012.

Query Health is working to establish standards to "send questions to the data" while keeping patient level information safe at the data source. Distributed query networks are using these standards in pilots for insights on diabetes and hypertension, national and regional situation awareness, post-market surveillance and dynamic querying for quality measures.

How can the measure development process be improved?

The policy and standards committees have the opportunity to introduce strategic changes that result in agile, responsive, clinically relevant measures in Stage 3.

The clinical quality measure development process today is slow and unresponsive to the rapidly evolving state of medicine in this country. Measures may take one to two years to define, and once defined, measures then take several more years to move through the regulatory cycle, be incorporated into EHR systems, be deployed to providers and then finally implemented for reporting.

Quality measures, even in their latest most formal expression using the Health Quality Measure Format (HQMF), are impossible for a system to digest “automagically”, as HQMF is verbose and not fully computable, with aspects of the measure even described in text. Ambiguity in measure specification leads to multiple interpretations by providers and thus variability, which then requires rework during implementation of the measure in the field.

EHR developers who work with quality measures have described the need for greater clarity and specificity on the supporting data requirements up front, and validation that required data elements can be effectively collected in the provider workflow.

Measure development can also be improved by focusing on a common set of building blocks which could be used to create simple computable queries, which could in turn serve as the foundation for more complex queries. This will also help us to mature the queries without having to re-implement and redefine every concept as part of each individual complex query.

How can measures better leverage electronic health record capabilities?

In collaboration with HL7, NQF and CMS, Query Health standards will enable Health IT vendors to dynamically respond to queries, including queries that align with quality measures. So assuming the data is being captured, the quality measure cycle time could go from years to truly a matter of days. The ability to generate measures nationally in a short cycle time has powerful benefits for patients and patient populations while enabling researchers and healthcare organizations to substantially reduce costs and increase speed.

Blackford talked about the importance of having an externalized set of target data that could deal with the curly braces problem. Query Health standards do just that in a manner that is aligned with the Quality Data Model and Consolidated CDA. Query Health standards provide a road map to better leverage EHR capabilities for dynamic querying of the EHR for quality measures. The standards include the questions (a “new” more parsimonious HQMF), the target data (ONC’s Clinical Element Data Dictionary or CEDD), the results (QRDA Categories 2 & 3) and the Query Envelope.

A Query Health pilot being conducted by Allscripts will evaluate Query Health standards and target data to deliver sample quality measures.

How can the measurement infrastructure and data be leveraged for other types of improvement?

Quality measures are an important class of aggregate measures that can be immensely valuable. Clinical quality measure queries, with the Query Health standards applied, align with the Stage 3 goals for improved outcomes and establishing a learning health system through rapid feedback mechanisms.

Pooled “big data” in healthcare has its benefits but also has several drawbacks. “Big data” is typically managed in large pooled data sets, combining data from many settings of care. While there are terrific applications for pooled data, including registries and other successful use of large research and commercial databases, there are also critical issues of policy and strategy that must be resolved. Query Health standards can serve as the safe on-ramp to “big data”.

Ultimately, we're at a defining moment for standards that will enable quality measures and big data analytics in a distributed environment. Researchers will be able to leverage these standards to “send questions to the data.” Questions can be sent to numerous data sources including EHRs, HIEs, PHRs, payers’ clinical record or any other clinical record. Aggregate responses leave patient level information secure behind the data source’s firewall. Those responses can support questions related to disease outbreak, quality, research, post-market surveillance, performance, utilization, public health, prevention, resource optimization and many others. The opportunities are truly endless. Thank you.

Query Health - by the numbers

noreply@blogger.com (Anonymous) — Thu, 31 May 2012 15:33:00 +0000

I'm finishing up a year with the Office of the National Coordinator for Health IT. Thought you'd be interested in this blog post, summing up the work on Query Health.

Query Health – by the numbers

From Rich Elmore, Coordinator, Query Health

I wanted to share with you an update on Query Health - - by the numbers.

One	Transformative concept	Sending questions to the data
Two	Operational documents	1) Data use agreement 2) Operational guidance
Three	Reference Implementations	1) i2b2 2) PopMedNet 3) hQuery
Four	Standards	1) Question (HQMF) 2) Data (CEDD) 3) Results (QRDA Cat 2&3) 4) Query Envelope
Five	Pilots	1) NYC/NYS DPH 2) Mini-Sentinel (FDA/BID) 3) CDC BioSense 2 4) Mass DPH 5) CQM (Allscripts)

The Query Health technical work group is making fantastic progress on the reference implementations. We’ve also had recent exciting news with ONC and HL7 working jointly on preparing HQMF and QRDA for ballot, and ONC and NQF working jointly on aligning CEDD with QDM.

The Query Health pilots are poised to ask and answer important questions related to diabetes, hypertension, post-market surveillance, situation awareness and clinical quality measures.

Most importantly, Query Health aligns with the concept of a learning health system, focusing on improving patient and population outcomes.

All of this is the result of the energized, expert, engaged community that have provided shape and direction for distributed population queries. Thank you to all of the Query Health members and support team for your outstanding contributions!

The time I had promised to ONC has gone by so quickly. I am thrilled that Feik (John Feikema) is taking the reins. We’ve been working together on the transition for the past month and the project will not miss a beat.

Onward!

Rich

Todd Park, Chief Technology Officer for the U.S.

noreply@blogger.com (Anonymous) — Sun, 11 Mar 2012 16:25:00 +0000

Todd Park recently assumed the role of Chief Technology Officer (CTO) for the United States reporting to the President. Last April, Todd (then CTO of Health and Human Services), Josh Seidman and I participated on a panel moderated by Sean Nolan on Citizen-Centric Health: How Public/Private Partnerships are Changing the Game. Todd's energy and passion on that panel were so great, that it is worthwhile reprising here.

Standards for Distributed Population Health Queries

noreply@blogger.com (Anonymous) — Mon, 05 Mar 2012 13:00:00 +0000

Originally published in Faster Cures' "bloggersation" regarding: What is the most important thing that could happen in 2012 to ensure better utilization of big data—housed in EMRs or other platforms—for drug development?

“Big data” is typically managed in large pooled data sets, combining data from many settings of care. While there are terrific applications of pooled data, including registries and successful use of large research databases, there are critical issues of policy and strategy. Pooled “Big data” in healthcare has its benefits but also has several drawbacks.

From a policy perspective, pooled data approaches are problematic. Large pools of PHI are targets for attack from bad actors. Also, many PHI-holders have their own consent agreements with their patients. It is difficult to manage these different consent agreements when pooling PHI in one place. Additionally, HIPAA requires covered entities to control the flow of PHI, either directly or through agreements. When data is pooled, the party pooling the data must have a business associate agreement or data use agreement (in the case of research databases) with each covered entity that contributes data to the pool, with the same (or similar terms). This can be impracticable for the third party or undesirable for covered entities, as they often have to agree to non-negotiable terms in the agreement in order to pool their data.

From a strategic standpoint, pooled data is inflexible, stale and inaccurate. Pooled data approaches aren’t generally sustainable: the benefits of pooled approaches are too indirect to support the operational costs and complexity. Furthermore, health care organizations are unwilling to lose control of their information not just for policy reasons, but also due to competitive considerations.

But the absence of a standards-based alternative has given rise to pooled data approaches with all of these substantial drawbacks.

2012 is the defining moment for new standards that will enable big data analytics in a distributed environment. An ONC sponsored open government initiative, Query Health, is defining the standards and specifications for distributed population queries. Researchers will be able to leverage these standards to be “send questions to the data”. Questions can be sent to data sources including EHRs, HIEs, PHRs, payers’ clinical record or any other clinical record. Aggregate responses leave patient level information secure behind the data source’s firewall. Aggregate responses support questions related to disease outbreak, quality, CER, post-market surveillance, performance, utilization, public health, prevention, resource optimization and many others.

The path for these new standards will dramatically cut cycle time for deployment of new questions from years to days – making possible support for a learning health system.

The focus of 2012 should be laying the foundation for success: defining the standards and services for distributed population health queries. This is one extremely impactful way to leverage the potential of big data for research. For more information, visit QueryHealth.org.

Meaningful Use Stage 2

noreply@blogger.com (Anonymous) — Sat, 25 Feb 2012 16:17:00 +0000

HHS News Release

Health and Human Services Secretary Kathleen Sebelius announced the next steps for providers who are using electronic health record (EHR) technology and receiving incentive payments from Medicare and Medicaid. These proposed rules, from the Centers for Medicaid & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), will govern stage 2 of the Medicare and Medicaid Electronic Health Record Incentive Programs.

“We know that broader adoption of electronic health records can save our health care system money, save time for doctors and hospitals, and save lives,” said Secretary Sebelius. “We have seen great success and momentum as we’ve taken the first steps toward adoption of this critical technology. As we move into the next stage, we are encouraging even more providers to participate and support more coordinated, patient-centered care.”

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it in a meaningful way. What is considered “meaningful use” is evolving in three stages:

Stage 1 (which began in 2011 and remains the starting point for all providers): “meaningful use” consists of transferring data to EHRs and being able to share information, including electronic copies and visit summaries for patients.
Stage 2 (to be implemented in 2014 under the proposed rule): “meaningful use” includes new standards such as online access for patients to their health information, and electronic health information exchange between providers.
Stage 3 (expected to be implemented in 2016): “meaningful use” includes demonstrating that the quality of health care has been improved.

CMS’ proposed rule specifies the stage 2 criteria that eligible providers must meet in order to qualify for Medicare and/or Medicaid EHR incentive payments. It also specifies Medicare payment adjustments that, beginning in 2015, providers will face if they fail to demonstrate meaningful use of certified EHR technology and fail to meet other program participation requirements. In a November 2011 “We Can’t Wait” announcement (http://www.hhs.gov/news/press/2011pres/11/20111130a.html), the Department outlined plans to provide an additional year for providers who attested to meaningful use in 2011. Under today’s proposed rule, stage 1 has been extended an additional year, allowing providers to attest to stage 2 in 2014, instead of in 2013. The proposed rule announced by ONC identifies standards and criteria for the certification of EHR technology, so eligible professionals and hospitals can be sure that the systems they adopt are capable of performing the required functions to demonstrate either stage of meaningful use that would be in effect starting in 2014.

“Through the Medicare and Medicaid EHR Incentive Programs, we’ve seen incredible progress as over 43,000 providers have received $3.1 billion to help make the transition to electronic health records,” said CMS Acting Administrator Marilyn Tavenner. “There is great momentum as the number of providers adopting this technology grows every month. Today’s announcement will help ensure broad participation and success of the program, as we move toward full adoption of this money-saving and life-saving technology.”

“The proposed rules for stage 2 for meaningful use and updated certification criteria largely reflect the recommendations from the Health IT Policy and Standards Committees, the federal advisory committees that operate through a transparent process with broad public input from all key stakeholders. Their recommendations emphasized the desire to increase health information exchange, increase patient and family engagement, and better align reporting requirements with other HHS programs,” said Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology. “The proposed rules announced today will continue down the path stage 1 established by focusing on value-added ways in which EHR systems can help providers deliver care which is more coordinated, safer, patient-centered, and efficient.”

The number of hospitals using EHRs has more than doubled in the last two years from 16 to 35 percent between 2009 and 2011. Eighty-five percent of hospitals now report that by 2015 they intend to take advantage of the incentive payments.

A technical fact sheet on CMS’s proposed rule is available at http://www.cms.gov/apps/media/fact_sheets.asp.

A technical fact sheet on ONC’s standards and certification criteria proposed rule is available athttp://www.healthit.gov/policy-research.

The proposed rules announced today may be viewed at www.ofr.gov/inspection.aspx. Comments are due 60 days after publication in the Federal Register.

Query Health: Distributed Population Queries

noreply@blogger.com (Anonymous) — Wed, 15 Feb 2012 13:30:00 +0000

By Michael Buck and Rich Elmore (and originally published in Health Data Management)

Query Health is an Open Government Initiative that is establishing the standards and services for distributed population health queries. Query Health standards will be used to send questions to clinical data sources which return aggregate measures of population health that can be used for many purposes including disease outbreak monitoring, post-market surveillance, comparative effectiveness research, quality and performance measures.

Query Health is pleased to announce the commitment of leading healthcare organizations to pilot the Query Health standards and specifications. Query Health also plans to present its progress on proposed standards and reference implementation at the HIMSS conference in Las Vegas, February 20-24, 2012. And in an unexpected twist, Query Health standards will deliver potential benefits beyond the scope of distributed population queries.

Announcing the first Query Health Pilot

Today, Query Health is announcing that the Primary Care Information Project (PCIP), within the New York City Department of Health and Mental Hygiene, and the New York State Department of Public Health have announced plans to pilot the Query Health standards and reference implementation. PCIP recently won awards for their work on distributed queries including the 2011 HIMSS Public Health Davies Award of Excellence and Healthcare Informatics first place Innovator Award. They will be using Query Health standards to expand their existing population health monitoring network from an existing 1.6 million ambulatory patients to encompass citywide HIE organizational coverage of both inpatient and outpatient encounters. This enhanced system will support optimal allocation of limited public health resources.

What will be shown at HIMSS?

ONC will host a demonstration of Query Health’s progress on the reference implementation including a live demo of distributed query execution.

· ONC Booth Theater on Wednesday February 22^nd at 9:45 AM.

· HIMSS Interoperability Showcase Stage on Thursday February 23^rd at 9:30 AM

Are there benefits beyond distributed population queries?

The path for a quality measure today is measured in years from the time of measure definition to delivery in vendor systems and deployment in EHRs. Want another quality measure? Wait several years.

In collaboration with HL7, NQF and CMS, Query Health standards will enable Health IT vendors to dynamically respond to queries, including queries that align with quality measures. So assuming the data is being captured, the cycle time could go from years to days.

The ability to generate measures nationally in a short cycle time has powerful benefits for patients, patient populations while enabling researchers and healthcare organizations to substantially reduce costs and increase speed.

What is Query Health?

Query Health was launched September 2011, with approximately 100 committed member organizations representing diverse healthcare stakeholders contributing to the project.

Today, when health researchers develop questions about a population, in many cases they manually pose these questions to care delivery organizations, which employ technical teams to manually generate queries and produce reports. Even where distributed queries are automated, the costs and time to link each data source are unacceptably high. The Query Health Initiative will make this much more efficient: the question can be delivered in a format that will be interpreted automatically by an HIT system. The HIT system will then generate a report with the “answer” to the query.

Questions can be sent to many different types of data sources including providers’ EHRs, payers’ clinical records, personal health records and health information exchanges. Decisions about which queries to process are under control of the data owner and the aggregated results protect patient level data, which remains safely behind data owners’ firewalls.

For more information:

For more information on Query Health initiative, visit the Query Health website http://www.QueryHealth.org or contact admin@siframework.org.

The authors:

Michael Buck is the clinical work group leader for Query Health and director for the NYC/NYS pilot. Dr. Buck is also Biomedical Informatics R&D Manager at New York City Department of Health and Mental Hygiene and Adjunct Associate Research Scientist at Columbia University’s Department of Biomedical Informatics.

Rich Elmore is the ONC Coordinator for Query Health.

Medical Errors Due to Indecipherable Prescriptions

noreply@blogger.com (Anonymous) — Tue, 10 Jan 2012 19:13:00 +0000

Thanks to e-Patient Dave for the image.

See also the recent report Hospital Incident Reporting Systems Do Not Capture Most Patient Harm which found that "Hospital staff did not report 86 percent of events to incident reporting systems, partly because of staff misperceptions about what constitutes patient harm".

The December HIT Standards Committee Meeting

noreply@blogger.com (Anonymous) — Wed, 14 Dec 2011 19:18:00 +0000

by John Halamka, Life as a Healthcare CIO

We began the meeting by relating our standards trajectory to today's agenda.

Our outstanding standards issues for discussion include

1. Content
Continued discussion of GreenCDA on the wire and overview of Stan Huff's CIMI initiative

Standardizing DICOM image objects for image sharing and investigating other possible approaches (e.g., cloud based JPEG2000 exchange). Consider image transfer standards, image viewing standards, and image reporting standards.

Query Health i.e. I2B2 distributed queries that send questions to data instead of requiring consolidation of data

Simplify the specification for quality measures to enhance consistency of implementation.

The December meeting included an overview of Query Health and Quality measure standards, leaving the discussion of GreenCDA/CIMI and DICOM to our 2012 meetings.

2. Vocabulary
Extend the quality measurement vocabularies to clinical summaries
Lab ordering compendium

The December meeting included a discussion of the lab ordering compendium, leaving the discussion of clinical summary vocabularies to our 2012 meetings.

3. Transport
Specify how the metadata ANPRM be integrated into the health exchange architecture

Additional NwHIN standards development (hearing re Exchange specification complexity, review/oversight of the S&I framework work on Exchange specifications simplification). Further define secure RESTful transport standards.

Accelerate provider directory pilots (Microdata, RESTful query/response that separates the transaction layer from the schema) and rapidly disseminate lessons learned.

The December meeting included an update on the provider directory and certificate components of transport

Our first presentation was an NCVHS update on ACA Section 10109 by Walter Suarez.

The Committee emphasized the need to coordinate NCHVS work and HITSC work given that division between administrative and clinical data is becoming less distinct over time

Our second presentation was an Implementation Workgroup Update by Liz Johnson about testing procedures that support the certification process.

The committee emphasized the need to pilot these procedures, ensuring they are as simple as possible and reflect a practical evaluation of the functionality intended to support policy goals.

Next, Doug Fridsma and Rich Elmore gave an ONC update. Rich Elmore described the Query Health initiative, as referenced in my previous blog post about sending questions to data (rather than sending data to registries).

The committee endorsed the work and noted that further research will be needed to link patients across multiple databases to avoid double counting individuals in quality measure denominators. The work of Jeff Jonas, as described in my earlier blog post about linking identity.

Doug updated the committee about the S&I Framework initiatives - Transitions of Care, Lab Results, Provider Directories, Data Segmentation (for privacy protection), and electronic submission of medical documentation for Medicare review.

We then discussed a preliminary framework for HITSC 2012 Workplan to ensure the items in the standards trajectory listed above are completed in 2012 as we continue to prepare for meaningful use stage 3.

A great meeting.

The Elephant in the Room

noreply@blogger.com (Anonymous) — Mon, 12 Dec 2011 23:00:00 +0000

Why aren't we talking about pricing failures? The US, has consistently higher prices than any other country. The 2010 report by the International Federation of Health Plans consists of 23 pricing measures and the pattern is the same across each of these measures. And a 2010 investigation of Health Care Cost Trends and Cost Drivers in Massachusetts found that "price variations are correlated to market leverage..."

Before his departure from CMS, Don Berwick was interviewed by the New York Times and took a "parting shot at waste". Berwick listed five elements of waste including overtreatment of patients, failure to coordinate care, administrative complexity, burdensome rules and fraud. Pricing failures didn't make the list. (Many folks have commented and analyzed the five factors including John Halamka's terrific piece on how EHRs can address these 5 factors.)

Then in Berwick's December 7th speech to the IHI National Forum, he adds a sixth element:

"Overtreatment – the waste that comes from subjecting people to care that cannot possibly help them – care rooted in outmoded habits, supply-driven behaviors, and ignoring science.
Failures of Coordination- the waste that comes when people – especially people with chronic illness – fall through the slats. They get lost, forgotten, confused. The result: complications, decays in functional status, hospital readmissions, and dependency.
Failures of Reliability – the waste that comes with poor execution of what we know to do. The result: safety hazards and worse outcomes.
Administrative Complexity – the waste that comes when we create our own rules that force people to do things that make no sense – that converts valuable nursing time into meaningless charting rituals or limited physician time into nonsensical and complex billing procedures.
Pricing Failures – the waste that comes as prices migrate far from the actual costs of production plus fair profits.
Fraud and Abuse – the waste that comes as thieves steal what is not theirs, and also from the blunt procedures of inspection and regulation that infect everyone because of the misbehaviors of a very few. We have estimated how big this waste is – from both the perspective of the Federal payers – Medicare and Medicaid – and for all payers."

The addition of pricing failures as a sixth element of waste is a subtle but critical shift for the national conversation. It should not go unnoticed.

Don Berwick defines pricing failures as "the waste that comes as prices migrate far from the actual costs of production plus fair profits." Think about that: "far from the actual costs of production plus fair profits". At a time when total healthcare expenditures consume a huge share of GDP and increasing at rates higher than inflation and wage increases, why haven't pricing failures been on the table? As we struggle to control costs and improve quality, there is intense focus on utilization, regulation and care coordination. Why not also focus on pricing failures?

So why hasn't pricing failures been part of the conversation up to now? Here's how the conversation usually proceeds: Health Affairs November 2011 article, Large Variations In Medicare Payments For Surgery Highlight Savings Potential From Bundled Payment Programs, "found that current Medicare episode payments for certain inpatient procedures varied by 49–130 percent across hospitals sorted into five payment groups. Intentional differences in payments attributable to such factors as geography or illness severity explained much of this variation. But after adjustment for these differences, per episode payments to the highest-cost hospitals were higher than those to the lowest-cost facilities by up to $2,549 for colectomy and $7,759 for back surgery."

Sounds like a clarion call for a focus on pricing failures doesn't it? Actually, no... The authors conclusions only speak to cost efficiency and utilization. "Our study suggests that bundled payments could yield sizable savings for payers, although the effect on individual institutions will vary because hospitals that were relatively expensive for one procedure were often relatively inexpensive for others. More broadly, our data suggest that many hospitals have considerable room to improve their cost efficiency for inpatient surgery and should look for patterns of excess utilization, particularly among surgical specialties, other inpatient specialist consultations, and various types of postdischarge care."

So is it time to broaden the conversation to include pricing failures? At least one health system has realized that "the jig is up". Perhaps it's time to peel the onion a bit... And take a serious look at pricing failures which deviate "far from the actual costs of production plus fair profits".
_______________________________
Background tables from the IFHP report:

The November HIT Standards Committee

noreply@blogger.com (Anonymous) — Mon, 21 Nov 2011 08:00:00 +0000

by John Halamka, Life as a Healthcare CIO, November 16, 2011

Today, the HIT Standards Committee shifted gears from the Summer Camp work on Meaningful Use Stage 2 and began new interoperability efforts.

We began the meeting with a presentation by Liz Johnson and Judy Murphy about the Implementation Workgroup's recommendations to improve the certification and testing process. These 15 items incorporate the Stage 1 experience gathered from numerous hospitals and eligible professionals. If ONC and NIST can implement this plan, many stakeholders will benefit. The Committee approved these recommendations without revision.

Next, we focused on content, vocabulary and transport standards.

In my October HIT Standards Committee blog post, I noted that HITSC should work on the following projects:

Content
*Continued refinement of the Consolidated CDA implementation guides and tools to enhance semantic interoperability including consistent use of business names in "Green" over-the-wire standards.
*Simplifying the specification for quality measures to enhance consistency of implementation.
*Standardizing DICOM image objects for image sharing and investigating other possible approaches. We'll review image transfer standards, image viewing standards, and image reporting standards.
*Query Health - distributed queries that send questions to data instead of requiring consolidation of the data

Vocabulary
*Extending the quality measurement vocabularies to clinical summaries
*Finalizing a standardized lab ordering compendium

Transport
*Specifying how the metadata ANPRM be integrated into health exchange architectures
*Supporting additional NwHIN standards development (hearings about Exchange specification complexity, review/oversight of the S&I Framework projects on simplification of Exchange specifications). Further defining secure RESTful transport standards.
*Accelerating provider directory pilots (Microdata, RESTful query/response that separates the transaction layer from the schema) and rapidly disseminating lessons learned.

The November Committee agenda included a discussion of Consolidated CDA, Quality Measures, and NwHIN Implementation Guides.

Doug Fridsma began with a discussion of the Consolidated CDAwork and the tools which support it.

The Committee had a remarkable dialog with more passion and unanimity than at any recent discussion. We concluded:
*Simple XML that is easily implemented will accelerate adoption
*That simple XML should be backed by a robust information model. However, implementers should not need expert knowledge of that model. The information model can serve as a reference for SDOs to guide their work
*Detailed Clinical Models, as exemplified by Stan Huff's Clinical Information Modeling Initiative (CIMI) hold great promise. Stan has assembled an international consensus group including those who work on
-Archetype Object Model/ADL 1.5 openEHR
-CEN/ISO 13606 AOM ADL 1.4
-UML 2.x + OCL + healthcare extensions
-OWL 2.0 + healthcare profiles and extensions
-MIF 2 + tools HL7 RIM – static model designer

Their work may be much more intuitive than today's HL7 RIM as the basis for future clinical exchange standards.

*Rather than debate whether Consolidated CDA OR GreenCDA(simplified XML tagging) should be the over the wire format, the Committee noted that "OR" really implies "AND" for vendors and increases implementation burden. The Committee endorsed moving forward with GreenCDA as the single over the wire format.
*We should move forward now with this work, realizing that it will take 9-12 months and likely will not be included in Meaningful Use Stage 2, but it is the right thing to do.

Thus, the future Transfer of Care Summary will be assembled from a simple set of clinically relevant GreenCDA templates, based on CIMI models, as needed to support various use cases. There will be no optionality - just a single way to express medical concepts in specific templates.

To support this approach, we'll need great modeling tools. David Carlson and John Timm presented the applications developed to support the VA's Model Driven Health Tools initiative. This software turns clinical models into XML and conformance testing tools. The committee was very impressed.

Next, Avinash Shanbhag presented the ONC work on Quality Measures that seeks to ensure quality numerators and denominators are expressed in terms of existing EHR data elements captured as part of standard patient care workflows.

Avinash also presented an update on transport efforts, which include easy to use, well documented implementation guides for SMTP/SMIME and SOAP. The work is highly modular and does not require that the full suite of NwHIN Exchange specifications be implemented for SOAP exchanges.

As part of the ongoing efforts to improve NwHIN Exchange, the HIT Standards Committee is seeking input from NwHIN implementers per this blog post.

Finally, Wil Yu updated the committee on the SHARP and other innovation programs.

There will be a great body of challenging work to do in 2012. What's needed after that? The next 5 years will include many new regulations as healthcare reform is rolled out. It's clear that the Standards Committee will have many topics to discuss.

The Elephant in the Room: The Prequel

noreply@blogger.com (Anonymous) — Mon, 14 Nov 2011 12:30:00 +0000

At the October HIT Policy Committee, Charles Kennedy described his work with health systems establishing accountable care models. His clients "have actual health plan products that are private labeled products with the delivery systems' name on it that they’re selling."

Kenedy talked with the COO of one health system that was particularly high cost. Kennedy asked the COO: "Why on earth would you want to form an ACO? You’re a monopoly. You’re making tons of money. You can keep doing this for some period of time."

The COO replied “Look I understand that the jig is up.”

The COO went on to say "I know how to take $60 out per member per month. $60 - - out of my cost structure. I know exactly how to do it. I never had a motivation to do it before - - until health care reform happened." Kennedy explained that the COO has now "taken those costs out of his delivery system and because he has a product in the marketplace he gets to reap those efficiencies. The second thing he said was that 'I never really had a use for health IT until I began to take costs out of my infrastructure'."

Query Health at the September HIT Policy Committee Meeting

noreply@blogger.com (Anonymous) — Wed, 12 Oct 2011 12:00:00 +0000

Today the HIT Policy Committee is considering the Privacy and Security Tiger Team recommendations on the Query Health policy sandbox.

By way of background, here are the minutes from last month's introductory discussion from the September HIT Policy Committee:

Richard Elmore of ONC presented on Query Health, recently launched initiative to develop standards and services for distributed population queries. Guidance from and linkage to the HITPC will be crucial to the success of this effort. Elmore presented the vision of Query Health as follows: ―Enable a learning health system to understand population measures of health, performance, disease, and quality, while respecting patient privacy, to improve patient and population health and reduce costs.

The nation is reaching a critical mass of deployed EHRs with greater standardization of information in support of HIE and quality measure reporting. There is an opportunity to improve community understanding of population health, performance, and quality through:

Enabling proactive patient care in the community
Delivering insights for local and regional quality improvement
Facilitating consistently applied performance measures and payment strategies for the community (hospital, practice, health exchange, state, payer, etc.) based on aggregated, de-identified data
Identifying treatments that are most effective for the community.

Elmore commented that the challenges include the high transaction and ―plumbing‖ costs associated with variation in clinical concept coding (even within organizations), the lack of query standards, and the lack of understanding best business practices. There is also a centralizing tendency that moves data further away from the source, increases personal health information exposure, and limits responsiveness to patient consent preference. Another challenge is that the work done to date, with a few exceptions, has been limited to larger health systems (with large IT and/or research budgets).

The goal is to improve the community understanding of patient population health to be able to ask a question, whether it is to a small physician’s office or a larger hospital, and obtain an aggregate result back. Questions could focus on disease outbreaks, prevention activities, research, quality measures, etc. With regard to scope and approach, Elmore explained that Query Health is being structured in a way that is similar to the Direct Project. It is a public-private partnership project focusing on the standards and services related to distributed population queries. The concept is to have an open, democratic, community-driven consensus-based process. There is a critical linkage with the HITPC and Privacy and Security Tiger Team to provide the guidance needed to drive this project.

Elmore reviewed a series of user stories to demonstrate how to adjust queries with simple, secure use cases to establish the standards and protocols for patient data that is going to be queried against, the query and case definition, and then getting the results back to the requestor of the information.

The organization has a voting group of committed members, the Query Health Implementation Group. There are three workgroups (Clinical Workgroup, Technical Workgroup, and Business Workgroup). In terms of timeline, Query Health is at the requirements and specification stage (the next steps are approaching consensus, and undergoing pilots). Query Health was designed with goals alignment with the S&U Framework, as an open government initiative that is engaging a wide variety of stakeholders. Query Health is also aligned with meaningful use and various standards, as well as with one of ONC’s major strategies, the digital infrastructure for a learning health system.

Elmore described the Summer Concert Series, a presentation by the practitioners that have working on distributor queries that highlights the importance of this project. Through this event, a number of challenges were identified, including best practices for data use/sharing, sustainability, auditability, etc.

It is hoped that the HITPC and Privacy and Security Tiger Team will provide Query Health with policy guidance and will monitor Query Health’s progress. It is anticipated that the first activity with which Query Health will be looking for such guidance is in the policy sandbox and to ensure that the project is safe, cautious, and conservative for the purposes of starting that initial pilot work. The initial set of policy sandbox ideas has been modeled after previous S&I Framework initiatives in consultation with ONC policy and privacy and S&I Framework leaders and their staff. The concept is that query requests and responses will be implemented in the pilot to use the least identifiable form of health data necessary in the aggregate within the following guidelines: (1) a disclosing entity should have its queries and results under their control (manual or automated); (2) the data being exchanged will be mock or test data, aggregated de-identified data sets or aggregated limited data sets, each with data use agreements; and (3) for other than regulated/permitted use purposes, cells with less than five observations in a cell shall be blurred by methods that reduce the accuracy of the information provided.

Discussion

Larry Wolf asked how Query Health relates to other activities focused on quality measure initiatives. Elmore indicated that this issue has been raised during the Summer Concert Series as well as in Query Health’s Technical Workgroup. In the next few months, it is expected that decisions will be made as to which standards will be applied. Query Health will be leveraging other ongoing initiatives moving forward. Wolf suggested minimizing the diversity of requirements generated for systems to handle queries and result sets.
In response to a question about information exchange, Elmore commented that the assumption is that the information behind an organization’s firewall is identifiable. Only in an instance of a public health permitted use would identifiable data be outside the firewall.
Farzad Mostashari noted that Query Health’s strategy has significant architectural and certification implications in the near future. Getting in front of those and considering them early on will be critical. Clarity about the potential timeframe is needed, as it affects work in areas such as quality measurement. The business case for this effort also requires careful consideration.
Gayle Harrell noted that there is a tremendous upside to Query Health, but there is also a significant potential for abuse that may frighten the public. She asked about the role of the HITPC in terms of providing input as this project moves forward. Deven McGraw noted that Query Health will be discussed at the next Privacy and Security Tiger Team meeting. Elmore added that the HITPC and Privacy and Security Tiger Team will be relied on to provide significant input for guiding the future of Query Health. He noted that with the exception of public health, where it is already allowed by law today to send some identifiable information, Query Health will be dealing with aggregated information and will not be exposing individual’s information. The project itself will be trying to drive towards enabling a non-centrally planned use of technology that is under the control of those responsible for the data.
Arthur Davidson discussed the burden faced by organizations trying to participate in these important population-based efforts to analyze and move towards the learning healthcare system. He asked if there has been a discussion at the ONC level regarding the leadership role that either the ONC or the HITPC might play in harmonizing these various data models. Elmore noted that Query Health’s Technical Workgroup is examining these data models with the vision of some harmonization of standards.
It is expected that, from the point of view of keeping it simple for an initial pilot implementation, the pilot will probably create a focus around the clinical record, whether that be an EHR or more of an HIE.

E-Consent Trial Project Contract Awarded

noreply@blogger.com (Anonymous) — Tue, 04 Oct 2011 10:32:00 +0000

From the ONC Announcement:

"ONC's Office of the Chief Privacy Officer recently awarded a contract to find an efficient, effective, and innovative way to help patients better understand their choices regarding whether and when their health care provider can share their health information electronically, including sharing it with a health information exchange organization. The project team will design, develop, and pilot innovative ways to electronically implement existing patient choice policies, while improving business processes for health care providers.

To learn more about the E-Consent Trial project, please see the Statement of Work. ONC's formal launch of the E-Consent Trial Project will be in October."

The September HIT Standards Committee Meeting

noreply@blogger.com (Anonymous) — Thu, 29 Sep 2011 18:12:00 +0000

by John Halamka, Life as Healthcare CIO

Today was a big day - the end of Standards Summer Camp. We presented the HIT Standards Committee work of the past 6 months and then attended a celebratory reception at the White House.

Judy Sparrow, the ONC "national coordinator" who orchestrated all our HITSC meetings, announced her retirement last month. Jon Perlin and I presented her with a silver bowl, engraved with the words "The Standard Bearer". Thanks for all you've done, Judy.

As we discussed our Summer Camp work during the meeting, we were guided by a few basic principles:

While it might not be perfect, does it represent the best we have at this point in history?
Does it point us in the right direction?
Is it the next step in an incremental approach to refining the standards and implementation guides?
Does it support our policy objectives?
Can we update it as needed going forward through the SDO community?

Doug Fridsma presented an overview of our Summer Camp activities to date:

The Metadata Analysis Power Team lea by Stan Huff completed the standards for patient identification, provenance (which organization generated the data), and security flags. Simple XML constructs from CDA R2 and standard X.509 certificates were chosen for these requirements.

The Patient Matching Power Team led by Marc Overhage completed its analysis of best practices for patient matching, noting the types of demographics that should be captured in systems to optimize the sensitivity and specificity of patient matching applications.

The Surveillance Implementation Guide Power Team led by Chris Chute chose one implementation guide for each of the public health transactions - surveillance, reportable lab, and immunizations. We had a spirited discussion about the optional fields in the implementation guides and made it clear that we want the core elements to be the certification criteria. We do not want each state public health department to mandate different "optional" fields. Our transmittal letter will note that EHRs that send the core set should meet the certification criteria. Public health departments should accept this core set. Optional fields are just that - optional items for future reporting needs.

Farzad Mostashari, National Coordinator, framed the important discussion of transport standards by noting that we must move forward, boldly specifying what is good enough. If we specify nothing, the silos of data we have today in hospitals, clinician offices, pharmacies, and labs will persist. There's a sense of urgency to act.

The NwHIN Power Team led by Dixie Baker presented its thoughtful analysis of the 10 standards guides included in NwHIN Exchange and the 2 standards guides included in NwHIN Direct. This analysis was not a comparison of the two, but was an objective look at the suitability of each standards guide for its intended purpose to support aspects of transport functionality at a national scale. The team did not discuss their suitability for use at the local, state, or regional scale. The team did not declare "push or "pull" as a superior architecture. Their thoughtful analysis led to a very robust discussion. I'd summarize it as:

*Direct is low risk for the purpose intended, pushing data from point A to point B using SMTP/SMIME with an optional XDR (SOAP) connector. Additional work needs to be done on certificate discovery, but that will use DNS and LDAP, two well adopted technologies.

*Exchange needs additional work to ensure it scales at a national level for pull and push transactions. The S&I Framework teams are working on modular specifications that should enable a subset of Exchange components to be used, simplifying implementation and support. The Standards Committee will seek additional testimony from Exchange implementers to learn more about their experience.

*It's worthwhile to think about additional transport standards that do not yet have well specified implementation guides, such as a combination of REST, oAuth and TLS - something that Facebook, Amazon, or Google would use to create a highly scalable transport architecture.

The ePrescribing of Discharge Meds Power Team led by Jamie Ferguson presented the use of HL7 2.2-2.51 transactions to support hospital information system workflows in a manner that is compatible with Medicare Part D. We clarified that newer versions of HL7 2.x which are backward compatible should also be allowed.

The Clinical Quality Workgroup and Vocabulary Task Force led by Jamie Ferguson presented their transition plans for vocabularies, identifying the cross maps between vocabularies that need to be created and supported as we evolve from our current use of vocabularies to a future state in which there is one structured vocabulary per domain of medicine (problems, medications, labs, allergies etc).

Doug Fridsma then presented an overview of the Standards and Interoperability Framework activities and next steps:

Transitions of Care - Doug described a brilliant approach that incorporates simple XML, such as has been used in the CCR, with the expandability of the CCD. He calls this next evolution of clinical summaries "Consolidated CDA templates". It's likely that the clinical summary certification criteria will evolve to a single XML format that is easy to use, fast to implement, expandable, based on a reference model, and human readable. Well done!

Reportable Labs - In the past, standards harmonizers struggled to balance simple, easy to implement lab specifications such as ELINCS with the comprehensive and full featured lab specifications from HITSP. The S&I group created a foundation based on ELINCS that is expandable to include all the features of the HITSP specifications using a single HL7 2.51 implementation guide. Amazing work.

Provider Directories - The S&I Framework team had the courage to admit that directory standards are still evolving and need more testing/piloting before selection. DNS/LDAP approaches are likely to work well for certificate discovery. Other aspects of directories such as provider routing addresses and electronic service capabilities may be stored in web pages (microdata), LDAP (HPD), or X12 274 directory structures.

Doug also described new works in progress - Query Health for distributed data mining, Data Segmentation to manage disclosures of protected health information, and Electronic Submission of Medical Documentation for transmission to Medicare review contractors.

Finally and very importantly, the Implementation Workgroup led by Liz Johnson and Judy Murphy presented the Implementation Workgroup certification criteria analysis. We had a thoughtful discussion of each open issue and suggested a path forward for each certification item.

Truly an inspiring meeting - the most work we've ever done in a single day.

The delivery of Meaningful Use Stage 2 Standards and Certification criteria was recognized at a White House celebration by Aneesh Chopra, Chief Technology Officer and numerous members of the Obama administration senior staff. Thanks so much to Aneesh and others for celebrating our work.

As I told the Standards Committee today, I am honored to serve with this team, the hardest working Federal Advisory Committee in government. A milestone day for the country.

September HIT Policy Committee on Query Health

noreply@blogger.com (Anonymous) — Mon, 19 Sep 2011 12:30:00 +0000

The HIT Policy Committee recently reviewed Query Health, the ONC sponsored initiative to define standards and protocols for distributed population queries.

HIT Policy Committee audio:

Query Health - Rich Elmore - HIT Policy Committee 2011-09-14