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White House Announces New Precision Medicine Commitments

White House Announces New Precision Medicine Commitments | Healthcare and Technology news |

The Obama Administration has announced new commitments to its precision medicine initiative (PMI) that it unveiled six months ago.

The initiative, which President Barack Obama touched on in his State of the Union address in January, aims to pioneer a new model of patient-powered research to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to select which treatments will work best for which patients.

This week, the Administration launched new commitments, which include:

Guiding Principles for Protecting Privacy and Building Trust: The White House is unveiling draft PMI guiding principles that seek to build privacy into the design of the PMI research cohort, which will include one million or more Americans who agree to share data about their health. The White House is seeking public feedback on the privacy and trust principles online through August 7, 2015.

New Tools for Patients: In collaboration with federal partners, the Department of Health and Human Services Office of the National Coordinator for Health IT (ONC) and Office for Civil Rights (OCR) will work to address barriers that prevent patients from accessing their health data. OCR will develop additional guidance materials to educate the public and health care providers about a patient’s right to access his or her health information under the Health Insurance Portability and Accountability Act (HIPAA).

Research Awards to Unlock Data Insights: The Department of Veteran Affairs (VA) is announcing awards to support four research projects on key questions relevant to precision medicine using the rich data from the Million Veterans Program (MVP), the largest U.S. repository of genetic, clinical, lifestyle and military exposure data.

Additionally, private sector commitments related to the initiative launched this week include:

Duke Center for Applied Genomics and Precision Medicine: Duke has developed a platform called MeTree that helps individuals have challenging but necessary conversations with loved ones and care providers about family health histories, so that physicians can tailor care to patients’ unique risk profiles.

Flip the Clinic: Flip the Clinic, a project of the Robert Wood Johnson Foundation, is announcing a collaboration with more than 160,000 clinicians and staff practicing at sites across the United States, who have pledged to inform patients about their right to get digital copies of their medical records.

Genetic Alliance: Along with collaborators, such as Cerner, Genetic Alliance is launching new capabilities for Platform for Engaging Everyone Responsibly (PEER), a data registry that empowers participants to share their data with medical researchers, advocacy groups, and others.

GetMyHealthData: The GetMyHealthData campaign is pledging to help thousands of consumers over the next 12 months access and download their own clinical health data, so they can use it to understand and improve their health, their care, and the system as a whole—including donating their data for research.

Sage Bionetworks: Recognizing the importance of health-data liberation, and the role of data in driving research studies, Sage Bionetworks is announcing that it will support clinical studies that import electronic health-record information to its open source research platform and that it will release open-source informed-consent prototypes to support these studies.

The White House also is honoring "Champions of Change" in precision medicine, which includes nine individuals who are working to use data and innovation to improve healthcare.

Sophia Nguyen's curator insight, July 24, 2015 7:55 AM

I found this interesting because it shows how important the world of healthcare and how the president has taken notice that it's important for consumers to understand their health and take charge of it.!

In Colorado, a Collaboration Around Healthcare Technology

In Colorado, a Collaboration Around Healthcare Technology | Healthcare and Technology news |

Across the country, technology and clinical leaders are figuring out ways to try to promote greater interoperability of healthcare data. For seemingly everyone, it’s been an uphill climb and a steep learning curve. In the U.S., there have been pockets of success; some states are at the forefront of true data exchange, while others aren’t quite as mature.

 In one of these pockets is Colorado, where the Denver-based Colorado Regional Health Information Organization (CORHIO) recently announced that its health information exchange (HIE) has grown in number of users by 111 percent, with the amount of data available in the network having grown by 118 percent in the past year. That marks the third consecutive year of triple-digit growth rates for the organization, which, as of a few months ago, encompasses 5,705 active providers/users, 47 connected hospitals, and with more than 223 million clinical messages having been sent.

To this end, also in Colorado are the Englewood-based Centura Health (with hospitals also spanning across Western Kansas) and the Aurora-based University of Colorado Health (UC Health), two organizations that will be represented at the iHT2 Health IT Summit in Denver on July 21 (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC). At the conference will be a panel on “Strategies to Advance Interoperability,” where Steve Hess, CIO at University of Colorado Health and Dana Moore, senior vice president/CIO and managing director, service center, at Centura Health, among others, will address the most effective models and mechanisms for exchanging data.

In Aurora, University of Colorado Health came together as a unified system about three years ago when all of its IT components collapsed into one core set which included the Verona, Wis.-based Epic Systems as the organization’s core electronic health record (EHR), Hess says, who says the health system’s HIE strategy is multi-faceted. “We do offer hosting Epic for independent community practices that want to use our EHR for their own continuity of care and clinical collaboration needs,” Hess says. “We also use a built-in HIE, Epic’s Care Everywhere, to exchange records, and that works very well for Epic-to-Epic health information exchange. We have exchanged records with systems in all 50 states using that methodology,” Hess says.

UC Health is also a part of CORHIO, and that’s where a lot of statewide collaboration has occurred. “There is exchange of not only demographics, labs and discharge summaries, but also immunization and public health interfaces through the HIE,” Hess says. “We are on a journey of health information exchange, and we’re fairly early on that journey. Exchange is happening but the next generation functionalities of orders and results, exchanging CCDs (continuity of care documents), things like that, are still in the early stages,” he says.  “In the meantime, we collectively look at technology not as a competitive advantage but a way to help patient care, doctors, and nurses across the state and beyond. We know our organizations will compete in terms of quality and service and other things, but we’re trying out best not to compete with technology.”

Meanwhile, at Centura Health, Moore says that the organization initially started its own private HIE in 2005 with a company that is now part of Cerner’s arsenal, but wasn’t even an established vendor at the time. Once CORHIO came around, however, Centura quickly migrated over. “We didn’t want to have a competing product and wanted to promote collaboration within the state. When CORHIO was in its infancy, Steve [Hess] and I were frequently helping them build its model,” Moore says. Then, in 2006, Centura installed the Westwood, Mass.-based MEDITECH EHR across its acute care facilities first, eventually expanding into ambulatory and home care. Now, Centura, which did receive Healthcare Information and Management Systems Society (HIMSS) Stage 7 designation, is in the process of switching over to Epic, Moore notes.

Bringing the Data to the Doctor

For both UC Health and Centura, the key to successful health IT adoption and electronic data exchange is that this time around, the HIE brings data into the physician’s workflow so he or she doesn’t have to leave that workflow to see the data. “Success is always relative, and one of the big issues with HIE in Colorado five or 10 years ago was workflow,” Moore says. “Clinicians had to go out of their workflow and try to find the patient. From a user standpoint, it wasn’t successful. The advancements we made getting HIE in their workflow have proven that we are leaps and bounds from where we were,” he says.

Hess agrees that keeping clinicians in the workflow that they use predominantly is crucial. “With CORHIO’s and Epic’s tools, the idea is to bring the data within the workflow of the doctor rather than make them go out of it. There has been a lot of interface work around that,” he says. As such, UC Health has approximately 800,000 records exchanged electronically each year, Hess says, noting that examples of the data being exchanged include complete patient records, CCD summaries, electronic lab results, and immunization and syndromic surveillance exchange.

Despite successes at both organizations, Hess and Moore understand that there is still a ways to go before true interoperability is achieved. For one, Hess says that not having universal patient identifiers will continue to be a struggle for everyone. “A big part in what all these things require is knowing which patient is which,” he says. “Having to pull our different medical record and encounter numbers and hope/make sure that we’re sending data on the right patient is a struggle that might never be solved in our lifetime.”

Hess adds that if you think about the old way of exchanging records where one facility called another and got a 36-page fax of patient data sent over, oftentimes the person trying to pull the clinically relevant data from that fax wasn’t the doctor. “As a result, sometimes that data would go ignored,” Hess says. “So now our struggle will be separating the noise from the gold. If we get 10 CCDs on 10 different encounters across four different care settings, how do we take all that data and turn it into information for the clinicians? I don’t want to have a bunch of CCDs acting like a stack of a paper on a fax machine,” he says.

 This, Hess says, is the next big hurdle, what he calls “HIE 3.0.” He says, “We need to figure out how to stratify the data and present it in manner that allows clinicians to do the right thing with it. If we’re not careful we can overwhelm them and they could potentially ignore the data like they did with the faxes.”

Moore adds that another pitfall is getting providers on board to the HIE. While he notes that most of the major hospitals in Colorado are on CORHIO, there are still some that are not, and that’s a problem, he says. “Also, we talk about CORHIO and that is great, but we have hospitals that border the state too; we actually have a hospital in Kansas right now,” he says. “It’s great that Epic talks across all 50 states, but getting all of these HIEs to talk to each other has been a big challenge, which is ironic since that’s what they’re designed to do.”

Moving forward, a major part of the solution is collaboration on the part of providers as well as vendors, Moore says. “A lot of the onus is on the providers, as we need to be the ones at table bringing people together and removing roadblocks. Vendors respond to the market, so if we as providers—their ultimate customers—demand collaboration and exchange, then they’ll have to respond,” he says.  He adds that close-minded vendors are also part of the problem. “This vendor needs to exchange information with this one and you try to bring two competitors to the table. That’s not easy,” he says.

As such, according to Hess, a lot of vendors see their technology as a competitive advantage. Organizations that do this, rather than use their service or quality as the advantage, are slow to the collaboration table because they don’t want to level the playing field, Hess says. “But we all need to do things in similar ways, and our service and quality will be what brings doctors and patients to us. We need vendors and providers to say ‘we need to level the technology playing field.’ We really need to push that. When someone who is influential goes off that path and starts to do things differently, we get in trouble,” Hess says.

Moore adds that while nationwide interoperability efforts such as CommonWell have popped up, they might not be in it for the greater good as much as some people think. “I’m not necessarily buying that it’s for the greater good, but rather for a competitive advantage or a response to Epic’s Care Everywhere [product]. It would be great if all the vendors got together to make HIE transparent across all platforms without a third party, as that would make everyone’s life easier. But I don’t see that happening. I see them continuing to compete to try to gain market share,” Moore says.

Nonetheless, Hess warns that complete consolidation on one EHR vendor such as Epic or Cerner wouldn’t good either, as that could stifle innovation. “Some of these vendors are expensive and will never get into the small hospitals, the moms-and-pops,” he says. “We have to come up with better ways to share data. This is a journey; if you look back on HIE five years ago compared with today, people would be amazed with the progress. At the same time, we all wish it would be easier,” he says.

Back in Colorado, Moore notes that the healthcare IT leaders in the state meet quarterly, pick up the phone often, and collaborate to ensure the residents of the state get the absolute best care from a technology standpoint. “We want to make sure that the tools we provide our providers with are the absolute best,” he says. Hess, who has been in the state for six years after living in the Mid-Atlantic region, adds that the penetration of robust, mature adoption of health IT in care setting is pretty deep in Colorado. “Without that deep maturity level the collaboration conversations would be much harder,” Hess says. “The combination of the collaboration that goes on and the health IT adoption is a pretty powerful formula.”

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PA’s Health Information Exchange Awards $674K to Hospitals

PA’s Health Information Exchange Awards $674K to Hospitals | Healthcare and Technology news |

The institution of a health information exchange (HIE) is imperative for the healthcare industry, as it allows for effective data sharing among multiple medical facilities located on opposite sides of the country and coordinates care throughout patient-centered medical homes, accountable care organizations (ACOs), and other healthcare settings.

The Penssylvania e-Health Partnership Authority is one such health information exchange institution, which has recently awarded onboarding grants of more than $674,000.00 to connect multiple hospitals and other healthcare providers including ambulatory care practices to its Pennsylvania Patient & Provider Network (P3N), according to a company press release.

Approximately $67,000 of the awards come from state funding while about $607,000 comes from federal funds. The program’s funding comes from the Centers for Medicare & Medicaid Services (CMS) and is being awarded with the assistance of the Pennsylvania Department of Human Services.
By integrating provider networks to health information organizations (HIOs), the P3N creates a strong system for electronic health information exchange. The release states that $355,000 is being awarded to the HealthShare Exchange of Southeastern Pennsylvania.

“The benefits of eHIE to patients and providers are significant,” Alix Goss, Executive Director of the Authority, stated in the press release. “This grant program is critical to helping providers connect to HIOs, and HIOs connect to the P3N.”

“As more HIOs join the P3N along with their connected providers, more patients will experience better coordination of their care, faster access to their clinical results, and reduced redundancy of medical tests,” Goss continued. “The bottom line for patients, providers, and the healthcare system will be improved patient safety and healthcare quality.”

These onboarding grants are helpful in terms of supporting sustainability among private-sector HIOs and assisting in increasing its membership. Additionally, the program brings about a stronger emphasis on the participation in electronic health information exchange, supporting healthcare reforms, and offering high-quality healthcare services.

The performance period for this grant ends on September 30, 2015 and is part of the Medicaid EHR Incentive Program. The onboarding grant funding itself is covered mostly by CMS while the Authority covers 10 percent of it.

Spreading health information exchange platforms throughout the nation is vital in the industry’s efforts to reduce medical errors, support population health management, improve care coordination, and offer better quality care.

While health information exchange remains vital to improving medical care services, there are certain regions throughout the United States that have not embraced the use of HIE platforms. Rhode Island is one example. Go Local Prov reports that as many as eight out of ten physicians in Rhode Island are not using the state’s health information exchange. Rhode Island Medical Society Government Relations Director Steven DeToy explained some of the reasons for the low numbers of health information exchange adoption.

"First, not every physician has a computer that they use for EHRs," DeToy told the news source. "Second, some of those who do, have a system that isn't CurrentCare compatible as of right now, but hopefully will be. There have been some proprietary issues. Certain EHRs don't allow physicians to prescribe electronically.”

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Mobile has put patients in the driver's seat. Here's how.

Mobile has put patients in the driver's seat. Here's how. | Healthcare and Technology news |

Many people used to believe that Facebook was an extremely defensible business and that it would be almost impossible for another social network to compete.

It has grown to an enormous scale with massive troves of data and more than 1.5 billion monthly users. The thinking around their defensibility was that because all of your friends and photos and updates are already stored on Facebook, it would be tedious and unnecessary to switch to another social network. Everything you need is there. Why go somewhere else?

Facebook did have quite a bit of defensibility back when the predominant access point to the service was the desktop web. Moving your data to a new social network was painful and impractical. But now that the main access point to social is our mobile phone (more than half of Facebook’s traffic comes through mobile) things have changed dramatically.

We now carry around all of the key elements of a social network on our cell phones. Our phones carry our location, our photos, and our address book and allow us to message anyone at no cost from anywhere in the world. With the click of the touchscreen, we can view and connect with all of our friends on a new social network and instantly recreate our social graph. We can take a photo and instantly send it to a multiple social networks. We can easily join different social networks with different groups of friends focused around different needs. The friction of leaving Facebook and joining a new network has disappeared. This wasn’t possible with the desktop web, or it was at least much more difficult.

As a result of the increasing use of mobile, we’ve seen lots of new social networks emerge. (There are now dozens of social networking apps with 1 million+ downloads in Apple’s App store, including Kik, WhatsApp, Tumblr, Google+, Instagram, Snapchat and many others.)

This increased use of mobile has reduced the friction of launching a new social network to near zero and, as a result, has shifted ownership of data away from the network and back to the individual. Trying to own the data and lock-in the consumer is no longer a viable strategy.

Facebook is well aware of this and has adjusted by rapidly buying up many of these new networks. We’ll likely see more acquisitions like these in the months to come.

Over the last several years, large health care provider organizations and health care software vendors have been employing a similar strategy to that of Facebook. Health systems have been growing by buying up ambulatory, community-based sites and employing doctors to build out giant systems that can offer clinical services across the entire continuum of caregiving the patient no reason to go anywhere else. In parallel, providers and software vendors have been creating a single patient record (including blood tests, physician notes, imaging and other data) that flows across the entire provider organization and can be easily shared with providers across the system. This avoids all of the classic frustration associated with having to fax your x-rays from one provider to another. Everything exists on the web in one single record. Providers then roll out a patient-facing portal that lays across the patient record where the patient can access all of their data (mostly through the desktop Web).

The strategy is simple. Providers are telling the patient to 1) stay with us because we do everything, and you don’t need to go anywhere else; and, 2) you can’t go anywhere else because we have all of your data.

But as we saw with Facebook, now that a consumer’s primary entry point to the web is their mobile phone, this strategy has some flaws.

Not only do our phones enable messaging and carry our location and address book and photos, they can also carry data on our movement, our sleep, our heart-rate, the prescriptions we’re taking, our body temperature and, with the use of implanted devices, much, much more. This real-time data that we carry on our phones is arguably more valuable than the data stored in our clinician’s patient record that only gets refreshed while we’re sitting in the examination room.

Increasingly, providers will own some patient data but the patient will own more data and better data.

Like Facebook, health care providers are trying lock in their customer by owning the data. But the increasing use of mobile has changed the game. Just like social network users can effortlessly syndicate their own data out to multiple social networks, a patient will be able to syndicate their real-time clinically relevant data out to multiple providers, regardless of which system they’re associated with.

Mobile has put patients in the driver’s seat.

Meanwhile, with the emergence of home care and telehealth and urgent care clinics and apps and implants that manage more serious and chronic conditions, in many ways health care has actually become more fragmented. The traditional providers may be consolidating, but new players are creating new channels for care and causing more fragmentation across the industry. Where and when and how care is delivered is being completely reshaped.

But unlike Facebook, large health care providers can’t buy their way out of this conundrum. First, because they don’t have enough cash (most are non-profits with microscopic profit margins) and second because health care is local. Health systems are no longer just competing with the hospital across the street; they’re competing with web services that are available to the global market.

As a result, large provider organizations are going to have to consider new ways of providing value and will have to select which segments of patients they want to serve.

In short, they can’t own the patient because they can’t own the data.

The idea of locking the patient into one network of providers was always a bit flimsy. But the strategy was somewhat understandable. A lot of this was driven by the trend towards value-based payments and the convenience of ‘owning’ a patient under that model.

But the lessons of Facebook are clear. Locking up the data is not a path to success.

Social networks and health care providers must focus on what they do best and focus on serving the consumer they want to serve and abandon their attempts to win by owning data that isn’t theirs to own.

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The Security Risks of Medical Devices

The Security Risks of Medical Devices | Healthcare and Technology news |
There are a large number of potential attack vectors on any network. Medical devices on a healthcare network is certainly one of them. While medical devices represent a potential threat, it is important to keep in mind that the threat level posed by any given medical device should be determined by a Security Risk Assessment (SRA) and dealt with appropriately.

So let’s assume the worst case and discuss the issues associated with medical devices. First off, it must be recognized that any device connected to a network represents a potential incursion point. Medical devices are regulated by the FDA, and that agency realized the security implications of medical devices as far back as November 2009, when it issued this advisory. In it, the FDA emphasized the following points:

Medical device manufacturers and user facilities should work together to ensure that cybersecurity threats are addressed in a timely manner.
The agency typically does not need to review or approve medical device software changes made for cybersecurity reasons.
All software changes that address cybersecurity threats should be validated before installation to ensure they do not affect the safety and effectiveness of the medical devices.

Software patches and updates are essential to the continued safe and effective performance of medical devices.

Many device manufacturers are way behind on cybersecurity issues. As an example, many devices are still running on Windows XP today, even though we are one year past the XP support deadline. They are often loathe to update their software for a new operating system. In other situations device manufacturers use the XP support issue as a way to force a client to purchase a new device at a very high price. All healthcare facilities would be well advised to review any purchase and support contracts for medical devices and make sure that things such as Windows upgrades do not force unwanted or unnecessary changes down the road. While there are options to remediate risks around obsolete operating systems, they are unnecessary and costly. Manufacturers should be supporting their products in a commercially reasonable manner.

Why would anyone be interested in hacking into a medical device? Of course there are those that would argue that anything that can be hacked will be hacked, “just because”. While it is possible that hacking could also occur to disrupt the operations of the device, the more likely reason is that getting onto a medical device represents a backdoor into a network with a treasure trove of PHI that can be sold for high prices on the black market. Medical devices are often accessible outside of normal network logon requirements. That is because manufacturers maintain separate, backdoor access for maintenance reasons.

Hackers armed with knowledge of default passwords and other default logon information can have great success targeting a medical device. For example, this article details examples of a blood gas analyzer, a PACS system and an X-Ray system that were hacked. Many times healthcare IT departments are unaware or unable to remediate backdoor access to these systems. These are perhaps more “valuable” as a hack because they are hard to detect and can go unnoticed for a long period of time. As a reminder, the Target data breach last year was initiated because the access that a third party had to the retailer’s network was compromised. A complete SRA should inventory all network connected medical devices and analyze the access/credentials that a device has, and any associated security threat. The best defense is a good offense – make sure that networked devices have proper security built in and implemented. Then your devices will no longer be “the weak link in the chain”.

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Beyond games, Oculus virtual reality headset finds medical uses

Beyond games, Oculus virtual reality headset finds medical uses | Healthcare and Technology news |

To help treat soldiers with post-traumatic stress disorder, Jennifer Patterson turned to a gadget typically associated with video games: the virtual reality headset from Oculus, a company Facebook Inc bought for $2 billion last year.

Patterson, an engineering student at the University of Pittsburgh, studied a software used on the prototype of the head-mounted display that creates virtual settings, such as a Middle Eastern-themed city or desert road, that soldiers would otherwise avoid, as a way to help them recover from their PTSD.

She hopes doctors and therapists around the country will better understand how the technology can be helpful to their own patients.

Patterson is one of a handful of researchers who have used the display for experimental treatments and studies that range from treating glaucoma patients to easing pain in burn victims.

While there are no estimates of the potential size of the market for virtual reality applications in the health care field, analysts say that success in this area would likely spur even broader adoption in a range of industries, such as education, fashion, media and telecommunications.

The potential size of those markets is quite large, possibly surpassing $5 billion over the next three years, according to some estimates, especially as the gadget's uses extend far beyond gaming.

Facebook CEO Mark Zuckerberg has said he views virtual reality as the next major computing platform, and he is working hard to ensure that it is. While Oculus headsets will not be available to consumers until 2016, the company has made prototypes of the system available to developers since 2013, with the expectation that an array of applications will be available to those buying headsets after the formal launch.

The company plans to hold a news event Thursday in San Francisco but has not specified what it will announce. It declined to comment for this story.

Virtual reality is not new to medicine or therapy, but its affordability is. Doctors and researchers often shell out $30,000 to more than $300,000 for medical headsets and simulators while the Oculus is available to developers for $350 to $400.

The more expensive medical virtual reality sets will still be needed for certain studies, doctors and researchers said, because of their accuracy in detecting sensitive movements and because patients with severe facial burns cannot use a head-mounted Oculus device.

But they still expect the Oculus Rift and other cheaper virtual reality headsets to quickly replace the expensive ones.

"As more and more companies get involved in this, we will keep seeing inexpensive and very accurate systems," said Felipe Medeiros, a professor at the University of California San Diego who used the Oculus device to evaluate patients with glaucoma, a disease of the eye's optic nerve.


Other companies, including Sony Corp, Samsung Electronics Co Ltd, Microsoft Corp, Google Inc and HTC Corp have either already released virtual reality headsets or plan to do so in the next year.

Oculus, however, has already distributed more than 100,000 units of its developer version. This is more than has been available in the history of virtual reality, giving it early brand recognition among medical researchers, analysts said.

"Oculus has basically jumped out in front," said Hunter Hoffman, a virtual reality researcher at the University of Washington Seattle who used the Oculus Rift to ease severe pain in an 11-year-old burn victim.

Some headsets, such as Sony's Morpheus, are built exclusively for video games. Oculus, however, allows researchers and developers to create their own software, whether for specialized applications like health care or for video games.

In Medeiros's study, for example, he evaluated patients with glaucoma. He created a simulated environment that made patients feel as though they were moving through a tunnel and then studied their bodies' responses.

That helped researchers predict the likelihood of a fall for glaucoma patients, allowing doctors to teach them how to avoid it.

Medeiros and other researchers said future studies will compare the inexpensive headsets against one another. But because of Oculus's early availability, it has already become the most popular headset.

"Oculus has done a great job of keeping themselves front and center and making themselves the product that everyone has to be compared against," said Brian Blau, Gartner research director.

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HHS, CVS Partner for Personalized Preventive Care

HHS, CVS Partner for Personalized Preventive Care | Healthcare and Technology news |

The U.S. Department of Health and Human Services (HHS) and CVS are collaborating to promote an online tool that provides recommendations for the personalized preventive services patients should receive based on their age and gender. 

Many of these preventive services are available to patients at MinuteClinic and CVS/pharmacy locations, as well as at their physician's office, and many are now covered by most insurance without additional co-pays or other cost sharing under the Affordable Care Act. The recommendations, officials say, come from government-recognized clinical experts.

Announced this week at Health Datapolooza 2015 in Washington, D.C., CVS Health says it is the first national partner to work with HHS to take advantage of the technology-based tools, developed within the Department by the Office of Disease Prevention and Health Promotion, which make it possible for the myhealthfinder tool to be available on and at

Commonly recommended preventive services available at MinuteClinic include blood pressure checks, cholesterol screenings, wellness counseling and routine vaccinations. In a blog post accompanying the announcement, Acting Assistant Secretary for Health (ASH) and National Coordinator for Health Information Technology (ONC) Karen DeSalvo, M.D. said, “Our collaboration with CVS Health was made possible by one of our projects that has been an example of innovation in the federal government since 1997. Nearly two decades ago, was the first government website designed to share health information with consumers and improve health literacy.

Since then, the Office of Disease Prevention and Health Promotion within HHS has developed the current website into a trusted, credible source for easy-to-understand prevention and wellness information. Through myhealthfinder, an interactive tool available on the website, you can enter your age, sex, and pregnancy status to receive customized wellness and prevention information along with steps you can take with your provider and at home to prevent illnesses and improve your health.”

What’s more, DeSalvo said, “To make myhealthfinder more readily available to more people, we recently developed a free, publically available application programming interface (API) to integrate the tool into any website. The API imports up-to-date information directly from This tool supports physicians and the care team, and is an easy way to help people understand the recommended preventive services that are often available to them at no out of pocket cost thanks to the Affordable Care Act,” DeSalvo said.

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This is the key quality for any health care provider

This is the key quality for any health care provider | Healthcare and Technology news |

Often I hear comments from people who have been treated for cancer and other illnesses talking about the things they wish they knew, or things they wish their doctors would have shared with them about their treatments or conditions.

I don’t have to remind anyone there is a tremendous amount of anxiety and fear when you are diagnosed with cancer or any other perceived or potentially life-threatening illness.

Our health care system has been changing quickly over the past several years and everyone, patients, physicians, nurses, and other health care providers have been scrambling to keep up and learn the ropes as rules, insurance coverage, government reporting requirements, and technology change.

One of the key qualities that a health care provider needs is resourcefulness. In health care terms, that translates to the ability to know where to find the information, even if the providers themselves do not know the answers.

A resourceful health care provider is willing to learn, listens to both patients and professionals outside of his or her scope of practice, reaches out into the community beyond their immediate circle of professional colleagues trained in the same way, recognizes a patient in need, and knows when to refer that patient to the appropriate resources. Resourcefulness saves time, money, and can reduce a lot of suffering.

The old paternalistic model of doctor knows best is being discarded, albeit slowly in some places. “Do as I say” won’t cut it anymore. Patients are learning to ask questions, get second opinions, and advocate for themselves.

One question you can ask your doctor at the beginning is, “Are you aware of resources in the community that can help us work as a team to achieve the best possible quality of life for me both during and after treatment?”

Doctors are trained based on a medical model. They learn how to apply medicine to diagnose, treat, or cure symptoms and disease. They know how to use available diagnostic technology, drugs and procedures. They are not trained in everything. Just like car mechanics might know how to fix your car, they can’t teach you how to drive, force you to keep up maintenance on your car, or enforce traffic laws.

It is easy to fall back into the old belief that doctors are deified-like creatures with superior knowledge of how to fix everything that goes wrong with your health. That is not a realistic expectation. Doctors are human beings and specialize in certain types of knowledge and application of that knowledge. They have limited time to spend with each patient.

What you can ask of them, is to be more resourceful. You must rely on them to make the time to become informed about what else is out there for patients. Their help in steering you toward these resources accomplishes important things: it saves time for both you and the doctor, and can result in a much better outcome, such as decreased suffering, improved overall well-being, and better quality of life for you, the patient.

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Breakthrough test can detect nearly every virus from single drop of blood

Breakthrough test can detect nearly every virus from single drop of blood | Healthcare and Technology news |

In what may be a scientific breakthrough, researchers have developed an experimental new blood test that can identify virtually every virus to which an individual has been exposed. In its pilot phase, which tested the blood of 569 individuals, it revealed that most people tested positive for an average of 10 virus species.

The new test, developed by scientists at Harvard University and Brigham and Women’s Hospital, may help researchers uncover important connections between viruses and their potential contributions to diseases, cancer and immune system responses. The test method, dubbed VirScan, requires less than a single drop of blood and has the ability to screen for more than 1,000 human viral species. What's more, the test may cost as little as $25, according to the The New York Times.

"I'm sure there'll be lots of applications we haven't even dreamed of," Stephen J. Elledge, senior author of the recent study, and a professor of genetics at Harvard Medical School and Brigham and Women's Hospital, told the Times. "That's what happens when you invent technology – you can't imagine what people will do with it."

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Partners Goes With $1.2B Epic Installation

Partners Goes With $1.2B Epic Installation | Healthcare and Technology news |

After living with varied EMRs across its network for some time, Boston-based Partners HealthCare has decided to take the massive Epic plunge, with plans to spend an estimated $1.2 billion on the new platform. That cost estimate is up from the initial quite conservative spending estimate from 3 years ago of $600M, according to the Boston Globe.

As is always the case with an EMR install of this size, Partners has invested heavily in staff to bring the Epic platform online, hiring 600 new employees and hundreds of consultants to collaborate with Epic on building this install. The new hires and consultants are also tasked with training thousands of clinicians to navigate the opaque Epic UI and use it to manage care.

The move comes at the tail end of about a decade of M&A spending by Partners, whose member hospitals now include Brigham & Women’s Hospital, Massachusetts General Hospital, the Dana-Farber Cancer Institute, McLean Hospital, Spaulding Rehabilitation Hospital and the North Shore Hospital.

The idea, of course, is to create a single bullet-proof record for patients that retains information no matter where the patient travels within the sprawling Partners network. Partners can hardly manage the value-based compensation it can expect to work with in the future if it doesn’t have a clear patient-level and population level data on the lives it manages.

Even under ideal circumstances, however, such a large and complex project is likely to create tremendous headaches for both clinical and IT staffers. (One might say that it’s the computing equivalent of Boston’s fabled “Big Dig,” a gigantic 15-year highway project smack in the middle of the city’s commuting corridor which created legendary traffic snarls and cost over $14.6 billion.)

According to a report in Fortune, the Epic integration and rollout project began over the weekend for three of its properties, Brigham & Women’s, Faulkner Hospital and Dana Farber. Partners expects to see more of its hospitals and affiliated physician practices jump on board every few months through 2017 — an extremely rapid pace to keep if other Epic installs are any indication. Ultimately, the Epic install will extend across 10 hospitals and 6,000 doctors, according to the Globe.

Of course, the new efforts aren’t entirely inward-facing. Partners will also leverage Epic to build a new patient portal allowing them to review their own medical information, schedule appointments and more. But with any luck, patients will hear little about the new system going forward, for if they do, it probably means trouble.

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Is This Population Health’s Moment? Time for Data and Analytics

Is This Population Health’s Moment? Time for Data and Analytics | Healthcare and Technology news |

Every year, the annual HIMSS Conference, sponsored by the Chicago-based Healthcare Information and Management Systems Society, offers its attendees a kind of conference-based snapshot of where the U.S. healthcare industry is with regard to the forward evolution of healthcare information technology adoption, as well as a sense of the overall policy and operational landscape of healthcare. Attendees can get a sense of the healthcare IT Zeitgeist through attending keynote addresses, educational sessions, association meetings, and networking-focused gatherings, as well as by wandering the exhibit hall and simply by having meaningful conversations with fellow attendees.

HIMSS15, held at the vast McCormick Place Convention Center in Chicago the week of April 12, offered perhaps the clearest portrait of the current moment that has yet been offered to date. Session after session focused on the shift beginning to take place from volume-based healthcare reimbursement to value-based payment, across a very wide range of mechanisms, between providers and both the public and private purchasers and payers of healthcare, and the implications of that shift for healthcare IT leaders.

Further, as part of the keynote session on Thursday, April 16 in the Skyline Ballroom at McCormick Place, Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), made the intentions of federal authorities crystal clear, when, referencing the statement of Health and Human Services Secretary Sylvia Mathews Burwell in January that she wanted the bulk of Medicare fee-for-service payments to providers to shift as quickly as possible over to quality- and value-based payment, Slavitt said, “Our priority is simple: to drive a delivery system that provides better care, smarter spending, and keeps people healthier. The success in the first five years since the Affordable Care Act has been very encouraging… Our agenda now,” he said, “is to get busy strengthening these gains. That will mean that more providers in more communities will need to be able to transform the care they provide so that they will benefit from value-based reimbursement. And they will need technology to help them get there.”

What’s more, in his keynote address two days earlier, Humana CEO Bruce Broussard had told HIMSS attendees, “We have to change the conversation on what we are doing in healthcare from a supply-based system to a system around demand, a system where we put the customer first as opposed to the system. Over the years,” he added, “healthcare has been built by creating more and more supply. I hope I leave today by convincing you that we have to change the focus towards how we improve health for our customers, members, and patients.”

The good news on the solutions side of this landscape is that vendors are rushing forward to provide population health- and accountable care-driven analytics solutions, at a time when such solutions are most desperately needed. Certainly, the hype at HIMSS15 was all around population health, care management, and accountable care solutions. The only question now, as the U.S. healthcare industry hurtles forward into the near future, is, is this a breakthrough moment for population health efforts? And if so, are provider and health plan leaders ready to effectively leverage the tools to make pop health really happen?

The long journey ahead

Leaders from all sectors of healthcare understand that the journey to population health and value-driven care delivery and payment success is going to continue to be a long, challenging one. Donald W. Fisher, Ph.D., president and CEO of the Alexandria, Va.-based American Medical Group Association (AMGA), says he and his colleagues are putting the vast bulk of their efforts into helping prepare physician group leaders for the transition. “We’re not quite there yet, and as we change to a new reimbursement system, even the large, sophisticated medical groups are going to need a few years to make the transition,” Fisher says.  “You’ve got to put the infrastructure in place, and the large integrated health systems have been putting those elements in place—EHRs [electronic health records], alert systems, analytics systems, data warehouses—and some have teams of people mining the data to assess patient status.”

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Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions

Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions | Healthcare and Technology news |

A few days ago, we wrote an editorial for US News and World Reports on the scant or dubious evidence used to support some healthcare policies (the editorial is reproduced in full below).  In that case, we focused on studies and CMS statements about a select group of Accountable Care Organizations and their cost savings. Our larger point however is about the need to reconsider the evidence we use for all healthcare-related decisions and policies. We argue that an understanding of research design and the realities of measurement in complex settings should make us both skeptical and humbled.  Let’s focus on two consistent distortions.

Evidence-based Medicine (EBM).  Few are opposed to evidence-based medicine.  What’s the alternative? Ignorance-based medicine? Hunches?  However, the real world applicability of evidence-based medicine (EBM) is frequently overstated. Our ideal research model is the randomized controlled trial, where studies are conducted with carefully selected samples of patients to observe the effects of the medicine or treatment without additional interference from other conditions. Unfortunately, this model differs from actual medical practice because hospitals and doctors’ waiting rooms are full of elderly patients suffering from several co-morbidities and taking about  12 to 14 medications, (some unknown to us). It is often a great leap to apply findings from a study under “ideal conditions” to the fragile patient. So wise physicians balance the “scientific findings” with the several vulnerabilities and other factors of real patients.  Clinicians are obliged to constantly deal with these messy tradeoffs, and the utility of evidence-based findings is mitigated by the complex challenges of the sick patients, multiple medications taken, and massive unknowns. This mix of research with the messy reality of medical and hospital practice means that evidence, even if available, is often not fully applicable. 

Relative vs. Absolute Drug Efficacy:

Let’s talk a tiny bit about arithmetic. Say we have a medication (called  X) that works satisfactorily for 16 out of a hundred cases, i.e., 16% of the time.  Not great, but not atypical of many medications.  Say then that another drug company has another medication (called “Newbe”) that works satisfactorily 19% of the time. Not a dramatic improvement, but a tad more helpful (ignoring how well it works, how much it costs, and if there are worse side effects).  But what does the advertisement for drug “Newbe” say?   That “Newbe” is almost 20% better than drug “X.” Honest. And it’s not a total lie.  Three percent (the difference between 16% and 19%) is 18.75%, close enough to 20% to make the claim legit. Now, if “Newbe” were advertised as 3% better (but a lot more expensive) sales would probably not skyrocket. But at close to 20% better, who could resist?   

Policy:  So what does this have to do with healthcare policy?  We also want evidence of efficacy with healthcare policies but it turns out that evaluation of these interventions and policies is often harder to do well than are studies of drugs. Interventions and policies are introduced into messy pluralistic systems, with imprecise measures of quality and costs, with sick and not-so-sick patients, with differing resources and populations, with a range of payment systems, and so on and so on. Sometimes, randomized controlled trials are impossible.  But sometimes they are possible but difficult to effect. Nevertheless, we argue they are usually worth the effort. Considering the billions or trillions of dollars involved in some policies (e.g., Medicare changes, insurance rules) the cost is comparatively trivial.

But there’s another question: What if a decent research design is used to measure the effects of a large policy in a select population but all you get is a tiny “effect?”  What do we know? What should policymakers do? Here’s what we wrote in our recent editorial in the US News and World Report.

In an ideal world, health policies are based on solid evidence. But what if influential research is flawed? What if policymakers can’t distinguish between weak and trustworthy studies? And what if the resulting policies dramatically affect our health care system’s quality and costs?

Two recent studies in top medical journals, the Journal of the American Medical Association and the New England Journal of Medicine, concluded that “pioneer accountable care organizations” – which receive monetary incentives in attempts to improve Medicare’s efficiency and quality – saved money or reduced spending increases. Last week, the U.S. federal Centers for Medicare and Medicaid Services noted these findings as a reason to expand the program.

While we also want accountable care organizations to succeed, we question whether the scant evidence reported in the studies justifies such a large public investment in time and money. The studies may have unfairly compared pre-selected, high performing pioneer accountable care organizations with less experienced and less selective controls. This is akin to comparing baseball’s all-star teams to a team made up of the players not even considered for that honor.

To make matters worse, the research found only tiny differences (for example, 1.2 percent medical cost savings in one study) that may be dwarfed by error, bias and unmeasured variables, such as implementations costs. Statistics can’t fix research designs with major bias. Moreover, the JAMA study that measured a second year of accountable care organization experience found declining “savings.” In the words of the co-editor-in-chief of the Incidental Economist, “Saving a couple hundred million out of the Medicare program is a decimal point.”

Our larger concern is how to interpret research on our costly, impossibly complex health system for policymakers who lack the scientific skills to evaluate the conclusions. Apparent cost savings often reflect coding irregularities, unreliable data (for example, insurance claims that may reflect what the companies will pay for rather than the patient diagnosis), unacknowledged biased comparisons, data omissions, arbitrary end points to studies or unrealistic time constraints.

Our worry is that as a research community, we are losing our humility and our caution in the face of declining research funding, the need to publish and the need to show so-called useful findings. Perhaps it’s becoming harder to admit that our so-called big data findings are not as powerful as we wish or are, at best, uninterpretable.

Probably, the most common weakness in such research is selection bias – for example, comparing volunteers to non-volunteers; programs chosen by the funding agency to those that weren’t; and, of course, comparing those who are healthy and wealthy to those who are too sick or poor to participate. Dead patients are also well known for not responding to requests for call-backs, responses or data.

The sociologist W.I. Thomas offered what is now called the Thomas theorem: “If men define situations as real, they are real in their consequences.” In this example with pioneer accountable care organizations, a finding that may be mostly measurement error becomes a truth to support a questionable policy.

What can we learn from this experience? Comparing haves and have-nots often generates exaggerated successes. Ideally, we can hope for randomized trials – in this example, by randomly dividing eligible, advanced health care organizations to accountable care organization participation or to non-participation. (The non-participating comparable controls might receive the program in a year or two after the results of the trial are in.) And when randomized trials are not possible, there are better designs than self-selection and administrative fiat.

We’ve had many randomized trials of government programs. When we are spending billions (or even trillions) of dollars, and the policies affect our social system, our economy and peoples’ well-being, we should require rigorous research methods and even more humility.

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Fixing health care doesn't necessarily need political reform

Fixing health care doesn't necessarily need political reform | Healthcare and Technology news |

It’s very hard to find a product or service that is both lousy and unaffordable. Such expensive duds are usually quickly replaced by cheaper and better competitors. Prior to the Affordable Care Act, health care was becoming more expensive every year while simultaneously becoming less convenient, less personal, and less satisfying. In 2009, I wrote a series of four posts explaining how the health care marketplace reached such a sorry state and offering a suggestion for reform.

Since then, the Affordable Care Act has passed. For many, insurance has become much more affordable, but whether this translates to better or more affordable care remains to be seen. If it results in many patients receiving affordable insurance that very few physicians accept, then the situation will be a repetition of the Massachusetts experience with universal coverage: Everyone has insurance; no one has a doctor.

At the same time, the intrusive and complex bureaucracy that physicians must navigate to collect insurance payments has vastly expanded. Physicians are now coerced into serving as the workforce for Federal plans to collect health care data, cut costs, and make their care increasingly legible to payers but increasingly opaque to patients.

Bear with me for just a few examples. In an ill-advised plan called “meaningful use,” physicians receive incentives for submitting complex reports documenting their use of electronic health records (EHRs). The time and effort required to comply with this program has earned it much scorn from physicians. And the incentives will likely distort the true value of EHRs and inflate their costs.

The International Classification of Diseases (ICD) is the coding system used by physicians and billers to report to insurance companies patients’ diagnoses. In October, the government will update ICD to its tenth version. ICD-10 will contain radically more complexity than its predecessors. It is widely ridiculed for the detail with which diseases must be reported. (Code V91.07XA is for a “burn due to water-skis on fire.”) The transition to ICD-10 was already postponed once, and I predict it will cause much disruption and grief.

My last example is the recently passed sustainable growth rate (SGR) fix which gets rid of the annual congressional scramble to increase Medicare reimbursement to physicians by increasing reimbursement in the short term, but tying reimbursement to outcomes measures in the long term. This is sure to become a data collection and reporting hassle that makes doctors long for the simpler days of meaningful use.

I honestly believe that there has been more bureaucratic complexity added to the typical physician’s life in the last few years than in the twenty years before that. None of it cares for a single patient.

Two weeks ago, my family and I spent ten days visiting New York City. We had a wonderful time. The services that completely transformed our experience were the ride sharing services of Uber and Lyft. We never used public transportation. We never hailed a taxi. For longer trips (and a family of five) this was likely cheaper than train tickets. For shorter trips, it meant not handling cash, never finding bus or subway stops, and never referring to transit schedules.

For years, passengers complained about high taxi prices and poor taxi service, and potential competitors complained about the legalized monopolies given to taxi companies by city governments. But rather than bang their heads against these barriers, companies like Uber and Lyft just started giving people rides.

This was an epiphany to me. I had always assumed that fixing the health care marketplace would mean political reform — undoing the myriad laws that substituted insurance for health care and caused prices to skyrocket, and dismantling the byzantine bureaucracy that physicians must navigate. Now, I understand that political reform is both unrealistic and unnecessary.

Doctors and patients aren’t waiting for political reform. More and more doctors are “going off the grid” to provide excellent care unencumbered by insurance regulations. Concierge primary care is just one example. The Surgery Center of Oklahoma lists on its website the prices for every surgery it offers. The prices are all-inclusive. You won’t get a separate bill from the anesthesiologist, the surgeon, and the facility. And they don’t care what insurance you have because they won’t deal with any insurance company. Other innovative companies are using video conferencing technology to connect patients to doctors thousands of miles away. LUX Healthcare Network (with which I’m proud to be associated) is building a multi-specialty concierge physician network.

I argued six years ago that using insurance for routine care is wasteful. I now realize that attempts at universal coverage and the bureaucracy that comes with it — ICD-10, meaningful use — will never be repealed. This bureaucracy will become the taxi monopolies of health care — increasingly ignored by both doctors and patients and increasingly irrelevant. The successful enterprises in health care will connect doctors and patients and then get out of the way. Like Uber and Lyft they will help patients find the service they want at a price they’re happy to pay, and they will facilitate not regulate the delivery of excellent care.

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CVS Health quits U.S. Chamber of Commerce over tobacco stance

CVS Health quits U.S. Chamber of Commerce over tobacco stance | Healthcare and Technology news |

CVS Health Corp said it was withdrawing its membership from the U.S. Chamber of Commerce after media reports that the trade group was lobbying globally against anti-smoking laws.

The No. 2 U.S. drugstore chain said it was "surprised" to read recent reports on the chamber's position on tobacco products outside the United States.

The New York Times reported last week that the chamber and its foreign affiliates were lobbying against anti-smoking laws such as restrictions on smoking in public places and bans on menthol and slim cigarettes, mainly in developing countries. 

"CVS's purpose is to help people on their path to better health, and we fundamentally believe tobacco use is in direct conflict with this purpose," CVS spokesman David Palombi said in an emailed statement on Tuesday.

The chamber, however, said that it did not support smoking and it called the report "a concerted misinformation campaign."

"... we support protecting the intellectual property and trademarks of all legal products in all industries and oppose singling out certain industries for discriminatory treatment," the trade group said in an email.

CVS was the first major U.S. drugstore chain to stop selling tobacco products last year.

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Getting a checkup will be very different in the not-so-distant future

Getting a checkup will be very different in the not-so-distant future | Healthcare and Technology news |

Sometime in the not-so-distant future, getting a checkup will be very different.

When the doctor writes down your symptoms, it will be cross-checked with others in your area, making it easier to identify outbreaks and epidemics sooner. If you complain of shortness of breath, your phone’s heart rate monitor will instantly report how well your heart has functioned over the last month. Those readings then could be aggregated with others in your community, revealing hidden trends. As your doctor thinks about the best treatment for you, big-data analysis will help her assess how various options have worked for others with similar histories and body chemistry.

This is the promise of big data in healthcare. And, it’s not just while you’re at the doctor. Medical research and findings are now being combined into massive searchable databases, making it easier to assess and compare results. Databases can absorb terabytes worth of disparate data, including things like the weather. This will make it clearer whether it’s the drug — or something extraneous like humidity — that’s making people feel better.

But all this is in its infancy, with the sector moving slowly and cautiously. The Affordable Care Act now mandates that doctors switch to electronic health records when they treat Medicare patients. So far, they’re not especially sophisticated.

“Electronic health records right now are only collecting about 100 megabytes of data per patient, per year,” says Dale Sanders, senior vice president of strategy at Health Catalyst, an analytics firm. “Most patients, if they knew how poorly informed healthcare was from a data perspective, would be really disappointed.”

Health Catalyst is one of a number of companies — big and small — working to change that, seeing the immense potential to both improve care and save money. US healthcare industry expenditures are approaching $3 trillion annually. The McKinsey Global Institute estimated in 2013 that deploying big data could create $100 billion in value every year across the healthcare industry.

In Pittsburgh, a major hospital system teamed up in March with the city’s biggest universities to advance big-data analytics in healthcare. As part of a consortium, Carnegie Mellon University is working on artificial intelligence that draws on databases of studies and health records.

Andrew Moore, Dean of Carnegie Mellon’s School of Computer Science, imagines a day when his phone gives his doctor a more accurate report on his health than he can himself.

“If he or she asks me, ‘have you been getting out of breath much lately?’ and I say, ‘I don’t think so,’ at that point I would like my cell phone to chime in and say, ‘yes, you have, actually, Andrew,'” he says. “That would be awesome for me and the physician.

Moore expects the systems to be able to trace hospital-borne infections back to a specific piece of equipment or patient. Or, some might make it possible to diagnose a rash with a smartphone photo.

The Pittsburgh Health Alliance plans to spend $10-$20 million a year on its big-data collaboration. Carnegie Mellon joins with the University of Pittsburgh Medical Center and the University of Pittsburgh on the project, and UPMC already takes in info from 200 sources.

And big data has the potential to become big business. In 2013, investors put nearly $200 million into analytics and big-data startups, according to research firm Gartner. There have been similar size investments in digital medical devices and personalized medicine. The government is investing millions in analyzing medical databases, too. That’s not to mention health-tracking research and products from the likes of Apple, Google, and FitBit.

“Hospital systems realize that healthcare is becoming more and more an information technology business,” Moore says.

For all the excitement over big data’s potential for personalized medicine and better public health, it’s not without obstacles and risks. Moore worries about security, knowing that any breach of privacy will threaten public acceptance of the whole industry.

Sanders of Health Catalyst thinks the real promise of big data is improving the basics of healthcare. “We keep attaching big data to these moonshot kinds of expectations,” he says. To Sanders, big data isn’t a revolution. It’s a way to improve the fundamentals of care, like reducing hospital-borne infections.

“Reducing variability in care and reducing over treatment of patients is probably the most important place for any organization in healthcare to start,” he says.

And perhaps the biggest challenge for big data is culture. Doctors and hospitals tend to be understandably cautious and skeptical about adopting new technology, waiting for it to be sufficiently proven safe and effective. But as analytics improve, and the pressure to bring down the cost of healthcare builds, most agree big data will become a big deal in medicine.

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Healthcare Industry in Midst of Digital Revolution

Healthcare Industry in Midst of Digital Revolution | Healthcare and Technology news |

Healthcare executives expect that, within the next three years, their industry will need to focus as much on training machines as they do on training people, according to a new report by the New York City-based Accenture.

The industry report, “Accenture Healthcare Technology Vision 2015,” is based on a survey of 601 doctors, 1,000 consumers and 101healthcare executives, and highlights emerging technology trends that will affect the health industry in the next three to five years.

Roughly four-in-five (84 percent) health executives agree or strongly agree that their industry will need to focus as much on training machines—such as using algorithms, intelligent software and machine learning—as they do on training people in the next three years. In fact, most of those surveyed (83 percent) agree that provider organizations, driven by a surge in clinical data, will soon need to manage intelligent machines as well as employees.

Intelligent machines will also support the surge in health data from various disparate sources, such as diagnostic tests, internet-connected devices, genomics and medical records. In fact, access to large volumes of new patient data is driving some challenges, as the survey found 41 percent of health executives said their data volume has grown more than 50 percent last year. This data explosion, accompanied by advances in processing power, analytics and cognitive technology, is fueling smarter software that makes it easier to turn big data into better decisions and better healthcare. Approximately half of the healthcare executives surveyed said they use rule-based algorithms (59 percent of respondents), machine learning (52 percent), intelligent agents (49 percent) and predictive analytics (45 percent) to infuse intelligence into systems.

Beyond turning massive amounts of new data into insights, this wave of new technology will create a single platform for data generated by patients, doctors and clinicians. Patient-generated data is already demonstrating benefits among health executives, as nearly three-fourths (73 percent of respondents) have seen positive ROI from their investment in these technologies, such as wearables tracking an individual’s fitness and vital signs. In addition, Accenture found that most physicians (85 percent) believe that wearables improve a patient’s engagement with their own health, while three-fourths (76 percent) of patients believe that wearables have the potential to help them better manage their health and potentially improve it. This is also why health monitoring is the top reason more than half (54 percent) of patients use smartphone applications.

“As the digital revolution gains momentum, doctors and clinicians will use machines to augment human labor, personalize care and manage more complex tasks,” Kaveh Safavi, M.D., who leads Accenture’s health business, said in a statement. “The digital revolution is also creating a data goldmine that can spark medical breakthroughs and improve individualized treatment plans.”

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Mixed Effects Are Seen on an Affordable Care Act Repeal

Mixed Effects Are Seen on an Affordable Care Act Repeal | Healthcare and Technology news |

The nonpartisan Congressional Budget Office said Friday that repealing the Affordable Care Act would significantly increase federal budget deficits and the number of people who are uninsured.

But, it said, repealing the law would also raise economic output because it would create incentives for some people to work more.

The estimates came in the first major study issued by the new director of the budget office, Keith Hall. It was also the first report to use new methods of fiscal analysis, according to instructions from the Republican majority in both houses of Congress.

Repealing the law would increase federal budget deficits by $137 billion in the decade from 2016 to 2025, Mr. Hall said in the report. In addition, he said, the number of uninsured people, estimated at 35 million under current law, would increase by 24 million if the law was repealed.

Mr. Hall itemized the likely changes: Fourteen million fewer people would be enrolled in Medicaid, and 18 million fewer people would have private insurance purchased on the open market or on public exchanges established under the health law. But eight million more would have coverage through employers.

The report came as consumers, lawmakers and politicians wait anxiously for a Supreme Court ruling on health insurance subsidies paid under the health care law to millions of people in more than 30 states.

President Obama has repeatedly threatened to veto legislation repealing the health care law, his biggest legislative accomplishment as president, but Republicans keep trying and stepped up their efforts this year after taking control of both houses of Congress.

Proposals to repeal the law are included in legislation being prepared by Republicans to respond to the Supreme Court decision, which is expected within days.

The report by the budget office is sure to be cited by members of both parties as they continue fighting over health care through the 2016 elections. Democrats, defending the law they passed five years ago, can use the report to argue that repealing the law would be a bad move because it would increase the deficit. Republicans can use it to argue that the law itself is bad.

Senator Michael B. Enzi, Republican of Wyoming and the chairman of the Senate Budget Committee, said the report showed that “repealing the president’s health care law will increase economic growth.” But Representative Nancy Pelosi of California, the House minority leader, said it showed that “repeal will explode the deficit.”

The budget office said that repealing the law — with its insurance subsidies and expanded eligibility for Medicaid — would increase federal budget deficits by $353 billion in the coming decade, largely because the government would forgo big savings in Medicare and would lose revenue from new taxes and fees. But after taking account of the positive economic effects of a repeal, it said, the increase in the deficit would be $137 billion.

The law tends to “reduce the supply of labor by reducing some people’s incentives to work,” the report said. Repealing it would reverse those incentives and could increase the output of goods and services, the gross domestic product, by seven-tenths of 1 percent, the study said.

The insurance subsidies, along with expanded eligibility for Medicaid, “generally make it easier for some people to work less or to stop working without losing health insurance coverage,” the report said.

■ The government would lose $167 billion in penalty payments from large employers, who are supposed to offer insurance to full-time employees.

■ It would lose $87 billion from eliminating a new excise tax on certain employment-based health plans with relatively high premiums. Under current law, revenue from this “Cadillac tax” will grow rapidly as more health plans are affected each year, starting in 2018.

■ It would lose $346 billion in new taxes paid by high-income people, $142 billion in fees paid by insurance companies and $54 billion in fees paid by manufacturers of prescription drugs and devices, provisions of the health care law meant to help pay for it.

■ It would save $822 billion because it would no longer subsidize some private insurance bought through the exchanges.

■ It would save $824 billion in Medicaid and the Children’s Health Insurance Program.

But, the budget office said, repealing the health law would accelerate Medicare spending, which has been growing at an exceptionally slow rate.

The law throttled back the growth of Medicare payments to hospitals,nursing homes, health maintenance organizations and other providers. Repealing it would undo those savings, and as a result, Medicare spending would rise by roughly $800 billion over 10 years, the report said.

The report analyzes the economic effects of the health care law and the ways in which those effects may, in turn, influence federal spending and revenues — a technique known as dynamic scoring. Democrats fear that Republicans will use that approach to help justify tax cuts. But at least in the report on Friday, Mr. Hall was cautious in using the new technique and carefully documented the economic assumptions that led to his conclusions.

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Oculus Rift Virtual Reality Headset Used to Fight Phobias

Oculus Rift Virtual Reality Headset Used to Fight Phobias | Healthcare and Technology news |
While the Oculus Rift, a virtual reality immersion device, is slated for release only early next year, researchers are already trying to implement practical uses for it. At Santa Clara University a couple engineering and computer science students are working on using the Rift to fight phobias, initially focusing on a fear of heights and flying. With a background in video games, the pair teamed up with the chair of the university’s psychology department to study how phobias are treated and how to create a virtual reality experience that will progressively address patient fears.

The investigators came up with a system that pairs a Rift headset with a touchscreen tablet. The patient wears the Rift, while a therapist uses the tablet to guide the experience and tailor it to the patient’s unique needs. In their heights simulation, for example, the treatment starts with the patient virtually standing on top of a building. Initially it is not very tall, but the therapist can slowly increase the building’s height while watching the emotional response of the patient. By increasing the height without terrifying the patient, the therapy can gently nudge acrophobics to get used to being on tall objects and hopefully eventually lose their fear.

While the heights in the virtual world may frighten patients, the team noted that because wearers of the device know they can take it off at any time, they seem to more accepting of trying out the system. Of course an important step will be to actually test the system with real patients to see whether it is truly effective at allaying fears once and for all.
Lyfe Media's curator insight, June 17, 2015 10:01 AM

The Oculus Rift virtual headset is going to create a world of opportunity for doctors, therapists, and counselors alike. Dealing with patients and their fears can be one of the most difficult topics to approach, especially since a lot of our fears are irrational or impossible. It's exciting to see the world of technology colliding with modern medicine in such an innovative, helpful way.!

Mayo Clinic, Apervita Collaborate for Self-Service Health Measures Marketplace

Mayo Clinic, Apervita Collaborate for Self-Service Health Measures Marketplace | Healthcare and Technology news |

The Rochester, Minn.-based Mayo Clinic and the health analytics and data community and marketplace Apervita are launching a health measures platform that will allow health professionals to publish or subscribe health measures which will turn definitions into analytics.

According to the companies, while there are already thousands of health measures for quality, safety, outcomes, and finance that are increasingly the basis for measurement of performance and reimbursement for value-based care, they are notoriously complex and organizations struggle with the costly process of implementing and maintaining them. This often results in delays of more than 12 months to report new measures or update existing measures.

With this new approach, Apervita will offer a family of open interfaces, including open web service APIs, allowing standard measure definitions to be imported, edited, published, executed and exported. Once an author has developed a measure, it can be connected to different data sets as well as shared through a global marketplace. Measure results can be displayed on the Apervita platform or accessed through APIs for display within electronic medical records (EMRs), third-party systems and mobile applications. The import and export of measures supports the Centers for Medicare and Medicaid Services (CMS) quality data model (QDM) through which all modern measures are today made available, the companies say.

“Healthcare providers and facilities should focus on what they do best, providing high quality patient care. After all, that’s what health are measures are designed to enable,” Dr. Jyotishman Pathak Ph.D., professor of Biomedical Informatics at Mayo Clinic, said in a statement. “With thousands of healthcare measures which continuously evolve, keeping track of, implementing and monitoring the measures has shifted some of that focus away from the patients, and it needs to shift back.”

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More Patients, Not Fewer, Turn To Health Clinics After Obamacare

More Patients, Not Fewer, Turn To Health Clinics After Obamacare | Healthcare and Technology news |

Nurse practitioner Martha Brinsko helps a lot of patients manage their diabetes at the Charlotte Community Health Clinic in North Carolina.

“Most mornings when you check your sugar, what would you say kind of the average is?” Brinsko asked patient Diana Coble.

Coble hesitated before explaining she ran out of the supplies she needs to check her blood sugar levels, and she didn’t have the gas money to get back to the clinic sooner. Brinsko helped Coble stock up again.

“If you need to get more than one box, get more than one box,” Brinsko said. “But you need to check them every morning so that we can adjust things.”

Coble, who is unemployed, lives with her sister and can’t afford insurance even now that the health law is in place, relies on the clinic for health care.

“They do a great job with everything,” Coble said. “I couldn’t do without them.”

Nancy Hudson was the clinic’s director as Obamacare rolled out and now consults for the clinic. She expected the insurance exchange, or marketplace, established under the Affordable Care Act would reduce the number of uninsured patients the clinic sees. The opposite happened, she says.

“What we found within our patient population and within the community is that a lot of the advertisement and information about the marketplace brought people [in who] didn’t know anything about free clinics and did not qualify for any of the programs within the ACA marketplace,” Hudson says.

And now they get free or low-cost care at the clinic, which is designated by the government at an FQHC, or federally qualified health center.

The health law was designed to cover the poorest people by expanding Medicaid, the federal-state program for low-income people. But the Supreme Court made that optional. The result in states that didn’t expand Medicaid is a gap, where some people make too much money to qualify for Medicaid but not enough to qualify for insurance subsidies. In North Carolina, about 319,000 people, like Coble, fall into the Medicaid gap.

“Over half of the people that we see would’ve been eligible for Medicaid expansion had the state elected to exercise that option,” says Ben Money is president of the association that represents North Carolina’s community health centers.

North Carolina is among the 21 states, including many in the South, that are currently saying no to Medicaid expansion. Louisiana is another.

Dr. Gary Wiltz, the CEO of 10 community health centers in the southwestern part of Louisiana, says demand has surged. “We’ve gone from 10,000 patients to 20,000 in the last six or seven years, so we’ve doubled,” he says.

Wiltz says other things are at play, too. The economic recovery hasn’t reached many of the poorest people, and some who do qualify for Obamacare subsidies say their options are still too expensive.

“The need keeps increasing, and I think that’s reflected throughout all the states,” he says.

Wiltz, who also heads the board of directors for the National Association of Community Health Centers, says clinics are packed even in states that expanded Medicaid. After all, most of the clinics treat Medicaid patients too.

The Charlotte clinic’s Nancy Hudson says there’s another part of the health law helping fuel the growth: additional funding for community health centers.

Hudson found out last week her clinic is getting about $700,000 to expand in partnership with Goodwill.

“Many of their clients did not have any access to health care,” she says. “They can’t train and sustain a job if they don’t have the basic needs taken care of, and health care is one of them.”

Nationwide, the federal government estimates its latest round of funding will lead to about 650,000 people getting better access to health care.

This story is part of a reporting partnership with NPR, WFAE and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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IT could save $100B for US healthcare

IT could save $100B for US healthcare | Healthcare and Technology news |

New research from Accenture projects that digital health tools will save the U.S. healthcare industry more than $100 billion over the next four years.

In 2014 alone, it calculates, technology such as Web-enabled devices, digital diagnostic tools and other FDA-approved IT help achieve some $6 billion in reduced costs – mostly thanks to things such as improved medication adherence, behavior modifications and fewer emergency room visits.

Accenture expects that number to approach $10 billion this year and $18 billion next year – increasing to $30 billion in 2017 and $50 billion in 2018 as these technologies take hold, proliferate and evolve.

It also predicts that FDA approval of digital health tools will triple by the end of 2018, to 100 (up from from just 33 this past year).

"A digital disruption is playing out in healthcare, as witnessed by the emergence of new business models and technology that will change the nature of patient interactions, alter consumer expectations and ultimately improve health outcomes," said Rick Ratliff, Accenture's managing director of digital health solutions in a press statement.

Factors, such as government health IT mandates, payment reform and other regulatory changes are accelerate the growth of FDA-approved digital solutions, the report shows.

Increasing ubiquity of health IT among physicians and patients will enable more and more devices to integrate withpatient portals and digital health records, according to Accenture, which finds that one in four U.S. physicians routinely use telemonitoring devices for some aspect of chronic disease management.

Meanwhile, as more and more patients take charge of their own care, the number of U.S. consumers who own a wearable fitness device will double in the next five years, according to Accenture, from 22 percent this year to 43 percent by 2020. More than half (57 percent) of consumers track their health online, such as medical history (37 percent), physical activity (34 percent) and symptoms (33 percent), according its poll.

Recent FDA guidelines for low-risk health products – setting a regulatory line between wellness tools and medical devices – will enable more clarity, expedite regulatory pathways and could drive 30 percent annual growth of digital tools through 2018.

The evolution toward value-based care is also creating fertile ground for clinical and business strategies that incorporate these technologies, with Accenture projecting digital health funding to reach $6.5 billion by 2018.

"The proliferation of Internet-connected solutions and evolving regulatory guidelines are blurring the lines between clinical and consumer health solutions," said Ratliff. "As consumer health platforms support more 'medical' devices, rather than just today's wellness trackers, they'll create a viable self-care model in a segment that today is occupied by chronic-disease monitoring companies."

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Are Bigger MD Groups Better Prepared for Population Health?

Are Bigger MD Groups Better Prepared for Population Health? | Healthcare and Technology news |

It was fascinating to interview Donald W. Fisher, Ph.D., the president of the Alexandria, Va.-based American Medical Group Association (AMGA), earlier this spring, as I researched and reported our May/June cover story on population health and data analytics. For one thing, Dr. Fisher has been in the trenches in supporting the management of larger medical groups in the U.S. for decades now, so his perspectives are weighted with many years’ experience and understanding of the healthcare system at the physician group management level.

What’s more, anyone familiar with AMGA knows that the leaders of its member medical groups have been at the forefront of healthcare delivery and payment innovation for years now. It was in fact the participation of a number of a number of AMGA member medical groups whose involvement and learnings in several different Medicare-facilitated primary care and care management initiatives helped convince senior CMS (Centers for Medicare and Medicaid Services) officials to move forward to the go-live of the Pioneer ACO Program a few years ago.

And it has been not only in the Medicare accountable care organization sphere that the leaders of large medical groups have been trailblazers; large medical groups have been pioneers, with a “small p,” in private-sector ACOs, collaborating in very innovative ways with private health insurers nationwide.

So what has been learned? Among other things, as Dr. Fisher told me this spring, and as was revealed in our extended interview published this week, one key challenge remains that, as he put it, “Some medical groups still have gaps in their primary care base; and if you’re going to do population health, you need a very good primary care base. So some are still struggling in that area. And then,” he added, “there is the cultural piece, which encompasses reimbursement-related goals related to this. You can try to change your culture, but if you’re still being paid fee-for-service, and still mostly paying your doctors fee-for service, you need to change that, and that is something they’re trying to get over pretty quickly.”

Beyond those issues, there is this issue that Dr. Fisher brought up in our interview, and which I think goes to the heart of the question of how the leaders of larger medical groups are turbocharging their learning process around accountable care and population health: “The thing is,” he told me, “that you have to go beyond the data; you have to reengineer the care process. The way it is today, it’s a reactive kind of care process. If you’re using predictive analytics and data sets, you’ve got to be proactive, and reach out to patients in advance. And that requires different skill sets, different providers; it’s a very, very big job to work these data sets and predictive analytics, but,” he added, “it can make a very big difference in patients’ lives; patients are just doing so much better as a result.”

And therein lies one of the keys to unlocking the secret of population health and accountable care success—the interplay between the harnessing of data analytics and the continuous process change work that needs to undergird everything.

In other words, at the same time that the leaders of a medical group—or, for that matter, any patient care organization—are collecting data, analyzing that data, making determinations of how to act on their analyses, and moving forward to make changes based on those analyses, they need to be engaged in continuous clinical and operational performance improvement, whether using methodologies like Lean management, Six Sigma, and Toyota Production System for healthcare, or any combination of those or other methodologies, or developing their own.

It’s all about a virtuous cycle or “blessed cycle,” as some are calling it, in which process change and analytics work are all intelligently and strategically combined. Now, here’s a legitimate question: what size medical group might do this best?

Of course, every physician group has a different organizational structure, specialty and clinician composition, history, culture, and set of IT and other tools, at its disposal. And it goes without saying that every medical organization has a different set of personalities. But, given sufficient leadership capability, and the taking on of personal-professional risk on the part of leaders in an organization committed to transformational change, anything is possible. But it does seem that larger medical groups—those with enough management skill individuation that they have not only a chief medical officer but also probably a CMIO, as well as someone who serves as a chief quality officer, and with each of those leaders having some team with at least part-time responsibility to participate in robust change management—it does seem that larger medical groups are more fully advantaged in the context of this kind of work.

And even though Medicare’s Pioneer ACO Program in particular has been facing challenges as of late, what is clear is that larger medical groups are moving forward with alacrity to pioneer, again with a “small p,” a lot of the innovations that are beginning to emerge as groundbreaking for the population health/accountable care path ahead for all of us. So it will be important for everyone to keep their eyes on all these developments in the next few years, as the ramp-up towards broader innovation is going to be both rapid and challenging. But as the leaders of some of the most innovative larger medical groups know, their organizations are continuing to be amazing test-beds of real innovation along all dimensions, in healthcare, and that combination of continuous process change around care delivery and the intensive, strategic leveraging of healthcare IT and especially data analytics, is bound to reap major rewards in the coming months and next few years.

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Why Doctors Are Quitting -- And Why It's Not Obama's Fault

Why Doctors Are Quitting -- And Why It's Not Obama's Fault | Healthcare and Technology news |

In September 2009, Terry Jones wrote in Investor’s Business Dailythat the United States was barreling toward catastrophe: Nearly half the nation’s physicians were on the verge of hanging up their stethoscopes.

“Four of nine doctors, or 45%, said they ‘would consider leaving their practice or taking an early retirement’ if Congress passes the plan the Democratic majority and White House have in mind,” Jones warned.

“Projecting the poll’s finding … 360,000 doctors would consider quitting.”

Well, Congress did pass that plan six months later. (You might have heard: It’s called the Affordable Care Act.)

But our doctors didn’t go away.

In fact, rather than lose 360,000 physicians, the nation’s gained nearly 100,000 practicing doctors in the past six years.

Time and again, surveys have predicted that physicians’ anger over Obamacare, over regulations, over declining reimbursement is driving them out of the industry. That doctors’ gloom will lead to doom for American health care.

“Six in 10 physicians say that it is likely that many physicians will retire earlier than planned in the next one to three years,” Deloitte warned in 2013.

“Recent anecdotes suggest more physicians may be retiring earlier than in the past and [in] a large cohort,” the Lewin Group concluded — in 2004.

But we see again and again: Intent doesn’t equal action. At least, not on a national scale.

For instance, the Wall Street Journal in 2013 implied that doctors were leaving Medicare en masse. It wasn’t true.

Last Friday, the latest high-profile pessimist popped up — Charles Krauthammer, a Harvard Medical School-trained doctor and a columnist for the Washington Post.

In an essay carried in hundreds of newspapers, and originally called “Why Doctors Quit,” Krauthammer argued that the Obama administration has “demoralized doctors and degraded care” by pushing providers to quickly adopt electronic health records, known in shorthand as EHRs.

In Krauthammer’s telling, EHRs have turned out to be “ health care’s Solyndra” — they haven’t justified the $27 billion in incentive payments that the White House used to get doctors to go digital.

“Many, no doubt, feasted nicely on the $27 billion, but the rest is waste: money squandered, patients neglected, good physicians demoralized,” Krauthammer wrote.

The stress of EHRs is so bad that many of his Harvard classmates from 1975 are thinking about quitting medicine, Krauthammer added. He writes:

Virtually every doctor and doctors’ group I speak to cites the same litany, with particular bitterness about the EHR mandate. As another classmate wrote, “The introduction of the electronic medical record into our office has created so much more need for documentation that I can only see about three-quarters of the patients I could before, and has prompted me to seriously consider leaving for the first time.”

You may have zero sympathy for doctors, but think about the extraordinary loss to society — and maybe to you, one day — of driving away 40 years of irreplaceable clinical experience.

It’s true that doctors — especially older ones — are frustrated about the shift to electronic health records.

And understandably so! EHRs have added a burden to a busy workday. The added value of digitized data isn’t always obvious. There’s evidence they hurt productivity.

As a journalist, I’ve heard these complaints over and over again from doctors. And as a patient, I’ve witnessed doctors’ anger firsthand.

A few years ago, I was in the office of a middle-aged neurologist, one of the greatest diagnosticians I’ve ever met. It was a routine check-up, but he spent more time looking at his computer screen than at me.

“This gets in the way of patient care,” he groused, his eyes locked on the screen.

“Why don’t you hire a medical scribe?” I asked the doctor. “Someone who can keep the notes while you see patients?”

He swiveled around and scowled. “The hospital doesn’t want to pay,” he said, as his eyebrows scrunched. “I don’t know how much longer I can keep doing this.”

But that doctor didn’t go anywhere. He’s got kids in Ivy League colleges and a D.C.-area household to fund. He’s got years invested in building a practice. And walking away from that will take more than frustration over a computer system.

In fact, the real reason why doctors are quitting is less dramatic: They’re aging.

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Connecticut Legislature Considers Giving Statewide HIE Another Try

Connecticut Legislature Considers Giving Statewide HIE Another Try | Healthcare and Technology news |

Although it is surrounded by states that have had relative success with statewide health information exchange efforts, Connecticut has struggled to develop an HIE. Last year it pulled the plug on its earlier efforts after spending $4.3 million in federal grant money. But legislators are taking another stab at it. Last week the state Senate passed a comprehensive healthcare bill that would establish a statewide HIE, according to the Connecticut Mirror, an online publication. 

The Mirror story quotes Senate Minority Leader Len Fasano, R-North Haven, as warning that the lack of a neutral, statewide system can give large health systems a business advantage, steering patients to other providers within the same system.

In written testimony earlier this year, Yale New Haven Health System noted that an earlier form of the bill did not take into account what many hospitals are already doing to share data and provide access to healthcare agencies and community physicians.

Between 2010 and 2014, the Health Information Technology Exchange of CT, or HITE-CT, spent $4.3 million unsuccessfully trying to create an exchange before being shut down by the state.

A state auditor’s report noted that the exchange was never able to provide services to stakeholders and thus, never developed a self-sustaining revenue stream.

“HITE-CT was unable to meet its strategic and operational schedule primarily due to its inability to adapt quickly to changing market conditions. The exchange’s board of directors recognized that the terms in the original contract with its vendor required significant modification to reflect the evolving market place for an integrated statewide electronic health information infrastructure,” the audit said. “A lengthy renegotiation period with its primary vendor reduced the exchange’s options for achieving sustainability. The resulting amended contract with the vendor had a reduced scope for deliverables. It no longer included the establishment of an operational statewide health information exchange that could provide desired revenue producing services to stakeholders through fees and other assessments.”

The responsibility for health information exchange efforts rests with the state Department of Social Services, and the bill allows DSS to propose an alternative solution to a centralized statewide HIE, the Mirror article said. The bill now goes to the Connecticut House for consideration.

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Ignoring the Penalty for Not Buying Health Insurance

Ignoring the Penalty for Not Buying Health Insurance | Healthcare and Technology news |

Obamacare’s big stick doesn’t seem to be scaring many people into buying health insurance.

The health law includes many inducements for people to obtain health insurance — including free Medicaid coverage for many low-income Americans and subsidies for those with moderate incomes. But it also includes the notorious “individual mandate,” a fine for those who can afford insurance but don’t buy it.

Because the law, and the fine, are new, many policy experts expected that some people would decline to sign up for insurance until they were hit with a penalty at tax time. Forecasters have estimated a big bump in marketplace enrollment next year, the first sign-up period after people have been fined. The Congressional Budget Office, for example, estimates 10 million more people will have Obamacare plans next year. The law’s structure relies on even healthy and otherwise disinclined consumers to enter insurance markets to help stabilize prices.

Certainly, some people who might otherwise go uninsured have been persuaded by the penalty. Polls have shown that it is a well-known provision of the law. And studies of the uninsured have shown that mentioning the penalty changes some people’s thinking about health insurance. At the end of the normal enrollment period in February, about 11.7 million people had selected marketplace health plans or renewed their plans from 2014, according to the federal government.

But the Obama administration just conducted a small experiment into how much the penalty would affect the behavior of the remaining uninsured. And the results leave some experts concerned that next year’s sign-ups will come in below expectations.

Because of the timing of the sign-up season and tax filing deadlines, it turned out that many people would find out about the penalty only after it was too late to enroll for 2015 coverage. Consumer advocates argued that this situation would lead many people to face a needless second year of uninsurance — and penalties. So, in February, the administration and most states agreed that people who were uninsured in 2014, faced a penalty and were still uninsured for 2015 could sign up late for new health insurance. The eligible population is a small slice of the country, but precisely the sort of people whom you might expect to be most motivated by the fine, if they were going to be.

The I.R.S. estimated that between 3 million and 6 million people faced penalties for being uninsured in 2014. On Tuesday, the federal government announced in a tweet that 147,000 people had signed up for the plans using the federal website that operates in most states during the new sign-up period. Not all of the states that run their own marketplaces and offered similar opportunities have published final numbers, but Charles Gaba, who tracks Obamacare enrollment data at his website,, estimates that total national tax-time sign-ups are around 200,000. Only three states — Colorado, Idaho and Massachusetts — declined to allow penalty-payers to sign up during a special period.

To be clear, the number of people eligible for the special sign-up period was probably quite a bit less than 6 million. Some who paid fines for 2014 may have gotten insurance with a new job in the intervening year. And some may have signed up for Obamacare insurance during the normal sign-up period, which ran from mid-November through mid-February. The Department of Health and Human Services has provided no estimates on how many people might have been eligible for the special sign-up period.

Some advocates have criticized the way the special period was set up, saying the low sign-ups merely reflect the last-minute nature of the decision to extend deadlines. Given more time to prepare, tax preparers might have been able to help enroll more people in health insurance, said Brian Haile, a former senior vice president at the tax preparation firm Jackson Hewitt. “H.H.S. refused to provide any information until the very last minute,” he said in an email. “As a result, the companies were not able to plan effectively.”

But several close watchers of the law say that the special enrollments look low enough to raise more substantial questions about whether the health law’s penalty will have the intended effect of increasing sign-ups for insurance in the coming years.

“It makes me more pessimistic,” said Caroline Pearson, a vice president at the health care consulting firm Avalere Health. When the government announced the special enrollment period, she estimated that between half a million and a million people would take advantage of it. “All the evidence is enrollment is not going to be where people thought.”

Ms. Pearson pointed out that people earning higher incomes, who would have to pay a higher proportion of their premiums, have been less eager to sign up than those whose low incomes qualify them for substantial government help with their health premiums. She recently published an analysis describing the penalty as “too low” to move many higher earners.

Mike Perry, a partner at the polling firm PerryUndem, says focus groups he’s held with the uninsured are consistent with Ms. Pearson’s theory. “A lot of them seem to be making calculations throughout the year what their premium would be versus this fine,” he said.

Behavioral economists who study incentives like the mandate penalty say it may just take time for people to learn about the incentive structure set up by the penalty. It is set to increase for the next several years, so people who remain uninsured will face not just repeated but rising bills for doing so.

Some people who learned about the fine late may not have had enough time to make room in their budgets for an insurance premium, said Brigitte Madrian, a professor at Harvard’s Kennedy School who has studied how incentives affect 401(k) plan sign-ups. Next year, uninsured people may have more time to plan ahead, and may remember the unpleasant experience of paying a fine.

“People learn from their mistakes, and this is true in the financial domain,” Ms. Madrian said. “The learning may be more effective a few years in as they see the penalty going up.”

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