Newly available Stage 2 Meaningful Use Documents

The Stage 2 Meaningful Use Public Health (PH) Reporting Requirements Task Force recently posted helpful resources for Meaningful Use Stage 2 to the PH connect public landing page. These resources, which include Version 2.0 of the Stage 2 MU Public Health Agency (PHA) Readiness Guidance and Stage 2 MU Frequently Asked Questions (FAQs), provide important information for anyone who is preparing to implement Meaningful Use requirements.

To access the Resource page: http://www.phconnect.org/group/ph-reporting-task-force

*NEW* ONC Training Course on Interoperability & Public Health

The Office of the National Coordinator for Health IT (ONC) recently announced a new 6-part training course on Interoperability and Public Health. 

The course contains lessons on the following topics:

• Introduction to Interoperability and Public Health
• Ongoing Submission to Public Health Agencies
• Submission of Electronic Data to Immunization Registries
• Submission of Syndromic Surveillance Data to Public Health Agencies
• Submission of Electronic Lab Results to Public Health Agencies
• Submission of Electronic Cancer to Public Health Agencies

For more information visit the course website.

Public Health - EHR Vendors Collaboration Initiative

**Update: Pre-registration is NOW REQUIRED. See details below.**

Dear Public Health Colleagues:

The Office of the National Coordinator for Health IT (ONC), in collaboration with Centers for Disease Control & Prevention (CDC) has launched a Public Health (PH)–Electronic Health Records (EHR) Vendors Collaboration Initiative. The proposed participants in this initiative will include Public Health Practitioners and EHR Vendors from across the nation. The initial focus of this initiative will be on meeting Stage 1 and 2 Meaningful Use (MU) objectives for public health.

Initially, separate virtual meetings were held with public health and an EHR vendor workgroup to help frame and plan this initiative.  Based on inputs gathered from these interactions, joint meetings of the public health practitioners and EHR vendors from across the nation will be held on a recurrent basis starting on August 20^th, 2013, to work collaboratively towards achieving the desired goals and creating value for the public health and EHR vendor communities.

If you have suggestions for topics or issues to be addressed by this initiative, please send those to meaningfuluse@cdc.gov with a Subject Line of “Suggestion for PH-EHR Vendor Initiative” by COB August 16^th.   The suggestions received will help identify common issues and areas of focus for this initiative.

WebEx information Date and Time:

Tuesday, August 20, 2013 3:00 pm, Eastern Daylight Time (New York, GMT-04:00)

Tuesday, August 20, 2013 2:00 pm, Central Daylight Time (Chicago, GMT-05:00)

Tuesday, August 20, 2013 12:00 pm, Mountain Time (Arizona, GMT-07:00)

Tuesday, August 20, 2013 12:00 pm, Pacific Daylight Time (San Francisco, GMT-07:00)

Event number: 646 100 152

Event password: open&88

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To register for the online event
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1. Go to https://ahrqhit.webex.com/ahrqhit/onstage/g.php?d=646100152&t=a&EA=cuhrig%40rti.org&ET=cafa7b000967412beb9e5f9793f0a58e&ETR=2deb918cb86a8626ce8ae6715b9ed2aa&RT=MiMxMQ==&p
2. Click "Register".
3. On the registration form, enter your information and then click "Submit".

Once the host approves your registration, you will receive a confirmation email message with instructions on how to join the event.

Agenda

• Introduction – Jim Daniel
• Overview, Scope, Goals, and Status – Jim Daniel
• New Public Health Processes in Meaningful Use Stage 2 – Denise Webb
• Open Discussion - All
• Next Steps – All

Have comments on PHIN Guide? Submit them through our new feedback form!

In the months since ISDS and CDC published the expanded PHIN Messaging Guide for Syndromic Surveillance, Release 1.9 (Guide) in April 2013 we’ve received several comments and questions as well as suggestions for future versions.

To streamline the process for gathering comments we’ve created a google form through which you can submit feedback. We’ll also keep track of who submits comments and invite you to participate in conversations on future Guide revisions.

You can also now access a list of feedback ISDS has already received on the Guide. This spreadsheet will be updated periodically (and anonymously) as feedback is submitted. ISDS and CDC responses and status updates are also included for your information.

For additional details on this project see the PHIN Messaging Guide Project Webpage.

For any questions on the PHIN Messaging Guide for Syndromic Surveillance, Release 1.9, please contact Becky Zwickl at bzwickl@syndromic.org.

BioSense User Community: Overview and Transition

ISDS has been hosting a series of BioSense 2.0 User Community Calls throughout 2012 and 2013, the most recent of which was held on July 16. These calls provide an opportunity to discuss BioSense 2.0, ask questions, and hear responses from RTI, BioSense Governance, CDC and ASTHO. ISDS is now transitioning into a monthly BioSense User Group Meeting, the first of which will be held on Tuesday, August 20, 3:00 PM - 4:00 PM EDT (registration is now open).

The User Group Meetings will follow a similar format to prior Community Calls. At the July 16th call we received responses to technical questions (submitted during meeting registration) that covered topics ranging from accessing BioSense to best practices for on-boarding. Mike Alletto at RTI led us through the questions and responses with additional input from Yvonne Konnor (BioSense Governance Representative), Alan Davis (CDC), and Scott Gordon and Lindsay Strack from ASTHO.

Yvonne also provided us with an update from BioSense Governance, including emphasizing a continuing focus on two-way communication between users, developers, and CDC to increase sustainability and transparency.

One of our interesting open discussion questions focused on using syndromic surveillance to look at information from a specific event such as a marathon, wildfire, or sporting event. We heard some good feedback from participants in Ohio, Florida, and Rhode Island with useful tips including creating a new, unique acronym to use specifically for monitoring the intended event. Other users noted that the increasing use of dropdown menus in EHRs may negatively affect the ability to create unique acronyms since there is no space for a free text chief complaint.

If you are part of the BioSense 2.0 community and are interested in asking questions, discussing your experiences, and hearing from others, we hope you’ll join us in August!

Future 2013 Meeting Dates: August 20th, September 17th, October 15th, November 19th, December 17th

Written by: Becky Zwickl, MPH, ISDS Public Health Analyst

Meaningful Use: Which PHIN VADS Value Set Should I Use?

As the guidance documents for the syndromic surveillance objective of Meaningful Use continue to change and improve, there is a constantly evolving set of value sets used and referenced. Many users are utilizing older versions of messaging guides and are unsure whether that provides the most up-to-date value set information.

To solve this problem, ISDS has identified a few hints to use when trying to dig through the various levels of the PHIN VADS value sets and vocabulary. PHIN VADS is CDC’s vocabulary access and distribution system that provides information on value sets and vocabulary for a variety of public health purposes, though this post focuses on syndromic surveillance.

First of all, the status of each value set (i.e., if it’s the most current version or not) is clearly depicted on the PHIN VADS website. For reference, consider the pictures inserted below. The first, referencing FacilityVisitType, shows the value set for Version 1, with a note “not current”. The second, also showing FacilityVisitType, shows the value set for Version 2 with a note “current”.

Looking forward, it may make sense to reference the most current available version when developing syndromic surveillance systems so that there is no need to backtrack later on. All of the items included in, for example, Version 2 of the observation identifier value set, are also included in Version 3. The updated versions add additional value sets and values so you will only be expanding, not diminishing, the capacity by using the most current value set. Release 1.9 of the PHIN Messaging Guide, now available at the CDC website, links up to the most updated versions of each of the value sets.

For additional questions, please contact Becky Zwickl at bzwickl@syndromic.org.

Written by ISDS Public Health Analyst, Becky Zwickl, MPH.

Developing EHR Standards, Improving Public Health: SDC Initiative

Since the inception of electronic health records (EHRs) both developers and users have struggled with balancing EHRs’ ability to gather and provide information with their lack of interoperability. EHRs are effective tools for clinicians who want easy access to health information from patient visits, but at present they have inefficiencies that decrease their usefulness for public health. More specifically, public health would benefit from a template that delivered all EHR information in a consistent manner, with consistent data elements (i.e., patient visit information). Standardization is especially important to data quality as Meaningful Use policies continue to expand the volume of data available to public health.

Structured data has the ability to increase public health’s ability to use, analyze, and disseminate information on events of public health interest or concern. In order to capitalize on this potential, the S&I Framework started the Structured Data Capture (SDC) Initiative in January 2013. Through engaging stakeholders and consulting experts, this initiative aims to develop standards for storing data which could then be passed on to public health within standardized templates. The SDC Initiative specifically aims to create standards for four types of reports: electronic case report form; incident report; surveillance case report; and the collection of patient information used for Determination of Coverage.

The development of these standards is community-driven and open to anyone with interest. The SDC Initiative engages stakeholders in a variety of ways, from weekly meetings to presentations from experts working on data standardization in both research and practice. Development of these standards is participatory and committed members of the initiative can vote on project materials.   

Currently, the initiative is working on finalizing a variety of use cases. Once this step is complete, guidance documents for standards will be created and pilot projects instituted. There is still substantial opportunity for interested ISDS community members to contribute to this project before it wraps up in August 2013. 

The next open teleconference is scheduled for Thursday, April 11, 3:30-5 pm EDT.

For more information on the S&I Framework’s Structured Data Capture Initiative, or to get involved as a member, please visit: http://wiki.siframework.org/Structured+Data+Capture+Charter+and+Members

Written by: Becky Zwickl, MPH, Policy Analyst, ISDS

Request for Proposals: Pilot Project for Public Health Case Reporting Using C-CDA

National Association of County & City Health Officials (NACCHO)  along with the Council of State and Territorial Epidemiologists (CSTE) announce a funding opportunity for state and local health departments to participate in a pilot project for the implementation of public health case reporting from electronic health records (EHR) to public health agencies using Consolidated Clinical Data Architecture (C-CDA).

CDC and the Office of the National Coordinator (ONC) Standards and Interoperability (S&I) Framework, Public Health Reporting Initiative (PHRI) are working to reduce the reporting burden on healthcare providers and public health agencies by harmonizing data elements across public health domains and developing a standardized data structure through the implementation of C-CDA. The PHRI has produced two work products: a set of harmonized data elements and a C-CDA library of templates for several public health conditions, which will be tested and demonstrated at pilot site(s). This pilot will help determine if and how the PHRI products can serve as resources to facilitate implementation of public health case reporting from clinical providers to public health agencies.  

If interested, please submit an application to Monica Huang mhuang@cste.org at the CSTE National Office by Friday, March 15, 2013.

Please click here for additional background information and instructions (pdf) »

Please Comment: PHIN Messaging Guide for Syndromic Surveillance Release 1.3

The syndromic surveillance stakeholder community is invited to provide comments on Release 1.3 of the PHIN Messaging Guide for Syndromic Surveillance now through December 21, 2012.

Over the last few months ISDS, in partnership and with the support of the Division of Informatics Solutions and Operations (OSELS) of the CDC, has been working to revise the PHIN Messaging Guide for Syndromic Surveillance (Guide). The Guide provides messaging specifications for emergency department and inpatient settings for select ADT and ORU (provided by our colleagues at the Washington State Department of Health) message types. The Guide was first released in 2011 as an emergency department and urgent care center messaging guide and is now being expanded to incorporate inpatient settings as well as stakeholder feedback on prior Guide releases.

Release 1.3 of the Messaging Guide provides a conformance profile for EHR Meaningful Use certification. It also includes an important update that creates a “Hospital Messaging Guide” incorporating Emergency Department, Urgent Care and Hospital Inpatient specifications. The goal of this Guide is to provide HL7 messaging specifications for hospitals providing clinical data to a public health agency for syndromic surveillance. This goal contrasts with that of the recently released ISDS Recommendations because it focuses on the technical specifications for providing the recommended data elements rather than the reasoning behind the data recommendations.

The new Messaging Guide Release 1.3 will improve upon prior releases by:

• Clarifying ambiguities from Release 1.0

• Responding to stakeholder feedback on prior releases

• Incorporating guidelines recommended by the ISDS Meaningful Use Workgroup for inpatient syndromic surveillance data

• Facilitating the formation of syndromic surveillance data exchange between hospitals (now including inpatient) and public health agencies

• Consolidating and clarifying hospital EHR conformance requirements for Meaningful Use certification

How to provide comments:

Stakeholder input helps ensure that the Guide will have widespread utility to facilitate both EHR development and the implementation of hospital-based syndromic surveillance systems. Following this community comment period ending on 12/21, the Guide will be revised further, and a finalized version will be released in the spring of 2013.

We encourage everyone interested in this initiative to provide comments on the Messaging Guide Release 1.3. You may provide feedback via an online survey available here or by emailing your comments to Becky Zwickl, MPH, ISDS Public Health Analyst, at bzwickl@syndromic.org. The comment period ends on Friday, December 21, 2012, 11:59 pm EST.

ISDS Releases Meaningful Use Recommendations

The International Society for Disease Surveillance is pleased to present "Electronic Syndromic Surveillance Using Hospital Inpatient and Ambulatory Clinical Care Electronic Health Record Data: Recommendations from the ISDS Meaningful Use Workgroup" (Recommendations). The ISDS Meaningful Use (MUse) Workgroup's Recommendations provide clarity for Stage 2 Meaningful Use, when on-going syndromic surveillance reporting will be required for eligible hospitals. These Recommendations provide a basis for planning and establishing data use relationships between Public Health Agencies and eligible providers while also building upon prior ISDS work by incorporating both lessons learned and broader stakeholder participation.

The Recommendations were developed in an open, iterative, and consensus-driven manner overseen by a multi-stakeholder workgroup of experts in public health, clinical care, medical informatics, and health information technology. Stakeholder feedback was gathered at the initial stages of development as well after Draft Guidelines and Revised Guidelines were released. In the end, 7 organizations and approximately 100 individuals participated in the development process. 

ISDS is grateful to the MUse Workgroup and HLN Consulting, LLC for their shared expertise, talents, and time over the one-year period that the Recommendations were developed. ISDS also thanks the subject matter experts, stakeholders, readers, and ISDS Board of Directors who provided thoughtful help and consideration during this process. Finally, thank you to the Division of Informatics Solutions and Operations, OSELS, CDC for making this work possible. ISDS is grateful for the on-going partnership and support of the CDC in convening the surveillance stakeholder community for expert, consensus recommendations about syndromic surveillance for Meaningful Use. 

Please visit the ISDS website for more information about the Recommendations and their development process.

Comment Now: NIST Meaningful Use Certification Test Procedures

Dear Colleagues, 

The syndromic surveillance Test Procedure and tools for the 2014 Edition EHR certification criteria are now available for public comment. The finalized Test Procedures will be used by ONC-approved Testing Bodies to certify EHR technology for electronic Meaningful Use syndromic surveillance reporting. This review process is a crucial step in ensuring that eligible healthcare professionals and hospitals use certified technology to fulfill the Meaningful Use requirements set by the Centers for Medicare and Medicaid Services (CMS). ISDS has worked to develop these draft Test Procedures and tools in partnership with Agilex Technologies, Inc to support the ONC, CDC, and the National Institute of Standards and Technology (NIST) in this effort. 

Please review and comment on the draft Test Procedures by October 12, 2012 before they are finalized. You may submit comments to Robert Snelick at robert.snelick@nist.gov or to ONC.Certification@hhs.gov with "2014 Test Methods" in the subject line. Finalized testing procedures, with the incorporated public comments, will be released in early 2013. You may find the draft Test Procedures here http://lri.sipilotdevelopment.org/mu-syndromic. 

Join ISDS on Thursday, October 11 from 1:00 PM - 2:00 PM EDT to learn more about the Test Procedures during an ISDS-hosted webinar. Robert Snelick, of NIST, and Sheryl Taylor, of Booz Allen Hamilton, will present the syndromic surveillance draft Test Procedures and certification criteria and encourage participants to offer feedback.

You may also learn more about this process on the ONC website: http://www.healthit.gov/policy-researchers-implementers/2014-edition-draft-test-methods. 

Sincerely, 

ISDS

ONC and CMS Release EHR Stage 2 Rules

U.S. Department of Health & Human Services

News Division                                   

202-690-6343

media@hhs.gov

www.hhs.gov/news

News Release: Thursday, August 23, 2012

HHS announces next steps to promote use of electronic health records and health information exchange

Today, Health and Human Services (HHS) Secretary Kathleen Sebelius announced the next steps in the Obama administration’s work to help doctors and hospitals use electronic health records.

“The changes we’re announcing today will lead to more coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests and greater patient engagement in their own care,” Secretary Sebelius said.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, doctors, health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt and meaningfully use certified electronic health record (EHR) technology.

More than 120,000 eligible health care professionals and more than 3,300 hospitals have qualified to participate in the program and receive an incentive payment since it began in January 2011. That exceeds a 100,000 goal set earlier this year.

That includes more than half of all eligible hospitals and critical access hospitals and 1 out of every 5 eligible health care professionals.  The program is divided into three stages:

• Stage 1 sets the basic functionalities electronic health records must include such as capturing data electronically and providing patients with electronic copies of health information.
• Stage 2 (which will begin as early as 2014) increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information.
• Stage 3 will continue to expand meaningful use objectives to improve health care outcomes.
  

Today, HHS’ Centers for Medicare & Medicaid Services and HHS’ Office of the National Coordinator for Health IT released final requirements for stage 2 that hospitals and health care providers must meet in order to qualify for incentives during the second stage of the program, and criteria that electronic health records must meet to achieve certification.

The requirements announced today:

• Make clear that stage two of the program will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined today before 2014.
• Outline the certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they use will work, help them meaningfully use health information technology, and qualify for incentive payments.
• Modify the certification program to cut red tape and make the certification process more efficient.
• Allow current “2011 Edition Certified EHR Technology” to be used until 2014.

The CMS final rule also provides a flexible reporting period for 2014 to give providers sufficient time to adopt or upgrade to the latest EHR technology certified for 2014.

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

A detailed fact sheet on ONC’s standards and certification criteria final rule is available at http://healthit.hhs.gov/standardsandcertification.

The final rules announced today may be viewed at http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1. More information on the Stage 2 rule can be found at the CMS EHR Incentive Programs website at www.cms.gov/EHRIncentivePrograms.

Last Day to Comment: ISDS MU Guidelines

Today, Tuesday July 3rd, is the final day to provide comments on the ISDS Revised Guidelines for Syndromic Surveillance Using Inpatient and Ambulatory Clinical Care EHR Data. This is your last opportunity to provide input that will inform ISDS's Meaningful Use recommendations that will be made to the Office of the National Coordinator for Health Information Technology (ONC).


View the Revised Guidelines: http://www.syndromic.org/uploads/files/RevisedGuidelinesforSS.pdf
View the Guidelines FAQ: http://www.syndromic.org/uploads/files/GuidelinesFAQ.pdf 


You can also view the presentation below for a summary of the key parts of the Guidelines to help inform your comments. 

Revised Guidelines for Syndromic Surveillance Using Inpatient and Ambulatory Clinical Care EHR Data on Prezi

Ways to Comment
1. On-line Survey: https://www.surveymonkey.com/s/ISDSRevisedGuidelines2012
2. Email your comments to Becky Zwickl, MPH, ISDS Public Health Analyst at bzwickl@syndromic.org.

Explore ISDS' Revised Guidelines!

Take a tour through ISDS' Revised Guidelines for Syndromic Surveillance Using Inpatient and Ambulatory Clinical Care EHR Data using the newly released presentation found below. Navigate through the various elements of the Revised Guidelines at your own pace to become better acquainted with the document before you provide feedback. This presentation provides a straight-forward overview of the Guidelines that will prepare you to review the full text of the Revised Guidelines and provide informed comments. The purpose of this presentation is to facilitate your understanding and encourage you to provide feedback during the final comment period. Remember, this is your last opportunity to directly shape the recommended guidelines to the ONC. Your input will either support the changes that were made in the Revised Guidelines or emphasize places where further edits are needed.

Comment Period Deadline: July 3, 2012

View the Revised Guidelines

Submit Feedback

Learn more

Revised Guidelines for Syndromic Surveillance Using Inpatient and Ambulatory Clinical Care EHR Data on Prezi

ISDS Meaningful Use Guidelines Update

On March 6, 2012, ISDS released the Draft Guidelines for Syndromic Surveillance Using Inpatient and Ambulatory Clinical Care EHR Data (Draft Guidelines) for a public comment period that ended on April 2nd. Thank you to everyone who provided feedback on the Draft Guidelines. During the comment period, stakeholders provided a wealth of thoughtful and insightful comments. This commentary is a source of valuable insight that is helping the ISDS Meaningful Use Workgroup recommend guidelines that best reflect the needs of the surveillance community. ISDS greatly appreciates the time and effort of the stakeholder respondents for providing their comments.

Figure 1

ISDS heard from 73 stakeholders in the form of survey responses, email communication, and phone interviews. Out of the 73 respondents, 78% (57) provided comments using the Draft Guidelines Stakeholder Comment Form via SurveyMonkey. The next popular method of feedback was comments provided through e-mail communication by 19% (14) of respondents. Finally, 3% (2) provided feedback during a phone interview. (See figure 1.)

Figure 2

The survey responses included information about the professional background of the respondents which help inform the commentary's perspective. The majority of comments were provided by public health stakeholders (42) followed by researchers (8). ISDS also received feedback from EHR/HIE technology vendors and one eligible healthcare professional or hospital. (See figure 2.)

Over the course of the next month, ISDS staff and the Meaningful Use Workgroup will continue to analyze the comments received and work to incorporate the responses and develop the Provisional Guidelines. The Provisional Guidelines will be released in June for a second round of public comment which will inform the release of the Final Guidelines due in September.

Until then, you can learn more information about the development of these guidelines by visiting the Meaningful Use webpage on the ISDS website. 


If you have any questions, you may contact Charlie Ishikawa, ISDS Associate Director of Public Health Programs, at meaningfuluse@syndromic.org or (617) 779-0886. 

Proposed Rule for Stage 2 Meaningful Use NPRM

The Proposed Rule for Stage 2 Meaningful Use has been Posted to the Federal Register; CMS Fact Sheet Provides Overview

The Notice of Proposed Rulemaking (NPRM) for Stage 2 meaningful use was posted to the Office of the Federal Register today. The proposed rule outlines the next stage of meaningful use for the Electronic Health Record (EHR) Incentive Programs, which are administered by CMS. View the NPRM.

CMS has developed a fact sheet to give providers an overview of the rule and how Stage 2 expands upon Stage 1 of meaningful use. The fact sheet can be found on the EHR Incentive Programs website https://www.cms.gov/apps/media/fact_sheets.asp.

The Office of the National Coordinator for Health Information Technology's (ONC's) NPRM was delivered to the Federal Register on February 22 at the same time as the CMS NPRM, and the policy is finalized. Additional news about the ONC proposed rule will be released once it is posted and the rules will publish on the same day.

Learn more about meaningful use by going to the CMS EHR Meaningful Use Overview web page.

Want more information about the EHR Incentive Programs? Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Other useful CDC/PHIN links:

1) New "In the Spotlight" on both PHIN (www.cdc.gov/phin) and MU (www.cdc.gov/ehrmeaningfuluse) pages

2) New Cancer subpage under the PH Options on MU site.

3) Updated Guides page on both pages

4) Updated About Meaningful Use Intro page on MU page

Interview with Dr. Farzad Mostashari

Alex Howard, Government 2.0 Correspondent for O'Reilly Media, recently conducted an interview with the National Coordinator for Health IT, Dr. Farzad Mostashari, about the current state and future of health information technology. During the interview, Dr. Mostashari discusses the success of increased adoption of electronic health records in physicians offices since the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act (ARRA) of 2009. He applauds the technologic innovation in the health IT marketplace as well as open standards in healthcare software development. Dr. Mostashari believes these innovations will encourage patients to become more engaged in their healthcare leading to the emergence of a system of practitioners and "epatients," or "engaged/empowered patients."

Read the full interview and view Dr. Mostashari's joint TEDMED talk with Aneesh Chopra below or at the original source found here. 

-- Start Copy --

Building the health information infrastructure for the modern epatient

Dr. Farzad Mostashari on how the web, data and epatients are poised to revolutionize healthcare.

by Alex Howard | @digiphile  | +Alex Howard  | Comments: 1 | 21 February 2012

 

To learn more about what levers the government is pulling to catalyze innovation in the healthcare system, I turned to Dr. Farzad Mostashari (@Farzad_ONC). As the National Coordinator for Health IT, Mostashari is one of the most important public officials entrusted with improving the nation's healthcare system through smarter use of technology.

Mostashari, a public-health informatics specialist, was named ONC chief in April 2011, replacing Dr. David Blumenthal. Mostashari's full biography, available at HHS.gov, notes that he "was one of the lead investigators in the outbreaks of West Nile Virus and anthrax in New York City, and was among the first developers of real-time electronic disease surveillance systems nationwide."

I talked to Mostashari on the same day that he published a look back over 2011, which he hailed as a year of momentous progress in health information technology. Our interview follows.

What excites you about your work? What trends matter here?

Farzad Mostashari‏: Well, it's a really fun job. It feels like this is the ideal time for this health IT revolution to tie into other massive megatrends that are happening around consumer and patient empowerment, payment and delivery reform, as I talked about in my TED Med Talk with Aneesh Chopra.

These three streams [how patients are cared for, how care is paid for, and how people take care of their own health] coming together feels great. And it really feels like we're making amazing progress.

How does what's happening today grow out of the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) Act in 2009?

Farzad Mostashari‏: HITECH was a key part of ARRA, the American Recovery and Reinvestment Act. This is the reinvestment part. People think of roadways and runways and railways. This is the information infrastructure for healthcare.

In the past two years, we made as much progress on adoption as we had made in the past 20 years before that. We doubled the adoption of electronic health records in physician offices between the time the stimulus passed and now. What that says is that a large number of barriers have been addressed, including the financial barriers that are addressed by the health IT incentive payments.

It also, I think, points to the innovation that's happening in the health IT marketplace, with more products that people want to buy and want to use, and an explosion in the number of options people have.

The programs we put in place, like the Regional Health IT Extension Centers modeled after the Agriculture Extension program, give a helping hand. There are local nonprofits throughout the country that are working with one-third of all primary care providers in this country to help them adopt electronic health records, particularly smaller practices and maybe health centers, critical access hospitals and so forth.

This is obviously a big lift and a big change for medicine. It moves at what Jay Walker called "med speed," not tech speed. The pace of transformation in medicine that's happening right now may be unparalleled. It's a good thing.

Healthcare providers have a number of options as they adopt electronic health records. How do you think about the choice between open source versus proprietary options?

Farzad Mostashari‏: We're pretty agnostic in terms of the technology and the business model. What matters are the outcomes. We've really left the decisions about what technology to use to the people who have to live with it, like the doctors and hospitals who make the purchases.

There are definitely some very successful models, not only on the EHR side, but also on the health information exchange side.

(Note: For more on this subject, read Brian Ahier's Radar post on the Health Internet.)

What role do open standards play in the future of healthcare?

Farzad Mostashari‏: We are passionate believers in open standards. We think that everybody should be using them. We've gotten really great participation by vendors of open source and proprietary software, in terms of participating in an open standards development process.

I think what we've enabled, through things like modular certification, is a lot more innovation. Different pieces of the entire ecosystem could be done through reducing the barrier to entry, enabling a variety of different innovative startups to come to the field. What we're seeing is, a lot of the time, this is migrating from installed software to web services.

If we're setting up a reference implementation of the standards, like the Connect software or popHealth, we do it through a process where the result is open source. I think the government as a platform approach at the Veterans Affairs department, DoD, and so forth is tremendously important.

How is the mobile revolution changing healthcare?

We had Jay Walker talking about big change [at a recent ONC Grantee Meeting]. I just have this indelible image of him waving in his left hand a clay cone with cuneiform on it that is from 2,000 B.C. — 4,000 years ago — and in his right hand he held his iPhone.

He was saying both of them represented the cutting edge of technology that evolved to meet consumer need. His strong assertion was that this is absolutely going to revolutionize what happens in medicine at tech speed. Again, not "med speed."

I had the experience of being at my clinic, where I get care, and the pharmacist sitting in the starched, white coat behind the counter telling me that I should take this medicine at night.

And I said, "Well, it's easier for me to take it in the morning." And he said, "Well, it works better at night."

And I asked, acting as an empowered patient, "Well, what's the half life?" And he answered, "Okay. Let me look it up."

He started clacking away at his pharmacy information system; clickity clack, clickity clack. I can't see what he's doing. And then he says, "Ah hell," and he pulls out his smartphone and Googles it.

There's now a democratization of information and information tools, where we're pushing the analytics to the cloud. Being able to put that in the hand of not just every doctor or every healthcare provider but every patient is absolutely going to be that third strand of the DNA, putting us on the right path for getting healthcare that results in health.

We're making sure that people know they have a right to get their own data, making sure that the policies are aligned with that. We're making sure that we make it easy for doctors to give patients their own information through things like the Direct Project, the Blue Button, meaningful use requirements, or the Consumer E-Health Pledge.

We have more than 250 organizations that collectively hold data for 100 million Americans that pledge to make it easy for people to get electronic copies of their own data.

Do you think people will take ownership of their personal health data and engage in what Susannah Fox has described as "peer-to-peer healthcare"?

Farzad Mostashari‏: I think that it will be not just possible, not even just okay, but actuallyencouraged for patients to be engaged in their care as partners. Let the epatient help. I think we're going to see that emerging as there's more access and more tools for people to do stuff with their data once they get it through things like the health data initiative. We're also beginning to work with stakeholder groups, like Consumer's Union, the American Nurses Association and some of the disease groups, to change attitudes around it being okay to ask for your own records.

This interview was edited and condensed. Photo from The Office of the National Coordinator for Health Information Technology.

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