Wednesday, June 08, 2016

#CM4H16 @jhalamka presenting to Connecting Michigan conference

John Halamka – Via Video Conference

Worked under 5 different ONC Leaders

Keynote Address – A Perfect Storm for Innovation

Dr. John Halamka, Chief Information Officer, Beth Israel Deaconess Medical Center

2016 is becoming a perfect storm for innovation – changes in payment policy, new standards, and patient/family expectations are enabling an ecosystem of apps that will change healthcare IT capabilities. Dr. Halamka will review where we’ve been, where we’re going, and how we’ll get there.

Consistent Ideas:

  • Interoperability
  • Engaging Consumers/Patients

Meaningful Use:
MU V1 was useful

MU2 Pre-supposed infrastructures that weren’t there.

eg. Using Direct protocols without a directory. Patient Consent.

Enabling Infrastructure is needed.

Now the push is to outcome-based approach rather than process-based.

More flexibility. Enabling Innovation.

CMS driving with MACRA and MIPS


Remember the CCR v CCD wars – is your XML better than mine….

Vocabularies and Crosswalks are now in place.

Problem lists and Medications can now traverse EHRs.

The Challenge is that the basis is CCD/CCD-A. Straightforward to create but hard to parse (Too much optionality).

Need to simplify and reduce optionality. Argonaut is the result.

JASON – secret scientist group tasked to define how to fix healthcare.

Argonaut is making good progress.

Patients and Families are important for interoperability

Interoperability: Send to the Patient. Let them choose where they send it.

Patient mediated Information exchange is important.

Apple Strategy

  • Health kit
  • Research Kit
  • Care Kit

All on your phone and in your home. You decide who you share what data elements with.

Care Kit – Includes subjective data.
Care plans and care plan tracking.

Too much data – not enough wisdom

What are the actionable issues that need to be addressed.
Collect data but only alert on actionable changes.

Focus on the wellness of the patient at home.

Requires Patient Generated Data as well as EMR data.

Cloud and Mobile

Doctors want Agile EHRs

Cloud-based, web accessible EHRs on a subscription basis is attractive.

AWS will sign a BAA.

Fixing MU

140 elements needed for Meaningful use certification for each encounter. Clinical Quality measures. 40% of clinicians feel burned out.

EHR 80% Adoption. But 453 clicks to admit a patient.

Value-based purchasing

Do we have the tools we need.

most tools are developed in PowerPoint…. :)

Citrix is NOT a mobile app! :)

Cloud/Mobile – We need to accept that risk can never be zero.

Interoperability: We can do reasonable push but not enough infrastructure for pull.

What can we do better?

Patient Generated data going from device to phone to EHR.

I2B2 is available for Free. Querying datasets across systems exist today. Barriers are policy and politics.

Average cost of a data breach is $300 per record breached.

Meaningful Use

MU has run its course.
Doctors are burned out.

Doctors will consider – Pay for Quality. Give them flexibility.

Process does not equal outcomes.

Declare victory on MU and move to a focus on outcomes.

Certification has run it’s course.

We now have such a burdensome level of certification that it takes 2-3 years to deal with certification criteria.

Innovation agenda has been co-opted by the certification rules.

Information Blocking

“like the Loch Ness monster”

What we need are the technology infrastructures.

  • National Provider Directory
  • Voluntary Patient Id
  • Trust fabric

The Future

Team-based workflows.
Teams including patient and families.

Return innovation to the private sector.

Time for Government to define outcomes and hand over to private sector to innovate.

Outcomes need to include patient and family input

MA created Provider participation Agreement to enable a Trust Fabric. This is a great role for State organizations.

[category News, Health]
[tag health, cloud, ONC, opendata, hdpalooza, blue button, CM4H16]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Stay up-to-date: Twitter @ekivemark

I am currently HHS Entrepreneur-in-Residence and CMS BlueButton Innovator working on an assignment to update BlueButton for Medicare Beneficiaries.

The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less Hassle, Better Care.

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