Wednesday, July 2, 2014

Health Datapalooza 2014

Health Datapalooza 2014 was a rousing success, once again bringing together a diverse audience to celebrate open health data. I was thrilled to be a judge for the apps that presented at the meeting, and impressed with the innovative and entrepreneurial spirit. We were treated to remarks from Todd Park, Chief Technology Officer of the US; Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services (her last appearance as Secretary); and Dr. Francis Collins, Director, National Institutes of Health, among many other great presentations.


Monday was hosted by Bryan Sivak, Chief Technology Officer at HHS, and Tuesday with Susannah Fox, associate director at the Pew Research Center's Internet & American Life Project.

On Monday the conference opened with some outstanding keynote addresses:
  • Dr. Elliot Fisher, Director of The Dartmouth Institute for Health Policy & Clinical Practice
  • Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP)
  • Todd Park, Chief Technology Officer of the United States
  • The Right Honourable Jeremy Hunt, Secretary of State for Health of the United Kingdom
  • Jonathan Bush, Co-founder & CEO of athenahealth
  • Dr. Atul Gawande, Director of Adriadne Labs and Professor of Surgery at Harvard Medical School
We also saw fantastic app demos from (so many great apps were submitted this year, the judging was difficult):
On Tuesday saw these keynote speakers:

Adriana Lukas, Founder & Organizer, London Quantified Self
Vinod Khosla, Founder, Khosla Adventures
Francis Collins, MD, PhD, Director, National Institutes of Health
Kathleen Sebelius, Secretary, Department of Health and Human Services
Steven Brill, author of “Bitter Pill” in conversation with HDC CEO Dwayne Spradlin

Tuesday we also saw an app demo from CareSync, and then there was the awarding of this year’s Code-a-Palooza top three winning teams (I was honored to be a judge for this year's challenge), and the winner this year was Smart Health Hero by LyfeChannel of San Carlos, California. We also saw this year's well deserved Health Data Liberators Award go to ProPublica for their data-driven series The Prescribers. They were honored for the work of their reporting team to leverage prescribing data to evaluate gaps in our system and then demand change. The team consisted of Charles Ornstein, Tracy Weber, Jennifer LaFleur, Lena Groeger and Jeff Larson of ProPublica.

Also be sure to check out The Kojo Nnamdi Show and their Tech Tuesday which was broadcast live from the event.

Some of my favorite moments were of this year's events were:

Bob Kocher



Elliot Fisher:



Todd Park:



Atul Gawande



Jonathan Bush



Steven Brill




The full playlist of the keynotes is HERE on YouTube.

Tuesday, May 20, 2014

CMS rule to help providers make use of Certified EHR Technology

Rule also proposes to extend Stage 2 of the EHR Incentive Programs through 2016


Today, HHS published a new proposed rule that would provide eligible professionals, eligible hospitals, and critical access hospitals more flexibility in how they use certified electronic health record (EHR) technology (CEHRT) to meet meaningful use. The proposed rule, from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would let providers use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for the EHR reporting period in 2014 for the Medicare and Medicaid EHR Incentive Programs.

Beginning in 2015, all eligible hospitals and professionals would still be required to report using 2014 Edition CEHRT. Since the Medicare and Medicaid EHR Incentive Programs began in 2011, more than 370,000 hospitals and professionals nationwide have received an incentive payment.

“We have seen tremendous participation in the EHR Incentive Programs since they began,” said CMS Administrator Marilyn Tavenner. “By extending Stage 2, we are being receptive to stakeholder feedback to ensure providers can continue to meet meaningful use and keep momentum moving forward.”

The proposed rule also includes a provision that would formalize CMS and ONC’s previously stated intention to extend Stage 2 through 2016 and begin Stage 3 in 2017. These proposed changes would address concerns raised by stakeholders and will encourage the continued adoption of Certified EHR Technology.

“Increasing the adoption of EHRs is key to improving the nation’s health care system and the steps we are taking today will give new options to those who, through no fault of their own, have been unable to get the new 2014 Edition technology, including those at high risk, such as smaller providers and rural hospitals,” said Karen DeSalvo, M.D., M.P.H, M.Sc., national coordinator for health information technology.

Proposed changes to meaningful use timeline
First
Payment Year
Stage of Meaningful Use
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2011
1
1
1
2
2
3 -> 2
3
TBD
TBD
TBD
TBD
2012

1
1
2
2
3 -> 2
3
TBD
TBD
TBD
TBD
2013


1
1
2
2
3
3
TBD
TBD
TBD
2014



1
1
2
2
3
3
TBD
TBD
2015




1
1
2
2
3
3
TBD
2016





1
1
2
2
3
3
2017






1
1
2
2
3


Current Stage 2 Start Date


Proposed Stage 3 Start Date


You would be able to attest for MU:
If you were scheduled to demonstrate:
Using 2011 Edition CEHRT to do:
Using 2011 & 2014 Edition CEHRT to do:
Using 2014 Edition CEHRT to do:
Stage 1 in 2014
2013 Stage 1 objectives and measures
2013 Stage 1 objectives and measures
-or-
2014 Stage 1 objectives and measures
2014 Stage 1 objectives and measures
Stage 2 in 2014
2013 Stage 1 objectives and measures
2013 Stage 1 objectives and measures
-OR-
2014 Stage 1 objectives and measures
-OR-
Stage 2 objectives and measures
2014 Stage 1 objectives and measures
-OR-
Stage 2 objectives and measures


Tuesday, May 6, 2014

Changes at Health IT Policy Committee and FDASIA Update

There were some changes announced in the membership of the Health IT Policy Committee (HITPC) at the May 5, 2014 meeting. Three departing members who have been with the HITPC from the beginning are:
  • Neil Calman, M.D., CEO of the Institute for Family Health, one of the largest networks of community health centers in New York State;
  • Judy Faulkner, CEO of Epic Systems;
  • Art Davidson, M.D., director of Public Health Informatics for Denver Public Health
The three new members replacing them are:
  • Christoph U. Lehmann, M.D., the founding medical director of the American Academy of Pediatrics Child Health Informatics Center and a professor in Pediatrics and Biomedical Informatics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Tennessee, as an expert on vulnerable populations;
  • Neal Patterson, co-founder, chairman and CEO of Cerner Corp. as a vendor representative;
  • Kim J. Schofield, health educator and advocacy chair for the Lupus Foundation of America’s Georgia Chapter, representing consumers and patients.
Notable is the departure of the Epic CEO, Judy Faulkner, being replaced by the Cerner CEO, Neal Patterson as a vendor representative. They also received an update from the FDASIA workgroup.



Next weeks very important Proposed Risk-Based Regulatory Framework and Strategy for Health IT Workshop convened by the FDA should provide even greater clarity into the development of the Health IT Safety Center and important development of potential regulations for software which falls into the Health Management Functionality category.

Karen DeSalvo also announced during the meeting that new workgroups are being formed. The ONC is Congressionally mandated to update its Health IT strategic plan, and will be adjusting its organizational structure and creating new workgroups to align with overall goals and available resources. The categories for new workgroups are being formed along:
  • Health IT Strategic Planning
  • Advanced Health Models and Meaningful Use
  • Interoperability & Health Information Exchange (HIE)
  • Health IT Implementation, Usability and Safety
  • Privacy and Security
  • Consumer
The HIT Strategic Planning and Interoperability & HIE Workgroups will begin forming first, followed by the Advanced Health Models and Meaningful Use and Health IT Implementation, Usability and Safety Workgroups later this year. For now the activities of the Privacy/Security and Consumer groups will continue as planned.

Thursday, April 17, 2014

The Health Data Analytics Hype Cycle

At the recent Healthcare Think Tank,  At the Crossroads: Technology and Transformation in Healthcare, sponsored by Dell, we had some very interesting discussions on a wide variety of topics. I will be highlighting some of the topics we covered in a few posts over the next couple months. At the first Think Tank three years ago at the HIMSS conference in Las Vegas I said that "Big data is the next big thing in healthcare." One of the hot topics discussed at this years Think Tank springing out of the HIMSS conference was health data analytics. I have also said that data analytics is the third wave of health IT that we're undergoing, after data capture and data sharing. It is this component - having robust analytics capabilities - that will provide the return on investment for the massive amount of government and private sector spending on health IT in the past few years.

During the session where we discussed data analytics Dan Munro, a contributor at Forbes, brought up the distinction between predictive analytics, proscriptive analytics, and persuasive analytics. Moving quickly past predictive analytics, which everyone seems to be working on, and into proscriptive analytics where actionable information is obtained and used. Then he introduces the notion of persuasive analytics. But sometimes the jargon we use can stand in the way when terms like "big data" and "analytics" become buzz words and lose some of their effectiveness. Dilbert also addressed this issue in the January, 9 2013 comic strip

Dilbert analytics jargon

Dan discussed the ability that retail giant Target has in consumer analytics, and went on to highlight the Gartner hype cycle and quickly walked through the Gartner Hype Cycle methodology which gives a good view of how a technology or application will evolve over time. According to Gartner each of the Hype Cycles drills down into the five key phases of a technology’s life cycle:
  • Technology Trigger: A potential technology breakthrough kicks things off. Early proof-of-concept stories and media interest trigger significant publicity. Often no usable products exist and commercial viability is unproven.
  • Peak of Inflated Expectations: Early publicity produces a number of success stories—often accompanied by scores of failures. Some companies take action; many do not.
  • Trough of Disillusionment: Interest wanes as experiments and implementations fail to deliver. Producers of the technology shake out or fail. Investments continue only if the surviving providers improve their products to the satisfaction of early adopters.
  • Slope of Enlightenment: More instances of how the technology can benefit the enterprise start to crystallize and become more widely understood. Second- and third-generation products appear from technology providers. More enterprises fund pilots; conservative companies remain cautious.
  • Plateau of Productivity: Mainstream adoption starts to take off. Criteria for assessing provider viability are more clearly defined. The technology’s broad market applicability and relevance are clearly paying off.



In it's recent report "Top Actions for Healthcare Delivery Organization CIOs, 2014: Avoid 25 Years of Mistakes in Enterprise Data Warehousing" Gartner makes the point that healthcare has a compelling need to use more information, and use it better. Enterprise data warehousing (EDW) is an important analytics component addressing various needs: The integrated clinical and business EDW; EHR; claims/revenue cycle; ERP; cost accounting; and patient satisfaction data.

Now that we have widespread adoption of EHRs, providers should leverage EHR data by advancing retrospective and real-time analytics because the superior use of analytics will be a dominant factor for success over the next 4-5 years. As a gushing of new data streams are on the way, CIOs cannot afford the cost, time or agony of repeating classic blunders (avoiding the "nine fatal flaws" in business operations improvement), just to get to an integrated warehouse with clinical data. They point out the Integrating business/financial and clinical data into an effective EDW is the top new healthcare IT initiative and will be necessary to succeed.

Over half of the early stage initiatives Gartner is tracking are either pure analytics (green) or contain an analytics component (yellow).

Hype Cycle for Healthcare Provider Applications, Analytics and Systems, 2013
Gartner Analytics Hype Cycle
Source: Gartner (February 2014)

In it's report Gartner stresses the need for strong information governance and the importance of data quality. They also warn not to overestimate the value of a commercial vendor's data model, to avoid underscoping the total effort and personnel needs, and never treat an EDW as just another module from the EHR vendor. They acknowledge the deep need for analytics solutions and show that the shift in payment models fueling this need includes both incentive-based and risk-reward payment models.

In the September 2012 Electronic Healthcare, a new eight-stage Analytics Adoption Model similar to the seven-stage EMR Adoption Model (EMRAM) from HIMSS Analytics was proposed. This model is being widely used to help analytics companies to inform their strategy and product roadmap. An excellent whitepaper that explains the model in greater detail is available HERE. Now HIMSS Analytics has partnered with the International Institute for Analytics (IIA) to create a benchmarking survey designed to measure and score clinical business intelligence and analytics maturity in healthcare organizations. They will use the DELTA model (data, enterprise-focus, leadership, targets and analysts) to assess analytic capabilities. The survey measures 33 competencies based within the DELTA model framework to assess the importance of each competency to the organization and the organization’s effectiveness in performing each competency.

As the Gartner report cautions over-reliance on vendor data models, one thing that I am interested in seeing is: Who will win the day in the exploding health data analytics market, EHR vendors or specialty analytics vendors? I do not think that specific EHR vendors, while they hold a great deal of data and are a critical piece of the puzzle, have the ability to aggregate all of these disparate data sources that will enable them to provide a comprehensive solution. So it will likely take partnerships between EHR vendors, HIE vendors, and analytics vendors to provide the true value that health systems will need to thrive in a transformed healthcare marketplace.