BOSTON – Health IT leaders at the Healthcare Experience Design conference and the Harvard School of Public Health's HIT innovation conference gave industry stakeholders a peek into what they hope to accomplish this summer with initiatives that include meaningful use stage 2 and the event that's become known by its unofficial name, the Health Datapalooza.
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The idea, they said, is to shift health information exchange (HIE) into high gear and get patients more involved in using that newly exchanged data. On top of that, the federal government is liberating as many public data sets as it can, some of it long kept in proprietary systems, so private companies can use and remix the data in ways that help them promote their own enterprise.
Finally, said Ashish Jha, M.D., health IT policy expert and special advisor for quality and safety to the Department of Veterans Affairs, it would be nice to see health care finally put a hurt on the fax machine, though it's not an official goal.
In the near term he sees little threat to that 1970s tech dinosaur. "The health care industry has singlehandedly kept the fax-machine industry alive," Jha said, "and I think that is unfortunate. I have nothing against the fax-machine industry, but I think that we need to stop supporting them."
Moving forward, the biggest health IT challenges include building infrastructure, data standards consensus and privacy structure to enable nationwide health data exchange, Jha said.
"There's a lot of enthusiasm, a lot of support, a lot of agreement," he said, "but I think the fax-machine makers are safe for a while. Very little health information exchange is actually happening."
Meaningful use stage 2 final rule coming in August?
Beth Israel Deaconess Medical Center CIO John Halamka M.D., whose team is tasked with building infrastructure to support care coordination for an accountable care organization (ACO), said HIE and patient data analytics will be the backbone driving federal health reform. In introducing federal health IT coordinator Farzad Mostashari, M.D., Halamka said meaningful use stage 2's tenets will help spur the construction of needed infrastructure and force competing hospitals to cooperate for the sake of patients.
"The reason we're going to get to this nirvana of [ACOs] is because Farzad and his organization, in stage 2, gets real. Stage 1 was…'Get us going, get started, get electronic health records, retire some paper,'" Halamka said.
Meaningful use stage 2, meanwhile, actually forces Beth Israel Deaconess and competitor Partners Healthcare to send data across Longwood Avenue. "It's no longer a competition issue, it's actually a survival issue," he said.
Halamka predicted "massive amounts" of data sharing and analytics starting in the next year, thanks to the meaningful use stage 2 final rule that he said should be out in August.
Mostashari: Not about technology, but the actions people take
For his part, Mostashari said in his keynote that his Office of the National Coordinator for Health IT (ONC) is working toward aligning meaningful use with other programs that have concrete goals, such as ACOs and the Million Hearts initiative, which is striving to prevent a million heart attacks and strokes over the next five years. The goal is to spur action via technology, not vice versa.
Implementing health IT initiatives is complicated, he added, but achievable with hard work. In the meaningful use stage 2 proposed rule, ONC is pushing standards-based HIE in order to create an ecosystem where technology can let public health agencies and small providers begin participating in HIE alongside the larger providers further down the road.
"We're implementing, as a country," Mostashari said, citing the system of regional extension centers that did not exist two years ago but which is now serving tens of thousands of physicians, many of them rural. He also gave credit to software vendors, who he said are constantly tweaking processes such as patient smoking status reporting for public health purposes, as that particular workflow's developing.
"I think what we need with meaningful use is to stay the course. We need to provide that regulatory predictability, working with our federal advisory committees," Mostashari said. "We've had a meeting, on average, every other day for the past three years. That [process] gives regulatory predictability, it lets people see that this is a long-term journey, and that we're going to get there -- slowly."
Consumers, industry spurred by mHealth, open health data initiatives
Mostashari, at Harvard, remarked that consumer health initiatives were evolving at a "mind-boggling" pace, much faster than on the provider side. It's important that health IT implementation not get in the way of this progress. Providers must liberate patient data so that patients can take it away and be free to remix it as they please on what may ultimately end up being whole new platforms.
I think what we need with meaningful use is to stay the course. We need to provide that regulatory predictability, working with our federal advisory committees.
Farzad Mostashari, M.D., national coordinator for health IT
Across town the previous week, Mostashari's former Health and Human Services colleague Todd Park -- recently named White House CTO after three years in the same capacity at HHS -- demonstrated how federal open health data initiatives were spurring private enterprise to incorporate publicly available health data into new applications to help the health care sector, and patients themselves, improve outcomes and foster research.
HHS is sponsoring the Health Datapalooza June 5 and 6 in Washington, D.C., to give entrepreneurs a taste of what they might do with open health data sets from federal agencies such as the Food and Drug Administration, National Institutes of Health, Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services.
Park said he hopes to promulgate the use of open health data in new ways, much like the National Oceanic and Atmospheric Administration spreads its publicly-accessible weather data that's become ubiquitous in Web sites and smartphone apps.
"[We want to] liberate it, make it available, make it known, so innovators can turn it into all kinds of magic that we never could," Park said.