AAFP Urges Improvements to Fledgling Patient Data Initiative

The AAFP made detailed suggestions to improve CMS’ recently announced initiative to improve patients’ access to and control of their electronic health data.

March 22, 2018 04:11 pm News Staff – The AAFP is working to propel a new CMS initiative meant to give patients better access to — and control of — their health care data into action that improves patient care and reduces physicians’ administrative burden.

CMS Administrator Seema Verma, M.P.H., publicly unveiled the MyHealthEData Initiative(www.cms.gov) on March 6 during a speech(www.cms.gov) at the Healthcare Information and Management Systems Society annual conference in Las Vegas.

She told her audience the United States will never achieve the long-sought goal of value-based care “until we put the patient of the center of our health care system.”

Verma said the Trump administration is determined to ensure that patients “have the information they need to be engaged and active decision-makers in their care.”

A CMS press release(www.cms.gov) noted the initiative is headed up by the White House Office of American Innovation with active participation from HHS, CMS, the Office of the National Coordinator for Health IT, NIH and the Department of Veterans Affairs.

STORY HIGHLIGHTS

  • The AAFP recently responded to CMS’ announcement about its MyHealthEData Initiative with a letter outlining suggested improvements.
    In a letter to CMS Administrator Seema Verma, M.P.H., the AAFP urged CMS to require vendors to provide any new government-required updates to electronic health records systems without additional cost to medical practices.
  • The letter also urged the agency to utilize the AAFP’s Principles for Administrative Simplification to reduce physician documentation requirements.
  • Midway through her speech, Verma related a personal story about a recent out-of-town health emergency in her family that led to her husband’s hospitalization. After his discharge, Verma asked for a copy of the complete medical record amassed during the inpatient stay to ensure that doctors back home had all the information they would need for follow up care.

“After the federal government has spent more than $30 billion on EHRs (electronic health records), I left with paper (five sheets) and a CD-ROM” that was both difficult to utilize and incomplete, said Verma.

“I couldn’t help but contemplate the disconnect between the genius of the medical system that used the latest technology and science to save my husband’s life but didn’t have the tools available to just give me his medical records, which I thought would have been the simplest task out of all they had performed,” she said.

Verma also announced an update to the agency’s Blue Button initiative, calling the new Blue Button 2.0(bluebutton.cms.gov) a developer-friendly, standards-based application programming interface “that enables Medicare beneficiaries to connect their claims data to secure applications, services and research programs that they trust.”

AAFP Weighs In
The AAFP has advocated long and hard for interoperability of EHRs and supports certain portions of the new initiative; however, other key points raised eyebrows among Academy leaders.

In a March 14 letter(4 page PDF) to Verma signed by AAFP Board Chair John Meigs, M.D., of Centreville, Ala., the AAFP weighed in on important portions of the initiative during its formative stages to ensure the final program doesn’t create more obstacles to already overburdened family physicians.

The AAFP noted its approval of agency efforts that “encourage patients to have meaningful control of their data” and to improve interoperability and administrative simplification.

“We would, however, object to placing responsibility for the adoption of interoperable systems on physician practices,” the Academy stated. “The creation of standardized interoperable systems should instead be the responsibility of vendors.”

The AAFP pointed out that physicians were promised EHR interoperability and secure patient access when they purchased certified EHR technology or upgraded their existing systems; however, many systems do not meet this standard.

Lack of this promised interoperability leaves physicians beholden to EHR vendors — a situation that has allowed vendors to engage in price gouging when peddling software upgrades and maintenance.

“We strongly urge CMS to require EHR vendors to provide any new government-required updates to such systems without additional cost to the medical practice,” said the AAFP.

Multiple studies have shown that physicians spend far too much time — up to 50 percent of their workday and even after clinic hours — using their EHRs, said the AAFP, referencing a Feb. 7 letter(6 page PDF) to Verma.

“CMS must take the time and financial costs physicians endure into account while addressing improved patient access to health care data,” said the Academy in its most recent comments.

Stop Information Blocking
In her speech, Verma zeroed in on CMS’ intent to prevent providers and hospitals from blocking patients — and their physicians — from seeing personal health data. “We will not tolerate this practice anymore,” she said.

In response, the AAFP noted that too often physicians receive summaries of care that are too long and “filled with clinically irrelevant information.” Indeed, said the letter, unnecessary information often is inserted into summaries by automated processes “designed to ensure compliance with CMS regulations and requirements for the MU (meaningful use) and ACI (advancing care information) programs.”

The AAFP told CMS to improve its regulatory requirements and focus on “how and when data is exchanged rather than focusing on the data in the exchange.”

Furthermore, the AAFP called on CMS to use the authority it was granted in the 21st Century Cures Act(www.fda.gov) to penalize health care organizations that are not sharing information.

“Policies should be focused on penalizing bad actors blocking information,” the Academy said in its letter.

Streamline Documentation, Billing Requirements
The AAFP pointed out that the level of documentation required of physicians has escalated in recent years despite the widespread adoption of EHRs. In particular, the Academy took issue with CMS’ documentation requirement guidelines for evaluation and management (E/M) services.

The letter argued that the guidelines, written for use 20 years ago in a paper-records era, “do not reflect the current use and further potential use of EHRs or team-based care.”

CMS should recognize and adhere to the AAFP’s Principles for Administrative Simplification to reduce documentation requirements. In these principles, the AAFP calls for

eliminating documentation guidelines for E/M codes 99211-99215 and 99201-99205 for primary care physicians;
applying a new standard to all public and private payers to allow medical information to be entered into a patient record by any care team member related to a patient’s visit;
discarding data templates and box-checking requirements that do not enhance patient care; and
redesigning and optimizing EHR systems through the collaborative efforts of physicians, vendors and workflow engineers.
Improve Related Programs
The AAFP addressed additional points in its letter to CMS, including suggestions related to

streamlining requirements associated with meaningful use and the Quality Payment Program’s advancing care information component;
interoperability of quality measures, including elimination of all health IT utilization measures and implementation by all payers of the Core Quality Measures Collaborative’s core measures sets championed by the AAFP;
widescale interoperability of patient admission, discharge and transfer data in as close to real time as possible; and
reducing hospital admissions and readmissions, and duplicative testing.
“With the modifications we have suggested and attention to other overarching health care IT issues as outlined above, we believe these programs will lead to great success for our patients by catalyzing better, more efficient quality care,” concluded the AAFP.

Related AAFP News Coverage
Fresh Perspectives: Doctor or Patient? Who Owns Medical Records?
(1/18/2016)

 

Source: AAFP Urges Improvements to Fledgling Patient Data Initiative

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More than 1,000 hospitals have closed in 35 years. Ezekiel Emanuel says that’s a good thing.

More than 1,000 hospitals have closed in 35 years. Ezekiel Emanuel says that’s a good thing.

In the past 35 years, hospitalizations have declined by more than 10% as more patients migrate to urgent-care centers, physicians’ offices, and at-home care—and the disappearance of hospitals is “inevitable and good,” Ezekiel Emanuel writes in a provocative op-ed for the New York Times.

Emanuel, a prominent physician and vice provost at the University of Pennsylvania, writes that U.S. hospitalizations reached their peak more than 35 years ago, in 1981. There are now fewer hospitalizations than in 1946.

Due to this decline, the number of hospitals has fallen as well, from 6,933 in 1981 to 5,534 this year.

 

Why hospitals are disappearing

One reason hospitals are disappearing, according to Emanuel, is that patients increasingly view hospitals as potentially dangerous places to be—”less therapeutic,” he writes, “and more life-threatening.”

In 2002, there were 1.7 million cases of hospital-acquired infections, resulting in nearly 100,000 deaths, according to CDC research. Plus, hospitalizations create risks of medical errors and falls—and constant interruptions in the middle of the night “are not conducive to recovery,” Emanuel writes.

Further, providers increasingly can provide complex care outside of the hospital, Emanuel writes. For example, anti-nausea medications and new forms of treatment mean that many cancer patients no longer have to receive their chemotherapy at hospitals. Similarly, hip and knee replacements are often performed at ambulatory surgical centers rather than at the hospital. Births frequently happen either at home or at birthing centers.

These trends will continue, Emanuel contends, and as they do, more hospitals will downsize, merge, close, or turn into doctors’ offices or outpatient clinics. The hospitals that remain, he writes, will focus on their ED, complex procedures like organ transplantation or brain surgery, and similarly urgent and high-complexity services.

Emanuel’s provocative argument about how hospitals will respond

Emanuel writes that, while he believes the shift away from hospitals will benefit patients, special interest groups within the hospital business may find it threatening. As such, he argues that hospitals are likely to lobby for higher payments from the government and insurers “to retain the ‘good’ jobs hospitals offer.”

But Emanuel argues that “the shift of medical services out of hospitals will create other good jobs—for home nurses, community health care workers and staff at outpatient centers.”

Further, revenue pressures will lead even more hospitals to consolidate and merge into massive health systems. Emanuel writes that the hospitals will claim that these mergers will create cost savings for the consumer, but he argues that these “mergers create local monopolies that raise prices to counter the decreased revenue from fewer occupied beds.” Federal antitrust regulators, he argues, should oppose these mergers.

“Instead of trying to forestall the inevitable, we should welcome the advances that are making hospitals less important,” Emanuel writes. “Any change in the healthcare system that saves money and makes patients healthier deserves to be celebrated” (Emanuel, New York Times, 2/25).

Source: More than 1,000 hospitals have closed in 35 years. Ezekiel Emanuel says that’s a good thing. | Advisory Board Daily Briefing

Flex Expands Digital Health Capabilities, Launches BrightInsight Connected Health Solution on Google Cloud Platform

Advanced medical-grade managed services solution analyzes connected medical device data and therapies, delivering real-time insights within a regulatory-compliant environment

SAN JOSE, Calif., March 1, 2018 /PRNewswire/ — Flex (FLEX), the Sketch-to-Scale™ solutions provider that designs and builds intelligent products for a connected world, has expanded its service offerings for the healthcare industry with a new digital health offering. BrightInsight is a secure, managed services solution built on Google Cloud Platform that can aggregate data and deliver real-time insights to optimize the value of connected drug, device or combination products. The company made the announcement ahead of the annual Healthcare Information and Management Systems Society (HIMSS) conference, taking place March 5-9 in Las Vegas, Nevada.

The  McKinsey Global Institute estimates that applying big-data strategies to better inform healthcare-related decision making could generate up to $100 billion in value annually across the U.S. healthcare system. Medical devices today collect massive amounts of data, which creates enormous potential for a rapid feedback loop that can help improve patient care and enhance drug therapy delivery and management. In order to make an impact, the data needs to be aggregated from a myriad of apps and stand-alone devices, as well as analyzed to provide actionable insights. BrightInsight solves these challenges and helps patients and health care professionals, from physicians to medical device and pharmaceutical manufacturers, to better understand medical device usage and medication adherence, and streamline the product development and certification process.

“We saw the need for a secure cloud platform designed to support highly-regulated connected drug delivery and medical devices, going beyond simple connectivity to deliver real-time intelligence and actionable insights,” said Kal Patel, MD, senior vice president of Digital Health for Flex. “With our 20 years of experience operating in global regulated medical environments, and having deployed more than 75 regulated hardware and software medical products, Flex can combine our cross-industry capabilities to simplify our customers’ digital transformation.”

Flex is partnering with Google Cloud to deliver insights through customizable analytics dashboards fueled by Google Cloud’s advanced machine learning and artificial intelligence (AI) capabilities. Google Cloud Platform enables BrightInsight to securely store, analyze and gain insights from health information, without pharmaceutical and medical technology customers having to manage the underlying infrastructure. Advanced use cases for BrightInsight may include controlling connected devices, drug dosing, decision support, personalized patient interventions, trend analysis and AI-driven insights.

“Google Cloud is committed to leveraging our deep engineering expertise to accelerate innovation in digital healthcare,” said Gregory Moore, MD, PhD, vice president, Healthcare, Google Cloud. “With a partner like Flex, we will enable our customers to develop innovative solutions and leverage machine learning-based analytics that can turn new data sets from wearables, medical devices, therapies and apps into actionable information for patients and providers.”

BrightInsight is designed to support CE-marked and FDA-regulated Class I, II and III medical devices, combination products and Software as a Medical Device requirements, enabling automated interventions. Deployed as a managed service, the BrightInsight platform allows pharmaceutical and medical technology companies to accelerate their time to market, reduce the cost of implementation and maintenance across multiple products, and scale for global markets.

BrightInsight features foundational capabilities for rapid development and a modular platform architecture to support customization and worldwide implementation. It is built from the ground up to securely manage highly regulated medical device data and personal health information, and Flex has put the people, technology and processes in place to monitor security and threat prevention to meet global compliance standards.

BrightInsight eliminates regulatory bottlenecks that can lead to costly delays by offering turnkey regulatory design control and file management of master files with the FDA. This service enables pharmaceutical and medical technology companies to focus on their drug, device or combination product submissions without the burden of documenting the software platform.

Source: Flex Expands Digital Health Capabilities, Launches BrightInsight Connected Health Solution on Google Cloud Platform

House balks at $10 billion price tag for VA-Cerner EHR project | Healthcare IT News


VA Secretary David Shulkin, MD, testifies at the House VA Committee meeting on Thursday. Credit: YouTube

VA Committee Chair Phil Roe was also concerned that the amount doesn’t cover maintenance or the cost to update the infrastructure necessary to accommodate the new platform.

As the time draws near for the U.S. Department of Veterans Affairs to sign its EHR contract with Cerner, Congressional members are growing increasingly concerned over not only the $10 billion price tag, but that the agency will need to keep the legacy system in place, perhaps indefinitely.

“While the EHR modernization effort is necessary, it is very expensive,” House VA Committee Chairman Phil Roe, MD, R-Tennessee, said during the Thursday hearing on the VA’s 2019 budget requests.

“The contract with Cerner alone has a price tag of about $10 billion and that doesn’t even include the costs of updating infrastructure to accommodate the new EHR, implementation support or sustaining VistA up until the day it can be turned off,” he continued.

In fact, Roe is concerned that the VA’s legacy EHR may never be completely gone.

“After visiting Fairchild Air Force Base in Spokane, Washington, recently, I’m not even sure you can ever turn VistA off,” Roe said.

President Donald Trump released his proposed FY19 budget this week, which earmarked $1.2 billion to get the project with Cerner off the ground. VA Secretary David Shulkin, MD put the potential Cerner contract on hold in January, pending an independent review of Cerner’s interoperability capabilities.

While Roe applauded Shulkin’s move to ensure interoperability, he’s still not certain the project can be successful.

“It’s unthinkable that VA could potentially spend billions of dollars on a project that doesn’t substantially increase the department’s ability to share information with the Department of Defense or community providers,” Roe said. “But that’s exactly what could happen if VA fails to proceed in a careful deliberate manner.”

In response, Shulkin stressed that the agency is taking the modernization very seriously.

“We have to make sure that we can be interoperable with dozens of different health systems out there,” said Shulkin. “And that’s a challenge that frankly the American healthcare system hasn’t figured out yet… We think VA can help lead this for the whole country by making this interoperable.”

Shulkin recognized the agency’s track record of failed IT projects – the Government Accountability Office recently reported that the VA likely wasted at least $1.1 billion on multiple EHR modernization attempts – and understands that this EHR replacement must work.

Given the size and scope of the project – there are more than 130 versions of VistA operating right now – Shulkin said the legacy system will need to be maintained over a 10-year implementation period.

To account for that, Shulkin is requesting Congress provide the VA a separate account to fund the project. The account would provide the VA with the necessary funds for maintaining VistA and implementing the Cerner EHR, and would provide transparency to where those funds are going.

The VA is expected to sign the Cerner contract in the next few weeks, after the vendor reportedly passed its independent assessment.

Source: House balks at $10 billion price tag for VA-Cerner EHR project | Healthcare IT News

Top 5 free apps to keep you healthy in 2018

The most-downloaded health apps on iPhone and Android app stores reveal where Americans are turning to take control of health issues.

A new year means it’s time to comply with new resolutions for many people. Most often, that means targeting health and wellness. A Google search analysis conducted last January showed that getting healthy was the most popular resolution, with more than 62 million searches, almost double the second-most-searched New Year’s resolution: getting organized.

The ubiquity of smartphones in daily life makes it easier than ever to make a resolution related to health — sticking to it is something else. App tracker App Annie provided CNBC with data on the most popular free versions of health and wellness apps from 2017 based on both the Apple and Android app-store downloads. The data was through Dec. 28, 2017.

As technology giants such as Apple, Amazon and Google get serious about remaking the health-care sector, these results show how Americans are using their phones to take more control of their health, and the specific health issues that are proving to be most app-friendly.

Source: Top 5 free apps to keep you healthy in 2018

Canada Digital Health Innovation Seminar

Pleased to be keynote, looking forward to seeing you all at The Innovation Seminar at More information here:

Learn about cutting-edge trends from leading international experts & get a look ahead at innovative thinking that will shape the future of digital health. At this seminar, you will learn why Canada is on the forefront of the Health IT industry and how you and your business can benefit from exciting new developments in this rapidly changing field.

Source: Canada Digital Health Innovation Seminar

EHR interoperability: A global conundrum | For the latest in interoperability, health information exchange (HIE) and connected care.

Black Book Research survey reveals “an enduring confusion on the definition of a highly interoperable EHR system outside the United States.”

Maybe it’s no wonder that interoperability appears to be an elusive goal in healthcare, since the vast majority of healthcare professionals around the world struggle to even define interoperability.

A new global survey by Black Book Research shows that 90 percent of the nearly 12,000 responding healthcare professionals across 23 countries say they are unsure about what constitutes a highly interoperable electronic health record (EHR) system.

“There is an enduring confusion on the definition of a highly interoperable EHR system outside the United States,” Black Book said. “Seventy-two percent stated in 2017 that their regional preferable strategy for electronic health records is to link disparate systems through messaging, APIs, web services and clinical portals. Only seven percent of all international EHR survey respondents described their regional HIT system as having ‘meaningfully connectivity’ with other providers.”

The seven-month poll, which closed in January, surveyed 11,838 doctors, clinical leaders, healthcare administrators, and technology managers.

Fortunately, many of these non-U.S. provider organizations are moving toward interoperability. Poll results reflect a pending shift away from siloed EHR systems in Europe, the Middle East, and South Asia, where nearly 57 percent of respondents foresee a move to comprehensive healthcare IT systems with data exchange and care coordination capabilities.

Countries with the highest potential for progressing EHR interoperability and expanded health IT functionalities beyond their local regions are (in order) New Zealand, Denmark, Israel, Singapore, Netherlands, Germany, Hong Kong, Norway, Australia, Canada, Sweden, Finland, United Kingdom, Switzerland, and France.

“A number of countries have launched national initiatives to develop ICT-based health solutions including EHR systems and have progressed well, despite several hurdles,” Black Book managing partner Doug Brown said in a statement. “As the obstacles are clearing with technological and non-technological interventions, approved standards and regulatory frameworks, funding and health-tech guidelines, the growth opportunities for U.S.-based global EHR vendors magnify as well.”

 

Source: EHR interoperability: A global conundrum | For the latest in interoperability, health information exchange (HIE) and connected care.

HIMSS urges ONC to modify draft Trusted Exchange Framework | For the latest in interoperability, health information exchange (HIE) and connected care.

Organization proposes changes around what is required of Qualified Health Information Networks (QHINs) as well as the eligibility requirements for QHINs.

HIMSS is calling on the Office of the National Coordinator for Health Information Technology (ONC) to change requirements for Qualified Health Information Networks (QHINs) under the federal agency’s draft Trusted Exchange Framework and Common Agreement (TEFCA).

In a February 20 letter to ONC head Donald Rucker, HIMSS Chair Denise W. Hines and CEO Harold F. Wolf III praised the TEFCA draft guidance for taking the right approach in attempting to “minimize the point-to-point interface agreements required in the long-term and the flexibility for providers to find the right exchange network that supports their care delivery model needs.”

“The overall concept underlying TEFCA is pushing our nation in the appropriate direction of enabling providers and communities to deliver smarter, safer, and more efficient care; promoting innovation at all levels; and, achieving a system where individuals are at the center of their care and where providers have the ability to securely access and use health information from different sources,” the HIMSS leaders wrote.

The HIMSS letter proposes maintaining the role of the Recognized Coordinating Entity (RCE), which, according to the ONC, will be responsible for ensuring the Trusted Exchange Framework is operational and which will be selected through a competitive process.

But HIMSS also said it “would like to see changes around what is required of QHINs as well as the eligibility requirements for Qualified Health Information Networks (QHINs).”

“HIMSS looks to find a path forward that allows existing interoperability exchanges, networks, approaches, and frameworks to largely continue to function under their existing business models, qualify as QHINs, and have them report to the RCE as the primary oversight mechanism of TEFCA,” the letter said.

“Today, there is significant momentum being built across the community to support broader nationwide exchange. All of the major interoperability approaches ONC identified as part of the process to implement 21st Century Cures have made considerable progress in building the reach of their networks, increasing collaborations/partnerships with other approaches, and enhancing the services that they offer to providers and other interoperability participants,” Hines and Wolf wrote. “However, HIMSS is concerned that the community will not be able to maintain the current upward trajectory of nationwide interoperability if these entities have to make significant adjustments to their workplans to become QHINs under TEFCA.”

 

Source: HIMSS urges ONC to modify draft Trusted Exchange Framework | For the latest in interoperability, health information exchange (HIE) and connected care.