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Additional FAQs for Guidance on Meeting Public Health Objective for 2015 EHR Reporting Period

Posted on November 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

On October 6, CMS released the final rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. To support provider participation in 2015, CMS has released two additional FAQs in response to inquiries about the public health reporting objective in 2015.

FAQ 13409
Question: For 2015, how should a provider report on the public health reporting objective if they had planned to be in Stage 1 meaningful use which required sending a test message and continued submission if successful, but did not require registration of intent?

Answer: We did not intend to require providers to engage in new activities during 2015, which may not be feasible after the publication of the final rule in order to successfully demonstrate meaningful use in 2015. Since providers in Stage 1 in 2015 were not previously required to submit a registration of intent to submit data to meet Objective 10 measures, providers may meet the measures by having sent a test message or by being in production. Providers who have sent a test message can be considered to have met Option 2 of Active Engagement – Test and Validation; providers who are in production can be considered to have met Option 3 of Active Engagement – Production.

FAQ 13413
Question: Does integration of the PDMP (Prescription Drug Monitoring Program) into an EHR count as a specialized registry?

Answer: If the PDMP within a jurisdiction has declared itself a specialized registry ready to accept data, then the integration with a PDMP can count towards a specialized registry. The EHR must be CEHRT, but there are no standards for the exchange of data.

EHR Data Integration and Changing Health Behaviors

Posted on November 16, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Every so often I like to highlight interesting tweets from the Twittersphere and add some of my own commentary. Here’s a few of them worth mentioning today.


How many EHR integrate with Fitbit? I’ve seen a few partial integrations, but none of them that really make an impact on the patients life. At best I’ve seen them take the data in, but then they do nothing with it. I’d love to see some examples where the EHR is actually doing something with the Fitbit data. In fact, is there anyone taking Fitbit data and making it more useful than what it is in the Fitbit app?


Speaking of outside data (Fitbit data), I agree with IBM that we’re heading towards a lot more data than just what the EMR can provide. In fact, I think the real breakthroughs in health care are going to come from the mixing of multiple data sources into a pretty little package with a bow on top. We’re still Christopher Columbus looking for the new world though. However, unlike Columbus, I know the world isn’t flat (ie. there’s value in the data).


I love when things are timely. I’m extremely interested in this discussion about behavior change in health care. I’m glad that the #hcldr chat is about this topic. I’ll be watching with a keen eye on what people share. I hope everyone will take the time to share their thoughts on how to change people’s health behaviors.

Complex Technologies Lurk Within Simple Interfaces – A Lesson for Health Care

Posted on November 13, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Technologists are justly proud of the complex problems they solve. What’s hardest is hiding that complexity from the end-user. When a great magician performs, the audience is not aware of the excruciating practice he put into the Disappearing Coin trick (I have tried to learn it). In the same, complex analytics and personalization may have to hide behind a simple one-button device.

The demands placed by health consumers on health technology were laid out persuasively by David Inns, CEO of GreatCall, at the recent Connected Health Conference. His reasoning could be proposed as a kind of classic syllogism:

  • Major premise: technologies continually advance, whereas people are most comfortable with the technologies they learned when young;

  • Minor premise: health needs are concentrated among the elderly or middle-aged;

  • Conclusion: the people most in need of health technology will not be comfortable with the latest technology.

Translated into practical advice, this means that any personal health technology must adapt to multiple interfaces. If an individual has the latest iPhone, that’s great. If she prefers a simple flip phone, let her use that. And if she has nothing and is willing to tolerate only a device she wears around the neck with a button, let her have it.

Let’s shift gears for a moment (for those readers who remember manual transmissions). What does GreatCall offer its clients?

GreatCall is a typical–though technologically advanced–component of a a wellness program or patient-centered health medical home. It allows older adults or disabled people to keep in touch with caregivers, both family members and professional caregivers. The individual obtains from GreatCall a device with 5 Star Service that he or she keeps close at hand. GreatCall learns the individual’s habits: it knows what a visit to the doctor looks like, a Sunday in church, etc. The software that powers the GreatCall Link app notices when something worrisome happens, such as a person staying in bed very late, not getting out of the house regularly, or leaving the house at odd times. It starts by notifying the family caregiver.

If a change has been flagged as urgent and a family caregiver fails to respond, GreatCall can escalate the issue to a 5 Star operator who can assist with such situations on a 24/7 basis. Everyday behaviors, such as medication adherence, can also be monitored.

The GreatCall Link app can also give individuals and their caregivers summaries of the individual’s status. These summaries are not presented as numerical lists or even two-dimensional charts, which would be hard for non-techies to understand. Instead, GreatCall creates a written paragraph that summarizes whether the older adult has engaged in more activity or less, and similar information.

What technologies are necessary for GreatCall to carry out its mission? First, there must be ways for the individual to communicate easily with his or her device. Even a flip phone can be enhanced with secure apps to accept messages from users.

GPS is also a critical component, but GreatCall adds another layer of positioning–A-GPS or assisted GPS. First, it enhances satellite-based GPS with the precision provided by cell towers when someone is indoors and satellites can’t provide location information. Second, GreatCall tracks changes in location over time to account for errors. A GPS system may report that a patient is two blocks from her apartment at 2:00 in the morning when actually she is safe in bed. Data collection and analytics allows GreatCall to avoid a panic call–but all of this sophistication lies behind a simple interface.

In the cloud, GreatCall stores the necessary information to match a user’s location with her favorite haunts and to contact caregivers or family members when necessary. Data is carefully protected and not shared with anyone outside GreatCall.

I’ve been intrigued by the GreatCall service because it combines fancy analytical technology with an interface that adapts to the needs of the user, whether a tech-savvy active ager or a 90-year old with more serious cognitive or health issues. They represent an inspiring story of investigating their users, understanding them empathetically, and offering their advanced technologies in a service that is likely to win adoption. Every app developer should carry out research like this.

Healthcare Interoperability Tort Reform

Posted on November 12, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The more I learn about health care the more I think that health care would really benefit from tort reform. In many ways we’ve needed this for a while. I’ve never seen this study, but I’d love to see someone study how many health care costs are associated with unneeded tests and procedures that were ordered by doctors in order to help them avoid liability.

This happens all the time in health care and you can’t blame the doctors for doing it. Them ordering a likely unneeded extra test in order to avoid possible liability is a common practice. It only takes one time that they don’t order the test for the doctor to start over ordering tests and procedures. It’s unfortunately the lawsuit happy society that we live in and that’s why tort reform could help

Turns out that technology actually exacerbates this problem in many ways. A great example of this is in interoperability of health records. We all love the idea that everyone’s health information is pushed to the doctor so it’s available whenever the doctor needs it. I think we can all agree that the doctor having all of the information on a patient will lead to improved care for many patients. However, pushing all this new health information to the doctor raises a lot of questions.

From the doctor’s perspective they’re asking the question “Will I be held liable for health information that’s pushed to me?” “What if that health information shows suicidal tendencies for my patient and I don’t do anything about it because the information was pushed to me and I never actually saw it?” We could highlight a few hundred other scenarios where the doctor could be held liable if they don’t act on some information that’s forwarded to them. Any rational person could see how the doctor shouldn’t be responsible, but most lawsuits aren’t very rational.

Another example would be a doctor who has access to an HIE but doesn’t use it. Should the doctor be held liable for not using that information? What if the HIE had the allergies of a patient and could have prevented the doctor prescribing a drug to the patient because they were allergic? Should the doctor be held liable for information that was available in the HIE, but for whatever reason she chose not to access that information and ended up doing something bad?

I’m not a lawyer and I don’t play one on TV, but there are so many examples of potential liability that it’s quite scary. Is it any wonder why doctors are so frustrated with medicine? I think the right tort reforms could help. If we don’t, I think the cost of health care will continue to rise.

Veteran’s Day

Posted on November 11, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today is Veteran’s Day and so I thought I’d take a minute to say thank you to all the people that have risked and are still risking their lives in order for us to have the freedom’s we enjoy. My brother is currently in Japan in the Air Force so I’m thinking about him in particular today. Who are you thinking about?

Of course, since this is a health care blog, I hope that the VA and DoD can get their EHR right and make sure that the Veteran’s get the very best health care in the world.

Veteran's Day

New EHR Incentive Program FAQs from CMS

Posted on November 10, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

On October 6, the Centers for Medicare & Medicaid Services (CMS) released the final rule with comment for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. To keep you informed of changes to the programs and how to participate in 2015, CMS has also released three new FAQs providing clarification on how to attest to certain measures for health information exchange, patient electronic access, and other objectives that require patient action.

FAQ 12817
Question: For the Health Information Exchange objective for meaningful use in 2015 through 2017, may an eligible professional (EP), eligible hospital or critical access hospital (CAH) count a transition of care or referral in its numerator for the measure if they electronically create and send a summary of care document using their CEHRT to a third party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document?

Answer: Yes. An EP, eligible hospital or CAH may count transmissions in this measure’s numerator when a third party organization is involved so long as:

  • The summary of care document is created using certified EHR technology (CEHRT);
  • The summary of care document is transmitted electronically by the EP, eligible hospital or CAH to the third party organization…read the full FAQ.

FAQ 12821
Question: If multiple eligible professionals or eligible hospitals contribute information to a shared portal or to a patient’s online personal health record (PHR), how is it counted for meaningful use when the patient accesses the information on the portal or PHR?

This answer is relevant to the following meaningful use objectives: Patient Specific Education and Patient Electronic Access measure 2.

Answer: If an eligible professional sees a patient during the EHR reporting period, the eligible professional may count the patient in the numerator for this measure if the patient (or an authorized representative) views online, downloads, or transmits to a third party any of the health information from the shared portal or online PHR. The same would apply for an eligible hospital or CAH if a patient is discharged during the EHR reporting period. If patient-specific education resources are provided electronically, it may be counted in the numerator for any provider within the group sharing the CEHRT who has contributed information to the patient’s record if that provider has the patient in their denominator for the EHR reporting period. The respective eligible professional, eligible hospital, or CAH must have contributed at least some of the information identified in the Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 3 and Modifications to Meaningful Use in 2015 Through 2017 final rule (80 FR 62807 through 62809) to the shared portal or online PHR for the patient. However, the respective provider need not have contributed the particular information that was viewed, downloaded, or transmitted by the patient. …Read the full FAQ.

FAQ 12825
Question: In calculating the meaningful use objectives requiring patient action, if a patient sends a message or accesses his/her health information made available by their eligible professional (EP), can the other EPs in the practice get credit for the patient’s action in meeting the objectives?

Answer: Yes. This transitive effect applies to the Secure Electronic Messaging objective, the 2nd measure of the Patient Electronic Access (View, Download and Transmit) objective, and the Patient Specific Education objective.

If a patient sends a secure message about a clinical or health related subject to the group practice of their EP, that patient can be counted in the numerator of the Secure Electronic Messaging measure for any of the EPs at the group practice who use the same certified electronic health records technology (CEHRT) that saw and patient during their EHR reporting period.

Similarly, if a patient views, downloads or transmits to a third party the health information that was made available online by their EP, that patient can be counted in the numerator of the 2nd Patient Electronic Access measure for any of the EPs in that group practice who use the same CEHRT and saw that patient during their EHR reporting period.

If patient-specific education resources are provided electronically, it may be counted in the numerator for any provider within the group sharing the CEHRT who has contributed information to the patient’s record if that provider has the patient in their denominator for the EHR reporting period. … Read the full FAQ.

For more information on accurately calculating the numerator for measures, please visit FAQ 8231.

5 Mobile Opportunities in Health Care

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently reading through this whitepaper called Going Mobile: Integrating Mobile to Enhance Patient Care and Practice Efficiency. The concept is lovely, but I’m afraid that most healthcare IT has fallen short of the mobile promise. We see the benefits of mobile in so many other aspects of our lives, but we’ve fallen short in delivering that same benefit in health care.

The good part is that the opportunity is still available for health care to benefit from mobile technology. So, even if the whitepaper might be talking about potential rather than the reality of what’s available today, it’s worth considering why more EHR vendors and other health care IT companies should invest in mobile.

The whitepaper offers 5 opportunities for mobile:

  • Clinical Decision Support – The first iteration of this was Epocrates. It was mostly information, but that’s where clinical decision support starts. Hopefully we’ll see rapid advancement in this area. Mobile makes that clinical decision support easily available at the point of care.
  • Workflow Efficiencies – It’s unfortunate that we haven’t realized this benefit. Mobile can really make things more efficient if we create the right interface. I just have seen so few EHR vendors invest in the right mobile interface to take advantage of these efficiencies.
  • Communication and Coordination – We’re starting to see this happen with services like secure text message. You’d think we’d need something more, but secure text message is a great place to start. It’s easily learned, completely malleable to any workflow, and easily implemented. Over time I’m sure we’ll find even better ways to communicate and coordinate care on mobile.
  • Patient Engagement – One of my favorite stats is that 98% of text messages get read. Plus, they get read almost immediately. Compare that to email and you’ll see why mobile is such an opportunity to engage the patient. We’re seeing more and more of these offerings on the market.
  • Security – Some might consider this a challenge, but I think it’s also an opportunity. Ever heard of 2 factor authentication. Your mobile device is perfect for it and provides a much more secure login. Certainly there are security challenges with mobile devices as well, but it can also be used as a great opportunity to improve how we approach security.

Be sure to check out the whitepaper where they dive a lot deeper into each of these subjects. Like I said, the benefits of mobile have not been really realized in health care, but that opportunity is still available.

Connected Health Conference Tops Itself–But How Broad is Adoption? Part 3 of 3

Posted on November 9, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous section of this article looked at advances in health care, as well as some warnings about their efficacy at the Connected Health Conference. In sessions about experiments in altering care, people managing the new programs stressed that commitment and expertise are not enough; these programs call for structural and culture change within organizations. One speaker pointed out that quality programs must assess not just an individual clinician, but the whole system that intervenes in patient care.

In its 12th year, the Connected Health Symposium is more successful than ever: the most attendees, most exhibitors, and biggest sponsorship ever. More to the point, I noticed more sessions this year focusig on immediate, practical logistics of getting new programs in place. But a number of adoption issues remain:

  • Many pilot programs weren’t designed to be sustainable and scalable; even when successful, they weren’t adopted by the larger organization. Some speakers blamed these dead ends on a lack of an individual champion, others on the lack of organizational structures for promoting change.

  • Payers expect to see a return on investment within three years, but patients take much longer to show benefits of health. This isn’t rational. One speaker pointed out that while an insurer’s patients will move on, it will gain new patients that another insurer invested in. So a long-term investment will raise all boats. However, the fossilized financial models remain in place

  • Cost savings can slip away from you. Robert Perl, executive director and CEO of The Permanente Medical Group, reported that the use of electronic health records at Kaiser Permanente improved care but did not lower costs. The savings all went into the very expensive EHR itself, as well as the extra time physicians had to spend entering data because of the EHR’s design. But Kaiser chose to install Epic, so one could ask Dr. Perl why he expected the outcome to be any different.

  • It’s also disheartening to hear visitors from other countries. One would think that Britain and Canada, with their more broadly designed health care systems, would have solved the problems with data exchange and cost control that the U.S. struggles with. But reports suggest they’re just as bad off. The Canadian speaker said that after his PCP retired, no records were sent to his new one. Britain’s integration data efforts are still a “work in progress,” according to Anne Avidon, Head of Global Health Innovation at the Life Sciences Organisation of UK Trade & Investment. South Africa is also lagging on interoperability and data exchange. Semih Sen, a health care executive from Abu Dhabi, pointed out that “health care is the only industry left that isn’t global” and suggested some reforms, such as cross-border licenses.

My impression, overall, is that strides are being made in using data, engaging with individuals around their health needs, and providing innovative treatment options–but mostly outside the traditional institutions of health care. Those institutions are still trying to figure out how to achieve the organizational change that can permit them to participate in the health care revolution. And some are pouring money into experiments that they eventually abandon or can’t get financial benefit from because the environment is against them.

Next year, perhaps more institutions will find the way forward.

Connected Health Conference Tops Itself–But How Broad is Adoption? Part 2 of 3

Posted on November 6, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous section of this article introduced this year’s highly successful conference, along with some reports from its lead sponsor, Partners HealthCare in Massachusetts. This section looks at some controversies.

A shiny techno-optimist view was offered by two leaders of the computer industry. Venture capitalist Vinod Khosla, co-founder of Sun Microsystems, is famous for suggesting that 80% of what doctors now do could be replaced by technology. Joichi Ito, Directory of MIT’s Media Lab, reinforced this claim by pointing out how much productivity scientists gained by replacing manual number-crunching with digital calculators. “The less subjective decision-making we have,” Khosla said, “the better health care quality will be.”

With diagnosis and prescribing thus handed over to smart machines (some descendant of IBM’s Watson, in my imagination), doctors can focus on building relationships with patients. It’s easy to parody the role of empathy in health care, but realistically, empathy is the one thing that we’ve found to make a difference in chronic care. One hospital in New Orleans achieved a 45% reduction in readmissions through interventions that reduce social isolation and other barriers such as transportation problems.

Furthermore, technology will not act alone: it will allow the delivery of care to move down the cost stack from specialists to general practitioners and from doctors to nurse practitioners.

However, a couple decades of research stand between us and the empathic, tech-supported future. Khosla expects a 20-year evolution, starting with systems that just recommend questions to rule out rare conditions, and devices to monitor patients. More specific interventions will come with the growth of data. Another speaker pointed out that recommendation systems are currently good enough to recommend movies we might like, but not to recommend what medication we should take.

A lot of data crunching in the health care space goes to predictions that have dubious validity and may even be obnoxious, such as guessing what your health patterns will be on the basis of your credit rating or the kind of car you drive. Thomas Goetz, former editor of WIRED Magazine and now an investor in medical research, stressed the importance of treating patients as partners if we want them to participate in big data research efforts. The subjects of experiments will demand full transparency about what we’re looking for.

The obverse of the coin was persuasively delivered by Ezekiel Emanuel from the University of Pennsylvania, the self-declared token techno-skeptic at the conference. He laid out a few narrow areas where we can expect technology to improve outcomes (or at least reduce costs) over the forseeable future: medication adherence (although he also wise-cracked that most people would do better on half their current medications) and preventing a useless trip to the hospital during the final weeks of life. Everything else we try to do relies on a long chain of technological and workflow changes that will be hard to put into place.

But mainly conference speakers firmly believe that technology is already making a difference, and are building businesses around them. Technologist Rosalind Picard found a possible indicator of epilectic seizures that had been missed by clinical research. Muse makes a headband that trains you to relax by showing your brain waves. And the social aspect of health is being avidly addressed, whether through simple phone calls to isolated elderly people (The Silver Line in Britain) or helping people with mental health problems communicate online anonymously (Big White Wall).

The anonymous communities of Big White Wall, of course, update practices that go back to the earliest days when ordinary people got onto the Internet in the 1980s. And the practice seems to work: CEO Jen Hyatt says that 73% of members share an issue there for the first time in their lives, and 95% of members report feeling better.

The final section of this article will generalize what I discovered at the conference.

Connected Health Conference Tops Itself–But How Broad is Adoption? Part 1 of 3

Posted on November 5, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Along the teeming circuit of health care conferences that Boston enjoys year-round, a special place is occupied by the Connected Health Conference sponsored by Massachusetts giant Partners HealthCare. For 12 years this conference, shepherded by the spirited Joseph Kvedar, has shown Boston and the rest of the world what can be accomplished by the integration of data, technology, and clinical empathy.

But people I talked to at the conference were asking: where’s change visible in the health care field? Why aren’t we seeing these great things adopted throughout the country to support value-based care? The much-vaunted Accountable Care Organization model is failing to thrive, interoperability continues to elude medical sites, and consequently, health care costs are “eating” American’s incomes.

The way forward may have been shown by the two final keynotes of the conference, delivered by executives at Massachusetts General Hospital (one of the central institutions in Partners HealthCare and a destination for patients around the world).

Chief Clinical Officer Gregg Meyer referred to “punctuated evolution” to suggest that the health care field is at an “inflection point” where change is starting to happen fast. What makes this change hard is that two major initiatives separate most health care institutions from the fee-for-value world we want. One initiative focuses on organizational change and payment regimes, whereas the other involves wrenching changes to technology that track, record, and analyze what doctors and patients are doing.

I believe the reason many ACOs and other fee-for-value systems are failing (or at least not showing cost improvements) is that they took on the organizational change before they were ready with the technological parts. According to Meyer, Massachusetts General Hospital took on the technological change first, years before a payment system was offered that reimburses them for it.

Many speakers at the conference pointed to recent payment changes, such as Medicare Advantage, that promote fee-for-value. Programs along those lines in Massachusetts have shown modest headway against costs.

Even so, MGH has made only some early steps in health IT. Some doctors allow virtual visits, but it’s not done strategically and most providers don’t understand that such visits could reduce their workloads in the long run. Chief Health Information Officer O’Neil Britton said that the Epic EHR they installed still can’t accept streaming data. But he vaunted MGH’s growing use of genomics, wearables, video information delivery, and telehealth. The use of video was praised frequently at the conference for bringing information to people when they need it and reducing office visits that are costly and inconvenient for everyone.

The next section of this article will contrast techno-optimists with techno-skeptics and mention some advances reported at the conference.