Thursday, March 22, 2012

Consumer Innovation Challenge

I am privileged to work with the ONC and six different states that are responding to the Consumer Innovation Challenge. The goal of the Challenge is to rapidly create a project that will provide patients with access to their health information within six months. These six projects will use about $200,000.00 - $300,000.00 each to rapidly create innovations with diverse areas of focus. It was an impressive group of innovators assembled for this challenge and these projects will help to improve healthcare and be a model for similar efforts around the country. From reducing breast cancer disparities to reaching out to homeless and underserved patients this is an opportunity for some innovation incubators to make a real difference.

Illinois – Chicago Mammography Image Exchange (CMIX)

The Metropolitan Chicago Healthcare Council is helping spearhead an effort to reduce a huge problem of racial disparities in breast cancer treatment in the Chicago metro area. This project will provide a cloud-based service to provide patients with easy access to mammography images via their Microsoft Health Vault PHR, while providing clinicians with the ability to search and retrieve mammography images from any web browser-based device. By making prior mammography images available at the point of care, physicians will be able to discern subtle tissue changes that would otherwise be undetected. This will allow for an earlier cancer diagnosis, when treatment is more likely to produce better patient outcomes and to do so at a lower cost. It is our expectation that CMIX will allow Chicago to reduce the current disparity in mortality rates.

As mammograms are created, a copy of the DICOM file will be sent via a VPN HL7 interface to the cloud-based Vendor Neutral Archive (VNA). Once stored in the VNA, a copy of the DICOM file will be sent via secure Internet, using the DIRECT protocol, for storage in the patient’s Microsoft Health Vault PHR. It can also be sent into the Chicago HIE. Patients will interact with their images and reports via their PHR. The data will be stored in Microsoft’s Health Vault container, which can support more than 40 different PHR front ends. This will allow patients to change health insurance (and PHRs) without losing access to their data.

The Chicago Breast Cancer Quality Consortium, a collaborative of Chicago-area health care providers, carried out research that showed that African-American women in Chicago with the disease are much more likely to die of it than their white counterparts. In the early 1980s, although the breast cancer mortality rates for white women in Chicago were higher than that of black women, the disparity between the two was comparatively low, only about 9%. Then, rates for white women went down dramatically but the rates for black women did not go down at all; in fact, they increased. Disparities began to widen dramatically in the early 90s and continued to widen through 2007. From 2005 through 2007, the death rate from breast cancer for black women was an average of 62% higher than that for white women. The trends have continued and this project seeks to reverse these terrible statistics.

Indiana – Consumer Access to Immunization Records

This project will create a customer portal that would provide individuals, parents or guardians access to the Children and Hoosier’s Immunization Registry Program (CHIRP). CHIRP is currently designed for and used by medical professionals in the state of Indiana. The application stores specific patient level vaccine history on about 6 million residents. The portal would act as a gateway to CHIRP while preventing non medical professionals from having direct access to the registry. This portal will provide screen view and download capability delivery options via Blue Button. Other features will include a CCD export option and audit trail tracking history.

Having access to current immunization information is important. Without access to a child's immunization information, it can be difficult to know which vaccine a child needs at any particular time. Currently parents are asking healthcare providers, schools and others to print immunization data for their children, sometimes many times a year. Providing a web portal for parents to manage this information makes sense and I expect pretty rapid adoption for this project.

Montana – State-Wide HIE as the Source of Aggregated Data for a Consumer Health Management Platform

HealthShare Montana will partner with PHR vendor Dossia to use aggregated CCD data from the HIE warehouse as the source for the Dossia Health Management System using Direct exchange standards. This system integrates aggregated personal health information with healthcare tools adding a layer of engagement, comprised of game and social dynamics, incentives and messaging in order to foster sustained user engagement, behaviour change and value. Providing patients access to and control of their own health information is without questions a very good thing. The lessons learned in Montana are going to be very valuable for scaling these types of projects nationally.

Maryland – CRISP to Microsoft HealthVault Interoperability

The Chesapeake Regional Information System for Our Patients (CRISP) is a not-for-profit membership corporation which is designated Maryland’s statewide health information exchange as well as the Regional Extension Center for Health IT (REC). This project will allow Maryland’s patients to be able to receive, store and share health information about them from the statewide health information exchange using Microsoft HealthVault. The first phase of the project is to use Direct to send health data from CRISP to HealthVault. The second phase of the project will be to allow patients to share the health information from their HealthVault account with providers across Maryland via CRISP. This will require onboarding HealthVault as a node on the statewide HIE. HealthVault’s functionality would need to enable patients to select CRISP as an outbound data feed and to have some level of granular control over which pieces of data within HealthVault they wish to make available.

Nebraska – “Big Red Button” Exchange to Consumers

The Nebraska Health Information Initiative (NeHII) and SimplyWell, a company which provides PHRs and employer wellness programs, are partnering to enable a XDS registry query and passage of the SAML token from SimplyWell to NeHII that will allow for the exchange of the CCD from NeHII to SimplyWell. Patients participating in SimplyWell’s PHR through their self insured employer will be able to request electronic access to their clinical health records from participating hospitals, labs, and clinics via a CCD document from NeHII. NeHII will use the ordering gateway and HIE clinical results delivery functionality to provide administrative value to SimplyWell, which routinely uses third party reference laboratories to process wellness checks for members and receives results via proprietary interfaces. NeHII will eventually offer PHRs to a broader set of consumers seeking their health data. It will also provide the ability to share their health information among providers.

Georgia – Chatham Connect with Direct

ChathamHealthLink (CHL) is an HIO in Chatham County, Georgia. CHL was developed to serve the needs of the significant population of uninsured and indigent patients who seek care in five clinics and two hospital systems. Chatham Connect with Direct, is designed to leverage the Georgia HIE Strategic Lab Program and the Georgia HIE Direct Project to build single, central patients records containing laboratory results from diverse sources which are then accessible to the patient using secure Direct addresses.

Chatham Connect with Direct will focus on using Direct addresses as both an identification/authentication solution for patient access and a key identifier in matching incoming laboratory data from the lab hub to patient records in CHL. Chatham Connect with Direct will also partner with state agencies to undertake the analysis and study necessary to integrate the Georgia HIE Strategic Lab Program with the Direct project on behalf of patients. One goal of this project is to design a model program that can be implemented by any of the existing HIEs in Georgia and the GaHIE being developed for the state. I am very excited for this project and look forward to seeing the real world impact this will have on this underserved patient population.

New incentives + Information liberation = Rocket fuel for innovation

This challenge is exciting on many fronts. Using challenges has been an effective method of spurring innovations with Todd Park's rocket fuel formula. Being a part of government being used as a platform for applying technology to solve healthcare problems and innovations rapidly developed is great fun. A number of the projects are using Direct Project standards to engage patients, so I am particularly enthusiastic to see these develop. But the best part of this challenge for me, after having met and worked with each of the participants, is the people that are leading these efforts. I am inspired by this fine group of innovators and their passion for making a difference.