Posts Tagged ‘AHIC’

conflict_of_interest_600As most of you well know, a certain Calvin Jablonski liked to comment here at Chilmark Research taking some pretty hard shots at the EMR certification organization, CCHIT and the close relationship between CCHIT and the vendor organization HIMSS.  Jablonski’s comments raised the ire of the HIMSS executive suite leading to a calling out of the dogs (lawyers) of which we were the humble recipients of their communications.

In our post on the subject, we were miffed that rather than countering Jablonski’s claims, HIMSS, through their lawyers, sought censorship. We did not comply.

What we countered with was what we thought a great idea:

HIMSS, we at Chilmark Research will gladly offer you the opportunity to guest post on Chilmark Research where, in full view of the public/readership you can provide a point-by-point response to Jablonski’s claims.

Seems sensible to us but for some odd reason, HIMSS has yet to respond to this offer.  Is there really something to hide here?  Does the cartoon above (simply substitute CCHIT for FDA) accurately portray what is really going on here?

Honestly, we tend to side with the belief that Jablonski is in some way a very disgruntled individual (former employee, contractor etc.) who has some ax to grind and was intimately familiar with some of the inner workings of both CCHIT and HIMSS.  But disgruntled or not, Jablonski does raise some broader issues that really need far closer review and scrutiny in light of the recently passed Stimulus Bill and the HITECH Act which will pour some $20B+ into the HIT market.

In today’s issue of Healthcare IT News, Neil Versel does a very good job of reporting on the controversy surrounding the Jablonski post and interviews others in the industry, including yours truly, on what many perceive as a strong potential for conflict of interests between an organization that is charged with certifying EMRs (CCHIT) and one responsible for promoting EMRs (HIMSS).

Many industry pundits, including John Glaser, CIO of Partners and senior member of NeHC (AHIC 2.0) believe that CCHIT will be the one responsible for making sure that all those EHRs that get adopted under HITECH Act, meet the “certified EHR” requirement.  But is CCHIT really in the best position to grant certification?  In one sense yes, as they have been doing just that for the last several years and claim over 160 products are now CCHIT certified.

But given their all to close relationship with the “HIT establishment” (HIMSS and the entrenched EMR vendors), are they really the best organization to oversee certification going forward?  Probably not in their current form.  Rather than contracting out to some third party, ala CCHIT, maybe a better solution would be to just let NIST do it themselves as they are truly neutral, have been given the authority (it’s in the legislation) and if they have sufficient staff, could certainly accomplish this task.

Ideally though, would not it be better to get the legislative body to go back and simply strike “certified” from the language of the HITECT Act?  To do so would leave us with providing incentives to physicians for “the meaningful use of EHR” by still promoting such behaviors as care coordination, quality, and eRx, without the burdensome requirement for “certified” EHR that will almost always be 3-5 years, at best, behind technology advances.

And by the way, just because it is “certified” does not, by any means, equate to interoperable.  One of the biggest fallacies in the market today.

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The pundits are out beginning to comment on what the Obama administration will mean to the healthcare IT market.  One of the leading HIT spokespersons, John Halamka made his predictions earlier this week.  Today, I came across a fairly lengthy article in CNN Money.  At first thought of critiquing both, found the CNN article to be poorly researched (despite all the quotes and numbers) and Halamka’s slanted (all about hospitals, physicians and standards, little about consumers, record access and control) and a bit too rosy on programs, committees and progress to date.

So, putting on our pundit and forecasting hat, here is what we see coming from Obama’s new administration:

The oft-quoted $10B a year investment in HIT will not materialize, in the near-term.  There is a small problem down on Wall Street that has extended across the country, heck the world, that will consume most available resources.  During the second half of his term, Obama may begin opening up the spigots and direct some significant funding towards healthcare IT but that will only occur if more pressing financial issues are brought under control.

Tighten budgets will put strain on all healthcare stakeholders.  This will lead to no one willing to give up their stake for the better good. Such committees as AHIC will be impotent in their ability to move anything significant forward.

Federal funding of RHIOs will continue, but at a lower level.  Limited resources and a lack of RHIOs that have actually succeeded (become self-sustaining) will force the Feds to reassess such funding, despite Kolodner’s loud protestations.

While being a strong supporter of Obama (worked local voting booth for the primary election), not convinced that throwing money at the HIT adoption problem is sound policy.  Such approaches tend to be top-heavy, too perscriptive, and despite the best of intentions, mis-aligned with true market needs.

Where the government can play a much more important and significant role is in the restructuring of programs it already funds (CMS), crafting incentive policies that create market forces to drive HIT adoption.  For example, the CMS program to push eRx, first with a carrot, later with a stick, makes a whole lot of sense.

Now, if we could only get legislation changed to allow CMS to support telehealth (new technology with clear benefits) or funding in support of PHR demonstrations, then we would be getting somewhere.

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Health 2.0 Wrap-up

Couple of long days and now listening to the wrap-up panel, Looking Ahead – The Business and Society of Health 2.0. One of the panel members, David Lansky, formally of Markle Foundation and now heading up the business healthcare group, Pacific Business Group on Health. Disturbing statement from Lansky was that he worked with Matthew to offer free attendance to the big business leaders in California, many of them from hi-tech, not a single one is in attendance. Lansky went on to say that there are extremely large vested interests in healthcare that are very good at protecting their financial stake and are not going to let go easily. Many will co-op Health 2.0 approaches to keep that control of the purse strings. Lansky encouraged all in attendance that healthcare is a policy issue and that Health 2.0 companies really need to work together and with their customers to force the policy changes needed. Very good and prescient comments.

Panel is for the most part cheerleaders for Health 2.0. Thankfully, Lansky is up there giving some balance – quite pragmatic. Oh, almost forgot, we do have Kolodner from HHS up there on the panel as well. He is encouraging the audience to get involved with AHIC successor. Oh Boy, you are better off siting in your Congressman’s office.

Final Wrap:

Looking at all the solutions I’ve seen here what strikes me most is the need for a roll-up. There is simply no way that a consumer is going to go to one site to manage their records, another to look at potential adverse reactions from meds, another to look at symptoms, a social community to talk about their health and the list goes on.

The WebMD/Healtheon merger leaves WebMD with a sizable war chest of some $340M to go out into the market and act as aggregator/acquirer to create a richer environment for their customers. Spoke to a couple of others who also have access to some very deep pockets who told me they will be out bottom fishing in 6-9 months.

Another strategy is a federated, best-of-breed roll-up where companies with complimentary solutions come together to deliver compelling solutions to institutional clients.

This market and the players within need scale. Virtually all of them are small operations with less than 25 employees. Most that I spoke to are still very much in start-up mode, fleshing out the product and only now begining to think about how they will take the product to market and scale. Channel strategies are immature, messaging non-existent. A lot of promise shown with regards to technology, despite all the overlap, but we are far from seeing this market truly succeed as technology is only a small piece of what it takes to make a business successful.

The event itself is a hell of a lot more interesting and more fun than HIMSS. Hat’s off to the organizers, they have done an excellent job bringing together some excellent people who are pushing the envelop and hopefully with input and engagement from the consumers and physicians they are targeting, these companies will push healthcare in the right direction.

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Yesterday, Healthcare IT News did a story on the AHIC event I participated in on Tuesday.  Article does  nice job of capturing some of the high-points, including a few quotes from yours truly.  Most of these quotes came in response to questions asked that followed my formal presentation.  The article also contains comments by Will Crawford of Dossia and Microsoft’s Sean Nolan and concludes noting Google’s quite bizarre absence.

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At the AHIC event earlier this week, there was a third panel that presented to the AHIC and HHS.  Their topic was focused on the need to link Clinical Research to Clinical Care, or more specifically, clinical researchers’ desire to tap into the treasure trove of data resident in health records.  Apparently, this request to AHIC to develop policies to enable this capability has been an ongoing issue/request for at least a couple of years.  Based on the passionate presentations of some on this panel, one could sense a fairly high-level of frustration.

One of the presenters, Greg Simon of the Milken Institute funded Faster Cures stated it quite clearly, to paraphrase: …we have a complete disconnect between the Care Community and the Cure Community.

Another presenter, Rebecca Kush of the standards consortium CDISC, also made an important point that with the strong push for EMR adoption, now is the time to harmonize the needs of clinicians with those of researchers.  This reminds me of a conversation I had with an executive from Amgen wherein they did attempt to collect data from clinical systems on breast cancer patients but the data was so inconsistent as to virtually worthless.  This would seem like a golden opportunity for an organization like CCHIT to take EMR certification one step further in support of clinical research needs.  But CCHIT is gong to need the guidance and blessing of AHIC/HHS before it would proceed down that path.

Where’s the Consumer?

While this panel presented some compelling arguments for the need to connect clinical care and clinical research, what I found very disturbing was the complete lack of discussion or acknowledgment that there is a consumer involved here, a consumer who’s records you wish to access.  When I asked a friend in the research sector about this he stated that researchers are miffed about HIPAA as they beleive it has hindered their ability to access records/data so the last thing they want to discuss is having to go through the consumer to get to the data.

Sorry Charlie.

You want my data, well you better ask for it first and ask nicely by clearly articulating how that data will be used, by whom, and what you will do with the data once your research project concludes. I don’t mean to be a burden, and I do want to help you, but I also don’t believe this is an unreasonable request. I hope you understand.

During follow-on discussions there was some stated commitment by AHIC that this issue will be put on the front-burner for the successor organization, AHIC 2.0.  We’ll have to wait and see but based on experience to date, I’m not going to hold my breath.

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Yesterday, I had the honor to present to Sec. Leavitt and the AHIC on trends and projections for personal health information. As I had only a brief 10 minutes to work with, I needed to put together a dense set of slides to hit the high points of what is happening in the PHR market. Below is the presentation.

Several others presented as well including Carol Diamond from the Markle Foundation, Jeffery Blair from the Lovelace Clinic, Sean Nolan from HealthVault, and Will Crawford from Dossia among others. The purpose of our collective presentations and following on Q&A were to educate those in attendance on where we are today regarding the ability of a consumer to manage their PHI and where we were headed in the future. Of course, being in front of so many policy makers, it also provided us an opportunity to provide policy guidance to encourage future adoption and use of PHI.

Surprisingly, Google Health did not send anyone, though I heard they were invited. Odd, Very odd.

Makes we wonder just how committed Google is to the health sector when they cannot find an individual to represent them at such an important event. Then again, maybe it is just a certain level of arrogance at Google wherein they decided that this administration is coming to a close and the future of what AHIC will become remains uncertain. Either way, a poor move on their part.

Back to the event.

I was quite impressed with the attentiveness Sec. Leavitt showed throughout this morning session. He took copious notes and asked several thoughtful and probing questions. Clearly, he takes this issue very seriously.

Unfortunately, I am not sure I can say the same about others who were present. Several questions and comments from AHIC members were clearly designed to derail any move towards personal control of health records. The usual Fear, Uncertainty, and Doubt (FUD) issues were raised such as the specter of privacy, the consumer at risk, the physician at risk, that PHI is not important for the advancement of health, etc. There are strong vested interests among those on the AHIC committee, thus not too surprising to see so little substantive action come out of the AHIC since its formation.

Key points & metrics:

  • Privacy is on everyone’s mind when it comes to PHI, though many agree that all the consumer wants to know are answers to two basic questions:
    Who will have access to my record?
    What might the information in my record be used for?
  • At Kaiser-Permanente consumers now simply expect their physician(s) to be digitally aware and connected. Adoption continues to accelerate and their members are increasingly engaging with their physicians over the Internet. Viewing lab results online is the most used feature of My Health Manager with 1.3M results viewed monthly.
  • From Jan-June 2008, the VA’s HealtheVet PHR had 4.1M visits. HealtheVet now has over 600,000 active users.
  • Reconciliation of multiple medical records from multiple providers for an individual to create a single, coherent, longitudinal record is proving quite challenging. This is not an easy task to automate.

Final Impressions:
There are many good people at HHS and on the AHIC that are working very hard to advance the quality of care. There were several at this meeting that are beginning to believe that the PHI market may indeed be moving far faster than the ability for government to respond, which honestly, may not be a bad thing. My biggest concern is that given time, government may actually do more harm than good in that given sufficient time they would put together confining prescriptive polices and regulations that would hinder innovation and follow-on adoption, rather than foster it. This led me to close my own comments during our session with the following:

What we need today are not prescriptive policies and definitions, but guidelines. When developing policies, think as though you are putting up guardrails to help guide adoption and use of HIT rather than laying down railroad tracks.

Hopefully, they were listening.

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Next week on July 29th, I have the honor to give a presentation at the “Community Meeting” of AHIC in Washington D.C.  While the link is thin on details, it does provide one with a link to listen in on this meeting, via video webcasting.

So what is the main purpose of the meeting?

It is to provide an update to the government policy makers, including Dept. of Health and Human Services Secretary Leavitt, and the public on: “The Evolving Landscape of Products and Approaches that Consumers may use to “mobilize” (access, use, and share) their Personal Health Information (PHI)”.

My presentation will focus on what are some of the current market trends and technologies now being offered to and used by consumers for PHI.  The presentation will leverage results of our recent research report on the PHR market and our continuing research on the broader issues of consumer-facing HIT, of which PHI is a subset.

Quite an honor to be a part to this event in which I’ll be joined by such well-known speakers on the topic as Carol Diamond of The Markle Foundation, Sean Nolan of HealthVault, Jeff Blair of the Lovelace Clinic Foundation, Will Crawford of Children’s Hospital of Boston and Jerry Bradshaw, Executive Director HIN, Arkansas BCBS among others.

I’ll provide a report next week on the meeting, including the slide deck I plan to use – so stay tuned.

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