Consortium News

  • 26 Feb 2015 9:57 AM | Brian Kelley (Administrator)
    Tableau for Healthcare Professionals
    Beginner and Intermediate Level

    March 12-13, 2015  |  Waltham, MA

    MHDC Members: receive a 10% discount!

    This two-day course is designed for the healthcare professional who works with data (regardless 

     of technical or analytical background), with a beginner to intermediate Tableau skill level. The 

    course will be delivered through lecture with demonstration, followed by extensive hands-on 

    practice with specific healthcare case studies in Tableau-ready workbooks. Our course is designed to resonate with the healthcare professional using the language and data of healthcare.

    This hands-on healthcare-centric training program integrates the best practices of data visualization as you learn how to build tables, graphs, charts and dashboards using Tableau software. Onsite training computers will be equipped with Tableau software, workbooks and healthcare datasets that have been selected to best demonstrate different visualization types.

    Learning Objectives

    When you complete this course you will be able to:

    • Connect to data utilizing a variety of options
    • Effectively navigate the Tableau workspace layout – components, shelves, data elements,
    • and terminology
    • Effectively build basic data reports using the following visualization types:
      • Text Table
      • Bar Graph
      • Line Chart
      • Area Chart
      • Scatter Plot
      • Table Lens
      • Box and Whisker
      • Histogram
      • Small Multiples
      • Bar / Line Variance
      • Geographic Map
      • Heat Map
      • Bullet Graph
      • Pareto Chart
    • Use the sort, group, bin, hierarchy, set, and filter options effectively
    • Create and utilize basic calculated fields, table calculations, and parameters
    • Use Trend Lines, Reference Lines, and statistical techniques to describe the data
    • Work with the many formatting options to fine tune the presentation of your visualizations
    • Effectively use table joins and data blending
    • Combine visualizations into Interactive Dashboards
    • Describe options for sharing your visualizations with others
    •  Describe how to ensure the security of the healthcare data
    Course Information
    • Course Instructor: Dan Benevento, our Principal and Senior Consultant, is Tableau-certified and a data visualization expert with a passion for using healthcare data to save the world. A black belt in the use and application of Tableau, Dan has collaborated with IT teams at leading companies and organizations nationwide to build databases and create hundreds of time-saving, high-impact reports and dashboards. His interactive perioperative dashboards and reports custom-designed for Directors of Surgery have streamlined medical procedures, lowered costs, and made patients safer.
    In addition to Dan, Tableau instructors will be circulating the room to answer specific questions and provide individual attention as needed.

    Questions: Email questions to or call 617-663-5510 between the hours of 9:00am and 5:00pm EST.

  • 25 Feb 2015 2:04 PM | Brian Kelley (Administrator)

    Retrieved from Life as a Healthcare CIO: John Halamka, MD

    Making Time for Innovation

    CIOs are at a challenging crossroads in their careers.   Regulatory burdens, security threats, and changing reimbursement models have led to a demand for change that seems overwhelming.   As workflow pressures increase, it’s easy to declare IT the rate limiting step.

    Given that many CIOs are ready to raise the white flag of defeat in desperation, finding time for innovation amidst the swirl of must do projects can be a challenge.

    My hope, and something I strive to do, is to take the long view, asking what innovations we’ll need in the next few years, which will enhance productivity, and possibly serve as generalizable tools, reducing the number of requests for niche systems.   As I think about 2016, here are a  few of the kinds of innovations I think we’ll want for healthcare organizations:

    1. In our home  lives, we use cloud hosted storage accessible  on our personal devices.     How can we give folks the same easy access to their files (in lieu of the SSLVPN web-based access) while still protecting patient privacy?
    2. In our home lives, we use social networking - Facebook, LinkedIn, and Google+ to provide collaboration spaces for sharing ideas, messages, and files among groups.   How do we offer these kind of applications to support our work lives?  Is Slack a good fit for healthcare organizations?
    3. In our home lives, we use texting for communication among teams.   How do we deploy secure, enterprise grade texting that is fault tolerant, supports delegation (if you are unreachable),  role-based messaging (the current administrator on call, whoever that is), and audibility.   Per Harvard rules, I must disclose that I serve on the Board of Directors for Imprivata which produces such a product.   I will recuse myself from any decision making processes about secure texting procurement.
    4. As I’ve blogged about previously, patient generated healthcare data will become increasingly important and we need to be able to incorporate objective data (home devices) from smartphone middleware like HealthKit and subjective data (electronic patient reported outcomes).
    5. Interoperability use cases will increasingly require closed loop transactions with tighter coupling among organizations.   The FHIR work accelerated by the Argonauts group is the best path forward to achieve this goal.

    As usual, sometimes we buy innovation and sometimes we build innovation. 

    If practical, we should procure these services from cloud-based software as a service providers.

    We need to work closely with our compliance and legal colleagues to balance risk and benefit, accepting that with all change and innovation there is a risk of the unknown.    We can mitigate risk in the face of ambiguity.

    Often organizations focus on the short term - the tyranny of the urgent.   Carving out time for innovation with a long term view is necessary to create true breakthroughs.   A dozen short term sprints will not add up to the marathon of transformation that is only accomplished via a steady pace over time.

  • 23 Feb 2015 8:50 AM | Brian Kelley (Administrator) | REDMOND, WA | February 20, 2015

    Microsoft's big move to adopt this standard represents a 'major milestone.'

    Google and Amazon: you just got outplayed – at least in the security standards arena. Just this month, tech giant Microsoft announced it was adopting the first international set of privacy standards for the cloud, making it the first major cloud computing platform to do so.

    Microsoft officials announced the company's cloud computing platform Azure has adopted the International Organization for Standardization's 27018 standard, which serves as a code of practice for personally identifiable data stored in public clouds. The move was partly in response to feedback from industry stakeholders, who wanted a platform that helps "improve capability to fulfill compliance obligations."

    The standard, according to the ISO, was created to ensure that public cloud service providers implement adequate security controls to better safeguard their customers' data.

    Microsoft's big move to adopt this standard represents a "major milestone," said Brad Smith, the corporation's general counsel and executive vice president of legal and corporate affairs, in a blog post announcement. And although a seemingly technical standard, Smith said it's one with "important practical benefits for enterprise customers around the world."

    Microsoft's Azure platform, in addition to Office 365 and Dynamics CRM Online, have all been independently verified to be aligned with the ISO 27018 standard. What this means for Microsoft customers, as Smith pointed out, is for one there are added security restrictions on how the company handles personally identifiable information. For instance, there are more restrictions around transmitting data over transportable media, or public networks.

    The standard's code of practice sets forth five key principles that certified companies must adhere to:
    • Consent: Client data won't be used for advertising or marketing unless consented by the consumer.
    • Control: The customer decides how their data is used.
    • Increased transparency: Cloud service providers must provide clients with greater transparency regarding where their data resides, how it's handled and third-party subcontractors involved.
    • Communication: If a breach were to occur, the company will notify customers. Cloud service providers also will inform customers about government access to data.
    • Independent and annual audit: Conducted by a third party, the audits will examine the cloud service provider's compliance documents and adherence to the standard.
    "All of these commitments are even more important in the current legal environment, in which enterprise customers increasingly have their own privacy compliance obligations," Smith added. "We’re optimistic that ISO 27018 can serve as a template for regulators and customers alike as they seek to ensure strong privacy protection across geographies and vertical industry sectors."

  • 23 Feb 2015 8:29 AM | Brian Kelley (Administrator)
    from  |  February 20, 2015 | By Katie Dvorak

    It's time for ICD-10 to be implemented, and added delays are not likely to motivate organizations any more than the others ones did, says pediatrician Michael Lee, the director of clinical informatics at Atrius Health.

    The past delays didn't help the industry, and only served to hinder forward momentum, Lee writes at Physicians Practice. In July, the U.S. Department of Health and Human Services finalized Oct. 1, 2015, as the new compliance date, the third time the transition has been delayed since 2009.

    Atrius Health, a nonprofit multi-specialty medical group based in Newton, Massachusetts, is ready for the new coding system, according to Lee. The organization has moved its front-end systems to ICD-10 and partnered with the Massachusetts Health Data Consortium to test and troubleshoot the new codeset.

    A recent report by the Government Accountability Office found that the Centers for Medicaid & Medicare Services has taken positive steps to help prepare the healthcare industry for ICD-10.

    However, Lee says that with testing by the CMS coming this spring, it doesn't give providers much time to address problems.
    "There is still a great deal of uncertainty in the healthcare community about what is going to happen with ICD-10, especially with recent staffing changes at CMS," he says.
    But, he adds, that doesn't mean ICD-10 should be delayed again.
    "While it would have been wise for the government to move forward with an Oct. 1, 2014, launch ... halting implementation now would be a huge burden to the industry," Lee writes. "It's not time for another delay; it's time to get to work."
    Healthcare providers are not the only ones who are ready for the transition to take place. Members of the House Energy and Commerce Committee's Subcommittee on Health made clear at a hearing examining ICD-10 implementation that they do not want to see the transition delayed yet again.

  • 19 Feb 2015 9:43 AM | Brian Kelley (Administrator)

    Retrieved from 
    Author Kyle Murphy, PhD | Date February 11, 2015

    Over the past several months, healthcare association and industry reports have highlighted the importance of EHR usability to the success of healthcare organizations and providers providing efficient, effective, and safe patient care.

    In 2014, the American Medical Association (AMA) released a new framework comprising a multitude of priorities for creating more intuitive (i.e., usable) EHR technology. Shortly thereafter, Frost & Sullivan published a report detailing how limited EHR usability was impacting healthcare CIOs and their organizations. Other research even indicated that an emerging EHR monoculture — that is, the dominance of a single EHR technology — might benefit EHR usability, interoperability, and innovation.

    A leading health IT subject-matter expert, however, contends that much of the criticism of a lack of EHR usability could be missing the point.
    “I am always very cautious about the whole usability conversation,” says Micky Tripathi, PhD, MPP, President & CEO of the Massachusetts eHealth Collaborative. “When you look at the vendor market there are thousands of them and even hundreds of the certified EHR vendors, and there is nothing in meaningful use or any government regulation that force them to have their products architected or engineered in a particular way.”
    Obviously, regulation requires that certified EHR technology can perform certain functions, but it does not prevent EHR developers from coming up with innovative ways of doing say.
    “In a free market essentially with lots of technology options and no barriers to entry, how is it that no one is making usable products and that we could make general statements about every one of those vendors aren’t doing this or that?” he asks.
    A better explanation, claims Tripathi, is the fundamental concept of economics — supply and demand. “Technology is always going to reflect the underlying businesses. Maybe I’m too much on the free market side, but the supply side is going to reflect what the demand side is asking for,” he says.

    In the context of healthcare, Tripathi calls to mind two forces at work in driving EHR design and usability to this point. The first centers on purchasing power, which in healthcare has historically been controlled by large institutions.
    “One might be that users of the systems for a long time were large enterprises rather than small enterprises,” he explains. “That tends to dictate how software was being designed because it was the large enterprises primarily providing feedback — an institutional mode focused on routinized practices.”
    Likely more important than the first is the immaturity of much of the EHR market. “There is a whole bunch of new vendors not tied to any of that legacy stuff. For me more than anything else, it is still early in our market cycle — that there is not enough market and user feedback yet to make the products better,” adds Tripathi.

    And considering how long end-user feedback takes to become incorporate in new software, EHR adopters are more than likely playing a waiting game.
    “If you don’t like your software either you can work with your vendor or it’s going to be a ten-year process to get that feedback back into the market,” Tripathi explains. “The only way to make EHR products more usable is to have more users using them. No one can architect a perfect system particularly for something as complex as this.”
    What’s next in EHR design and usability

    If current EHR technology is not meeting the needs of healthcare organizations and providers, then what does the future of EHR design and usability hold? According to Tripathi, three emergent trends are starting to gather momentum.

    Given the growth of value-based care, EHR expansion to include population health and care management is the first:

    We are already starting to see care management and population health types of applications that are considered bolt-ons to existing EHR systems if developed by a new or third-party vendor. Increasingly, you have Epic, Cerner, eClinicalWorks, and other vendors reaching up-market essentially to build their own kind of those abilities and functions and integrate them back into the standalone EHR experience so that users have one continuous experience even though it is spanning the spectrum of care.
    Another entails a new but familiar approach at aggregating and displaying patient health data. “I imagine we would start to see is more of a Facebook-like experience to the extent that we will have different contributors to the patient record, including the patient ultimately, that will be seen more as an ongoing stream of those contributions that are both narrative and have the ability to be structured,” claims Tripathi.

    The last and most promising is similarly a capability already in use in other information technologies, using metadata and tagging elements.
    “Lastly, we’re starting to see some products that have more of that fluid experience similar to using a browser but also supporting more of a user-generated structure of data,” says Tripathi. “Rather than all your data being LOINC, coded, or pulled down from drop-down menus, you’re able to go through and tag different parts of the note that you define as a user. You can then perform searches, aggregations, or slicing and dicing — all of that — based on those tags.”

  • 18 Feb 2015 9:59 AM | Brian Kelley (Administrator)

    Retrieved 18-Feb-2015 from written by Gina Kolata

    Suffering. The very word made doctors uncomfortable. Medical journals avoided it, instructing authors to say that patients “ ‘have’ a disease or complications or side effects rather than ‘suffer’ or ‘suffer from’ them,” said Dr. Thomas H. Lee, the chief medical officer of Press Ganey, a company that surveys hospital patients.

    But now, reducing patient suffering — the kind caused not by disease but by medical care itself — has become a medical goal. The effort is driven partly by competition and partly by a realization that suffering, whether from long waits, inadequate explanations or feeling lost in the shuffle, is a real and pressing issue. It is as important, says Dr. Kenneth Sands, the chief quality officer at Harvard’s Beth Israel Deaconess Medical Center in Boston, as injuries, like medication errors or falls, or infections acquired in a hospital.

    The problem is how to measure it and what to do about it.

    Dr. Sands and his colleagues decided to start by asking their own patients what made them suffer.

    They found several categories. Communications — for example, a doctor blurting out, “Oh, it looks like you have cancer.” Or losing a valuable, like a wedding ring. Or loss of privacy — a doctor discussing a patient’s medical condition where an adjacent patient could hear.

    “These are harms,” Dr. Sands said. “They elicit suffering. They can be long lasting, and they currently are largely unquantified, uncounted, unrecorded.”

    One way to quantify these harms is to observe and note them, which is part of what Beth Israel Deaconess is doing. Another is to supplement efforts with patient surveys. Patient surveys, of course, have been around for decades. And since 2007, Medicare has required short surveys after discharge.

    But patient surveys were usually not used by hospitals to measure suffering. Now they are. And even when a survey question does not directly ask about suffering, sharp-eyed administrators are seeing a suffering component.

    That is how Dr. Michael Bennick, the medical director for patient experience at Yale-New Haven Hospital, solved a problem. He noticed a question on a Medicare survey asking, Is it quiet in your room at night?

    Maybe, Dr. Bennick thought, what is really being asked is: Can you get a good night’s sleep without interruption? Is it really necessary to wake patients again and again to take blood pressure and pulse rates, to draw blood, to give medications?

    He issued instructions for his unit. No more routinely awakening patients for vital signs. And plan the timing of medications; outside intensive care units, three-quarters of drugs can be given before patients go to sleep and again in the morning.

    Then there were the blood tests. “Doctors love blood tests,” Dr. Bennick said, and want results first thing in the morning when they make rounds. That meant waking patients in the wee hours.

    “I told the resident doctors in training: ‘If you are waking patients at 4 in the morning for a blood test, there obviously is a clinical need. So I want to be woken, too, so I can find out what it is.’ ” No one, he said, ever called him. Those middle-of-the-night blood draws vanished.

    Without anything else being done about noise in the halls, the medical unit’s score on that question rose from the 16th percentile to the 47th nationally in the Medicare survey. Now the entire hospital follows that plan.

    “And it did not cost a penny,” Dr. Bennick said. “The only cost was thinking not from our perspective but from a patient’s perspective.

    Dr. Lee says he joined Press Ganey — he had been network president for Partners HealthCare System, a Harvard-affiliated hospital system — because one of its goals was to reduce suffering. At first, he said, he was a bit uncomfortable with the concept.

    “I wondered whether it was a tad sensational, a bit too emotional,” he wrote in The New England Journal of Medicine. Then he realized reducing suffering was one of the most important challenges in health care.

    Press Ganey administers detailed surveys to discharged patients, asking things like how well the medical staff responded to them and their emotional needs, and how well the doctors and nurses informed and educated them. The company also encourages hospitals to let doctors know the results.

    Surveys can be misleading, though, cautions Dr. Scott Ramsey, a health care economist and cancer researcher at the Fred Hutchinson Cancer Research Center in Seattle. Patients, worried about saying something bad about a hospital they depend on, may not reveal what they really experienced. Or they may look back and, not wanting to live a life of regrets, excuse a doctor who seemed not to listen.

    On the other hand, Dr. Ramsey said, the suffering issues are real, and if survey answers can get doctors and hospitals to change their ways, “that is great.”

    Although half the nation’s hospitals use Press Ganey surveys, it is not clear what many do with the data. But at some places, like the University of Utah, the survey and other efforts prompted significant change. One Utah doctor said he was stunned when his patients rated him in the first percentile nationally, about as low as a score can go. “I was thinking: That’s just crazy. Something wasn’t entered right,” said the doctor, James Ashworth. Then he decided to take the criticisms to heart.

    The next quarter, he was rated in the upper 90s. The big difference was slowing down and listening to patients, answering their questions.

    Utah began its program a few years ago by showing its 1,200 doctors, nurses and other workers their scores. Next, said Dr. Vivian S. Lee, the hospital system’s chief executive, they showed them how colleagues did. Then they posted individuals’ scores and patient comments online.

    There was an immediate and noticeable change. When the university began, it was in about the 30th percentile nationally on the Press Ganey survey. Now, half its providers are in the 90th percentile and 26 percent are in the 99th percentile.

    “It’s unbelievable,” Dr. Lee, the chief executive, said. “We were not like that before, I can tell you.”

    “People wanted to improve,” she added.

    The comments, she said, are more revealing than the scores. Not all are complimentary. “There are still cases where people say: ‘I loved Dr. So-and-so. Too bad I had to wait so long to see him,’ ” she said.

    At Stanford Health Care, said Amir Rubin, the president and chief executive, “we are reducing suffering.” To do it, the medical system changed its focus.

    “We train each and every staff member,” Mr. Rubin said. “We talk to staff, we talk to patients, we hear from patients directly.”

    Supervisors coach doctors and nurses, giving feedback every month.

    The initiative changed hiring, he said. Administrators tell job candidates: “These are our care standards. Do you think you can always do it for every person every time?” They carefully observe new hires to see if they can provide care that minimizes suffering.

    “Every patient visit is a high-stakes interaction,” Dr. Thomas Lee says he has learned. “It is a big deal for the patient and it is a big deal for you.”

    “And all you have to do is be the kind of physician your patient is hoping you will be.”

  • 06 Feb 2015 7:05 PM | Brian Kelley (Administrator)

    Retrieved from Feb 5, 2015

    At least 14 hospitals are now either actively involved in a HealthKit pilot or in talks to roll one out, according to a new report from Reuters. Google and Samsung are beginning to approach hospitals to use their platform as well.

    Reuters didn’t name the 14 hospitals, but several have already spoken publicly about using HealthKit: Oschner Medical Center in New Orleans, Stanford Children’s Hospital, Penn Medicine, and Duke University Hospital. An earlier Reuter’s report named several others: Johns Hopkins, Mt. Sinai Hospital, and the Cleveland Clinic. And Beth Israel Deaconess CIO John Halamka has spoken at length about using the technology.

    Reuters reported that Oschner is already working with several hundred patients on a blood pressure tracking pilot and that Cedars-Sinai Medical Center in Los Angeles is developing “visual dashboards” to present patient-generated data to physicians. The chief technology officer at Epic Systems, Sumit Rana, told the publication that smartphone-connected patient-generated data was an idea whose time has come.

    “We didn’t have smartphones ten years ago; or an explosion of new sensors and devices,” Rana told Reuters.

    In a recent investor call, Apple CEO Tim Cook also addressed the adoption of HealthKit by hospitals, and also said that Apple is working with “more than 600 developers,” though he notably didn’t give numbers on hospitals or individual apps connecting to HealthKit. Last November, a MobiHealthNews analysis found 137 publicly available apps that connected to HealthKit.

    “There has also been incredible interest in HealthKit with over 600 developers now integrating it into their apps,” Cook said in the call. “Consumers can now choose to securely share their health and wellness metrics with these apps and this has led to some great, new and innovative experiences in fitness and wellness, food and nutrition and healthcare. For example, with apps such as an American Well, users can securely share data such as blood pressure, weight or activity directly with physicians, and leading hospitals such as Duke Medicine, Stanford Children and Penn Medicine are integrating data from HealthKit into their electronic medical record so that physicians can reach out to patients proactively when they see a problem that needs attention.”

    As for Google and Samsung, Reuters reports that Samsung is working with Massachusetts General Hospital in Boston and the University of California’s San Francisco Medical Center, while Google hasn’t announced any official partners. Reuters said a number of hospitals they spoke to are eager try a pilot of Google Fit, echoing the sentiments of Dr. Ricky Bloomfield at a recent mHealth Summit panel.

    “I think Google needs to do a little bit more to get it into the place where HealthKit currently functions, but I can’t wait until we can use Android devices as well as iOS devices, one to the other,” Bloomfield said at the time. “For me the most important thing is we give this ability to our patients. And I don’t care which device they have, I just want them to be able to give us the data so we can make good clinical decisions to help them out.”

  • 06 Feb 2015 3:11 PM | Brian Kelley (Administrator)
    ICD-10 Implementation and Medicare Testing
    Thursday, February 26, 2015
    1:30 PM - 3:00 PM Eastern Time

    CMS is offering acknowledgement testing and end-to-end testing to help the Medicare Fee-For-Service (FFS) provider community get ready for the October 1, 2015 implementation date. During this MLN Connects™ National Provider Call, CMS subject matter experts will discuss opportunities for testing and results from previous testing weeks, along with implementation issues and resources for providers. A question and answer session will follow the presentations.

    Participants are encouraged to review the testing resources on the Medicare FFS Provider Resources web page prior to the call, including MLN Matters® Articles and testing results.

    • Participating in acknowledgement and end-to-end testing
    • Results from previous acknowledgement and end-to-end testing weeks
    • National implementation update
    • Provider resources

    Target Audience

    Medical coders, physicians, physician office staff, nurses and other non-physician practitioners, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare providers.


    The presentation for this call will be posted at least one day in advance of the call on the MLN Connects™ National Provider Calls and Events web page. Select the call date and scroll to the "Call Materials" section to locate the slide presentation. A link to the audio recording and written transcript of this call will be posted under the "Call Materials" section in approximately 2 weeks following the call.

    Registration will close at 12:00 p.m. ET on the day of the call or when available space has been filled.

  • 05 Feb 2015 4:03 PM | Brian Kelley (Administrator)

    WASHINGTON, D.C.—The OpenNotes effort to allow patients access to their own records has grown significantly over the past few years and John Mafi, MD, discussed at the ONC 2015 Annual Meeting the recent $450,000 grant from The Commonwealth Fund to develop OurNotes, an initiative to promote active patient engagement in health and illness that invites patients to contribute to their own EMRs.

    Studies indicate that patients forget 40 to 80 percent of what their doctor just told them and of what they do remember, about half is wrong, said Mafi, a fellow in internal medicine at BIDMC. “The appeal with OpenNotes is that patients feel more in control of their own care and remember their plan of care better.”

    Two-thirds of OpenNotes users reported better medication adherence. By expanding the effort, “the hope is for freed up time during visits for shared decision-making. Patients can think about what really matters to them and contribute to the care plan.”

    The biggest hurdle, he said, is making sure clinicians are supported rather than adding to their workflow.

    Through the OurNotes grant, participating organizations will build, implement and pilot test patients and physicians co-generating their medical records. We think of this in three paths, Mafi said. Previsit data entry, during the visit and after the visit, particularly for people with chronic disease. “They can sign off on the plan and make sure it’s truly patient-centered and we can measure what that does to chronic disease care and patient and physician satisfaction.”

    Currently, Mafi said the team is measuring those things that are easily measured. “We’re finding that there are very few things where one size fits all.” They’re also working on promoting shared decision-making and getting the patient’s perspective into the record. “We currently don’t measure whether treatments are matching patients’ values. In fact, data show most don’t. Health IT needs the patient’s voice.”

    Studies show that 60 percent of patients would view their notes within 30 days and that level was sustained for two years, said Mafi. At Geisinger Health System, however, they stopped inviting patients to view their records and note viewing plummeted to about 10 percent. “The key difference is push invitations.” Although about 5 million patients have access to their records through OpenNotes, “no organizations are doing the invitation piece with the exception of two places. As we see OpenNotes spread rapidly, we’re probably going to see low viewing rates unless organizations are doing push invitations.”

    OurNotes will focus on chronically ill patients, he said. “We need to be intelligent about this. We need a multifaceted approach and policies narrowing healthcare disparities. On the ground level, we need an effort to engage these patients.”

    Researchers plan for OurNotes to allow patients to add topics or questions they’d like to cover during an upcoming visit to create efficiency for those visits, as well as review and sign off on notes after a visit to make sure patients and clinicians are on the same page.”

    The Commonwealth Fund grant will support work at five sites, including original OpenNotes study partners, BIDMC, Geisinger in Danville, Pa., and Harborview Medical Center in Seattle, Wash., and more recent OpenNotes adopters, Group Health Cooperative, also in Seattle and Mosaic Life Care in St. Joseph, Mo.

    retrieved Feb 4, 2015 from

  • 30 Jan 2015 10:22 AM | Brian Kelley (Administrator)

    The federal health information technology coordinator released a wide-ranging report Friday morning on how to improve interoperability in electronic health-record systems.

    The report, “Connecting Health and Care for the Nation, A Shared Nationwide Interoperability Roadmap,” (PDF) calls for most providers to be able to use their systems to send, receive and use “a common set of electronic clinical information ... at the nationwide level by the end of 2017.”

    The common data set consists of about 20 basic elements, such as patient demographics, lab test results and identifiers for a patient's care team members. The plan is open for public comment through April 3.

    Accompanying the 10-year interoperability plan is a 13-page “advisory” to the health IT community on what the feds see as the best available healthcare information exchange standards and implementation specifications to facilitate health data information exchange. The ONC intends to keep the list updated periodically.

    Some health information is being exchanged among these EHR users, in regions, and among customers of the same EHR vendors, and through statewide health information exchanges, according to the report. These success stories should provide “best practice models we can look to where data and information is flowing,” said Dr. Karen DeSalvo, coordinator of HHS' Office of the National Coordinator for Health IT.

    But the agency also has heard from both insurers and providers that the level of health information exchange is insufficient for their needs, she said. Healthcare organizations wanting to exchange information have been hampered by a lack of consensus on which information exchange standards to use, how to configure computer systems to use them, and which rules and business practices to follow. 

    “What we don't see yet is a complete coalescing around the rules of the road” for a nationwide exchange network, DeSalvo said.

    The ONC's interoperability roadmap calls for a public-private partnership to create a “governance framework” for health information exchange. It also calls for more work to be done developing and harmonizing interoperability standards “that will allow us to facilitate the sharing without a whole lot of extra effort,” she said.

    The plan also calls for both government and private sector players to provide additional incentives for interoperability – beyond those in the EHR incentive payment program. And it sees a need to better educate providers and their health information exchange partners on federal privacy and security rules, which the report says should enable data sharing, rather than inhibit it as is often the case now.

    The 2009 economic stimulus legislation that created the EHR incentive payment program, specifically ordered the ONC to “establish a governance mechanism for the nationwide health information network.” Since then, the agency has been under increasing criticism from members of Congress and professional groups about the lack of interoperability of EHRs despite the substantial public investment in them.

    Improving interoperability of health information is a critical prerequisite for providers seeking to create patient-centered medical homes, population-based care management systems and accountable care organizations as both government and private sector payment reforms shift from fee-for-service to performance-based payment models.

    On Monday, HHS Secretary Sylvia Mathews Burwell announced that by 2016 the CMS wants 30% of Medicare payments to be linked to these payment reform models, and 50% by 2018.

    Wednesday, a coalition of providers, insurers and employers pledged to have 75% of their members' business switched to performance-based contracts by 2020.

    In 2013, six Republican senators chastised the ONC for multiple health IT program failings, including a “lack of a clear path toward interoperability.” That month, the ONC issued a formal “request for information,” about possible governance models for health information exchange, a move that was viewed fearfully by some healthcare IT players as a possible first step toward federal regulation of health information exchange.

    The ONC backed off in September in the face of industry pleadings to allow interoperability to develop, unregulated, through market-based approaches.

    Earlier this month, in a letter to DeSalvo, the American Medical Association and nearly three dozen other medical societies and associations took the ONC to task on its health IT program problems, including a lack of interoperability

    “Ensuring electronic health information follows patients during transitions of care is one of the most sought after, yet the least successful exchange paradigms in health care today,” the AMA letter said.

    DeSalvo insists the ONC roadmap isn't an attempt by the agency to become a national network regulator. A heading on a section of the roadmap refers to “non-governmental governance.”

    “We are not specifically calling for a new entity for nationwide governance,” DeSalvo said, but, “We still want to give guidance and a timeline” for meeting plan objectives.

    Veteran physician informaticist Dr. William Bria applauded the inclusion of priority use cases targeting electronic sharing of patient data with public health authorities and enabling patients to access to their own healthcare information, particularly on mobile devices. 

    “It strikes me that it's way past time to give the American public access to their own information and in a way they can actually use (it),” said Bria, president of the Association of Medical Directors of Information Systems. “They are the key customer that's really been left. It's overdue.”

    View the first release of the Health IT Roadmap here.