Last Thursday, I attended Governor Deval Patrick’s HIT conference in Boston and present my own musings and takeaways from day 1 of the conference. Be sure to check out Dr. John Halamka’s reactions from last Thursday morning’s CEO summit at the Govenor’s HIT Conference and look for a recap of day 2 of the conference on the Galen blog this Wednesday.
Keynote Address: The State and National Vision for Health IT and HIE
Dr. David Blumenthal, National Coordinator for Health Information Technology – U.S. Dept. of HHS, presented his own anecdotal experiences with the EHR, namely a story of how he was going to prescribe a patient a drug containing sulfa, yet the clinical decision support software in the EHR flagged him for a drug-to-drug interaction. If CDS tools within the EHR not available, would the pharmacist have caught this? Could the patient potentially been adversely affected?
Dr. Blumenthal then elaborated on two key components to which he felt would impact behavior via policy: writing regulations and spending money.
- There have been 2000 comments received on the Interim Final Rule, with the publication of the final regulation anticipated by the end of the spring
- No comments questioned the conceptual framework nor the direction of Meaningful Use.
- The framework of Meaningful Use consists of 5 domains – quality, efficiency, patients & family, coordination of care, protection and security
- In speaking of the Interim Final Rule, Dr. Blumenthal utilized the analogy of an escalator – allow providers ease of introduction and steps for clear path of usage while lowering barriers to entry.
- Information Exchange – infrastructure is poorly developed for information to follow the patient and thus policy needed to address this. Certification will be the key to interoperability and with tighter standards, HIX should be more interoperable.
- CLIA (Clinical Laboratory Improvement Amendments): Currently, legacy regulations are being addressed such that the barriers to LDX (Laboratory Data Exchange) can be removed.
- Privacy & security: Providing authorities with the means of penalizing individuals and organizations for violations to ensure controls, access, protection
- Regional Extension Centers (RECs) are currently modeled after US agriculture, which was intended to disperse new info to the family farm. The goal is to ensure that HIT is reaching the family physician and providing advice in terms of selection and implementation.
- Focused on <10 provider practices such that the full benefits of HIT can be reaped by the practice. Facilitation of re-design of work flows and mobilization of information for quality and efficiency improvements
- 50 states have been funded to promote RECs.
- Different localities will have different solutions for health information exchange (HIX)
- 70 community colleges were funded for workforce training and it is anticipated this will facilitate staffing of RECs
Next Year: Direction
- Finalize requirements for Meaningful Use
- Beacon Community Program – Fund 15 communities around the country directly through a grant program with the intent to offer a source of lessons and inspiration. There have been over 130 applicants to the program thus far.
- Physicians are worried that HIT happens to them, not with them and that users not intimately involved with the design
Panel – Consumer-Centric: The Role of the Patient in Health IT and HIE
- John Moore from Chilmark Research introduced term the term “citizen” as the term patient can often be paternal. He mentioned a John Halamka quote – “automating bad processes will not lead to improvement”.
- David Szabo, a partner, Edward Angell Palmer & Dodge brought up the point of how do we go about engaging citizens and brought up some serious concerns over privacy, especially in regards to patient portals. The topic of behavioral advertising in PHRs was brought up and it was mentioned that FTC may provide governance to this regard.
- A question was posed about those surveyed and focused on in regards to Healthcare IT in that they are predominately affluent and white. John Moore responded with mobile health technologies being the enabler to reach all demographics and minorities.
- A comment was made concerning the power of secondary data to pre-populate EMRs. Barbra Rabson, Executive Director, Mass Health Quality Partners, provided a response and brought up a cautionary tale in the highly publicized case of e-patient Dave as published in the Boston Globe.
- To touch on concerns about patient security and privacy in regards to the Personal Healthcare Record (PHR), John Moore also brought up a really cool Massachusetts company called “Patients Like Me” and highlighted the fact that through this vehicle, “citizens” currently share their healthcare stories and experiences.
Regional Collaboration Meetings (CT, ME, MA, NH, RI, VT)
Later in the afternoon a breakout session allowed public officials to meet with neighboring states to discuss current plans, areas of concern, regional interoperability and opportunities for collaboration.
- NESCO (New England States Consortium Systems Organization) represents a business model built around collaboration and their Deputy Director, Nancy Peterson, acted as the facilitator.
- The idea of health delivery system reform was immediately brought up in that the system incentivizes and currently pays for sickness instead of for health via preventative and behavioral care.
- The model of the state of ME was addressed. Currently they have an operational provider-only HIE available to facilitate treatment improvement and representative of six of the largest healthcare systems in the state. The HIE, established in 2004 and live as of the summer of 2009, covers 50% of the hospitals 46% of ambulatory care.
- Some of the questions and comments posed by the audience included the following
- How do we bridge between standards?
- The business case needs to be established as this will drive investment. We need to clarify a vision and clearly express the financial incentive model.
- Challenges with the business case in that savings on one side put costs on another.
- We need to attack some of the low-hanging fruit first by implementing a common consent framework.
- Ownership of the data: Who owns the data? The patient?
- HIEs need to be consumer-driven.
- Are we focusing too much on the standards with meaningful use, whereas we should be focused on the transport and the “network”?
- Where are the interconnections in healthcare delivery that have the highest yields in terms of clinical data?
- We face the underlying competing entities in clinical standards versus claims standards. Integration of the two needs to be addressed.
- We are up against perverse incentives as there are many other resistive forces towards HIE, namely disincentives, in the health system.