Many in healthcare agree that big data, data analytics and data sharing in healthcare are important. In fact, many are greatly investing in these areas. For example, Marc Probst, CIO at Intermountain Healthcare in Salt Lake City, said his organization is heavily investing in data analytics and John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston is a huge advocate for data sharing, especially because data sharing and data analytics helped his wife overcome breast cancer.
However, a Bloomberg Business article argues otherwise.
Based off the documents of a U.S. Department of Health and Human Services (HHS) investigation, the article recounts the experience of two women –a mother and a daughter — back in 2008. A clinician called up the daughter, who was a prospective customer applying for health insurance, to ask her why she had left the names of several medications she was taking off the application she submitted to Aetna, the article said.
The clinician then proceeded to name the medications, the dates they were prescribed and the doctors who prescribed them. But the woman insisted that the information was wrong, the article said. As it turns out, those medications were her mother’s, and this slip-up inadvertently exposed medical conditions the mother had been hiding from her daughter.
After the mother filed a complaint with HHS, it was discovered that the women’s medical records had been mixed up in a database maintained by a supplier to Aetna, the article said. Eventually, HHS determined no privacy violations had occurred because the two women figured out the link between the records themselves and were not told by Aetna or the supplier, the article said.
Ifeoma Ajunwa, an assistant professor of law at the University of the District of Columbia in Washington, told Bloomberg that medical data is legally shared with more third parties than many Americans realize.
“A major concern with prescription databases is that they provide ample opportunities for invasions of privacy,” Ajunwa said in the article.
Although the mother-daughter incident occurred in 2008, the Bloomberg article argues that because the medical data industry is projected to surpass $10 billion by 2020, according to McKinsey & Co., this story is a cautionary tale of how big data can go wrong in healthcare.
“The emergence of shared medical records makes errors all the more dangerous because they can propagate more easily between providers,” the article said.
Although the sharing of data can increase the chance of mistakes and mix-ups, it’s important to recognize that these types of occurrences are nothing new in the world of healthcare and such mistakes have and can still happen regardless of data sharing, and regardless of whether a patient’s record is electronic or paper-based.
Healthcare professionals and groups noticed the signs that the the Office of the National Coordinator for Health IT (ONC) is shifting its focus from the meaningful use program to health data interoperability. Now, many of those groups are questioning why ONC designated 2024 as the year by which nationwide interoperability can be achieved.
In a letter addressed to Karen DeSalvo, M.D, national coordinator for health IT, the board chair of the American Academy of Family Physicians (AAFP), Robert Wergin, M.D., expressed the group’s concern with the path of ONC’s recently-finalized Shared Nationwide Interoperability Roadmap.
The AAFP letter called on ONC to delay meaningful use and asked ONC to dedicate more of its energy to promote national interoperability, something AAFP believes can be achieved this decade — by 2019. The letter’s firm message is summed up in one sentence: “We do not have until 2024 to improve interoperability.” ONC must show more urgency in guiding healthcare technology vendors, health systems, physicians and others to cooperate for the sake of healthcare interoperability, the AAFP asserted.
The ONC’s distant interoperability end date could be due to several agency officials departing the office in the last year-plus. DeSalvo could be next after her nomination as assistant secretary of the Department of Health and Human Services. Those personnel moves and recent downsizing of the meaningful use program have kept ONC busy working on tasks unrelated to interoperability.
From 2015 to 2017, eligible professionals will only have to satisfy 10 meaningful use objectives. That number was cut from the previous total of 18 as part of recent changes made by ONC and CMS. Critical access and eligible hospitals were also cut a break. Those facilities, originally expected to meet 20 meaningful use objectives during that period, will now only be required to meet nine. Those changes weren’t totally unexpected because ONC hinted at its 2015 annual meeting that it was pleased with the adoption level of EHR systems and that it was zoned in on nationwide interoperability.
Disaster has not yet ensued since the transition to ICD-10 on Oct. 1.
While there have been pockets of discontent, reports from the medical coding front have been largely positive about the changeover that had caused many healthcare providers fear and worry, though many also said during the run-up to ICD-10 that they were prepared.
Indeed, two major payers, Humana Inc. and UnitedHealth Group, the nation’s largest health insurer, said this week that business has been “smooth” and “normal,” Forbes Pharma and Healthcare writer Bruce Japsen reported.
“It’s been pretty smooth so far,” a Humana ICD-10 implementation specialist told Forbes in the Oct. 13 news post. “Almost everyone who is submitting claims is getting it right.”
And a UnitedHealth vice president said the giant insurer has seen only a “slight uptick” in claims denials amid normal call volumes, Forbes reported.
CNBC recently carried another good news ICD-10 story.
Meanwhile, in an interview last week with SearchHealthIT, Shivani Mishra, a senior marketing associate and ICD-10 specialist with cloud EHR and billing vendor athenahealth Inc., largely echoed the insurer representatives’ sentiments.
Mishra said the claims denial rate in the early days of the ICD-10 implementation, as monitored by athenahealth, was running at about 14%, roughly the same percentage as a few days before the changeover.
By Oct. 8, the end of the first full week of ICD-10, that rate had fallen to 8%, according to athenahealth’s real-time monitoring service on its Web site. Check out the ICD-10 performance of the company’s clients here.
“It’s not quite Y2K, but it’s still early,” Mishra said.
She was referring, of course, to the much-ballyhooed fretting over the transition of computer and timing systems when the 20th century changed to the 21st century at midnight on Dec. 31, 1999.
As everyone knows now, nearly nothing unusual, let alone horrible, happened after that transition.
On a personal note, I experienced the Y2K non-event as a newspaper reporter assigned to sit in the emergency command center in Worcester, Mass., with city officials from around 10 p.m. on Dec. 31 into the early morning of the new century.
We all were prepared for the worst, but I was forced to report — after driving around the city for a few hours around dawn — that most signs of city life were apparently completely normal. It was eerie, but welcome.
All of this is not to say that bigger problems won’t develop as ICD-10’s profusion of about 70,00 codes — up from ICD-9’s approximately 17,00 – -and attendant increased complexity inevitably trigger rejected claims and probably reduced productivity for at least a while among some providers.
But it’s been pretty hard to find really bad ICD-10 experiences far.
Again, it’s still early.
Physicians who have ICD-10 Medicare claim problems can report them online to the American Medical Association.
Two U.S. senators introduced a bill into Congress that could simplify and expand the practice of telemedicine for the benefit of American veterans. Joni Ernst (R-Iowa), Mazie Hirono (D- Hawaii) and eight other senators co-sponsored the bill, the Veterans E-Health & Telemedicine Support Act of 2015 (VETS Act), which would permit U.S. veterans to receive remote care in their homes, regardless of whether the veteran and caregiver are located in the same state.
The current law allows the U.S. Department of Veterans Affairs (VA) to waive state telemedicine licensure regulations only when both the patient and provider are in federally owned facilities. Under the VETS Act, qualified VA healthcare professionals could offer remote care, including mental healthcare, across state lines.
State telemedicine licensure is a complex issue, even for those treating patients in a more mainstream setting outside of the VA. Each state’s medical board controls the telemedicine licensing process, creating irregularities concerning what qualifications are required of physicians and what services they are allowed to perform remotely in different areas of the country. In most states, physicians must be fully licensed to offer telemedicine services, while others require separate telemedicine licenses. Patients can receive physical checkups through telemedicine under the laws of more than a dozen states.
The bottom line for civilian patients and their caregivers is they must be aware of their state’s telemedicine stipulations, something that veterans won’t have to concern themselves with should the VETS Act become law.
Ernst issued numerous tweets after the bill’s release. Her message was that the VETS Act will help conquer “unneeded hurdles” preventing veterans from receiving treatment via telemedicine across state borders.
— Joni Ernst (@SenJoniErnst) October 8, 2015
“The VETS Act will build on a VA telemedicine program that removes barriers to accessing care, particularly for veterans in rural areas,” Hirono said in a release. Telemedicine doesn’t only help those in rural areas. Vendors at this year’s American Telemedicine Association conference displayed products, including hospitals video carts, that target city-based healthcare organizations and their patients.
When Karen DeSalvo, M.D., national coordinator for health IT, elaborated last week about the final stage 3 meaningful use rules that ONC and CMS had just released, one had to wonder if these would be among her last public pronouncements as the top ONC official.
After all, while it is not yet official, DeSalvo has been in effect confirmed as assistant secretary of the Department of Health and Human Services (HHS), the parent mega-agency of ONC and CMS.
DeSalvo, a former city health commissioner of New Orleans whose post-Hurricane Katrina work has been lauded in many quarters, has already received unanimous consent to her nomination by President Obama from the Senate Health, Education, Labor and Pensions Committee, despite the fact that her nomination hearing in August was canceled.
The committee’s chairman, Tennessee Republican Lamar Alexander, obtained the unanimous approval for DeSalvo and sent the matter to the full Senate, in which the nomination is expected to go through just as easily.
Alexander is a moderate, but he managed to secure every vote on the committee — even from the most partisan members — for DeSalvo. That means her approval by the full Senate (a hearing has not yet been scheduled) is all but guaranteed with such bipartisan backing for DeSalvo, who is well-liked on both sides of the political aisle.
Which brings us to the question of who, if anyone, will run ONC when and if DeSalvo departs for the full-time HHS job (she has been serving for a year now in dual roles as ONC chief and HHS acting assistant secretary for health).
For a brief period last October, DeSalvo appeared to step down from the ONC after her appointment to the acting HHS job in the wake of the Ebola crisis, and ONC COO and Deputy Coordinator for National Operations Lisa Lewis was briefly at the ONC helm as acting national coordinator.
But DeSalvo quickly announced in a blog post that she would serve in both capacities.
By the time DeSalvo leaves again, the Obama administration, while not in official lame duck status, will be in that nether-period a year from the 2016 presidential election, during which top agency officials start quitting for other jobs.
Accordingly, we can probably expect even more turnover at ONC, which has already seen a host of departures of key officials over the past year.
In the context of all that, DeSalvo’s remarks during a media conference call last week about changes that relaxed rules for the EHR incentive program appeared, at least to me, to signal a sort of soft exit for meaningful use itself.
And DeSalvo, who has championed health IT interoperability during her tenure at ONC, seemed to deliver a mixed message about interoperability.
One of the notable changes (poorly received by patient advocates but applauded by many providers) was to lower the threshold for the so-called view, download and transmit measure to a single patient per provider being able to immediately see or receive his electronic health records. The rule used to be 5% of patients.
DeSalvo argued that despite the virtual gutting of one of the key interoperability measures, the new meaningful use regulations would ultimately lead to better access to records for all because of improved interoperability in other areas.
“As a part of that overall strategy to get to interoperability, we take advantage of some of the opportunities we have, and for the office of the national coordinator, our certification program and the certification of electronic health records helps us to move to a more interoperable health system,” DeSalvo said.
In order to not only truly achieve population health but also accurately measure its success, it may mean sacrificing some efficiency. At least, that’s what Sandro Galea, M.D., dean of the Boston University School of Public Health, thinks.
In a Harvard Business Review article, Galea writes that one of the great challenges that population health initiatives face — the Institute for Healthcare Improvement’s “Triple Aims” and the Affordable Care Act (ACA), for example — is how to measure success.
The issue here is that when it comes to measuring outcomes, the focus is on the group of individuals as a whole. Therefore, researchers and clinicians do not always take into consideration the various circumstances individuals may be facing, Galea said.
“That’s unfortunate because, as every business person knows, what gets measured is what gets managed,” Galea said.
Often what happens is population health initiatives target what Galea calls “low-hanging fruit” — in other words, the groups of people that are more easily accessible and more open to changing their behavior.
This dilemma inevitably widens health gaps, improving the health of some while marginalizing other communities and leaving them behind.
Take behavioral intervention apps that help people quit smoking, for example. “People who can neither afford a smartphone nor lead lives organized enough to be driven by apps are left out, widening the health gap between app users and non-users,” Galea said. “Closing those gaps should be at the heart of efforts to measure and improve population health, even if it means sacrificing some efficiency.”
And, in Galea’s opinion, here’s why we should be willing to accept these sacrifices even though the cost of healthcare is a top concern right now:
- Health equity could bridge social divides and yield larger dividends than simple cost savings.
- Narrowing health gaps drives much of healthcare.
- Poor health in some groups ultimately threatens the health in all groups. Take the recent Ebola epidemic in West Africa, for example: “While concern about the health of West Africans may feel like a distant problem for some of us, their health in an age of ready travel is inextricably linked to the health of Americans — an inescapable fact that should impel even the most cost-conscious among us to call for investment in better health for all,” Galea said.
Galea believes there are several ways the measurement of health indicators can be changed so that metrics can better account for inter-group differences:
- Make closing the health gaps between groups a prime objective — for example, closing the gap between those who have access to mobile apps and those who don’t.
- Include relative indicators of health along with absolute indicators in metrics. Therefore health systems would be required to measure factors that may differ, like race, ethnicity and income, for example, and would also be required to tabulate, report and hold themselves accountable to relative achievement across these groups.
- Establish incentives that promote both efficiency in improving numbers and equity in closing gaps.
Stage 2 of the meaningful use program is too complicated. Because of its sophistication, most physicians and hospitals haven’t successfully attested to stage 2 and ONC shouldn’t rush into stage 3 of meaningful use, Chairman Lamar Alexander (R-Tenn.) asserted at a U.S. Senate Committee on Health, Education, Labor and Pensions meeting last week.
Alexander gave other reasons why plans to finalize stage 3 should halt, including that industry groups also recommend a delay. He also discussed a U.S. Government Accountability Office (GAO) report that showed meaningful use requirements are interfering with communication between EHR systems. More than half (10 of 18) of the healthcare organizations polled in the GAO report said that attesting to meaningful use redirects resources away from interoperability efforts.
Karen DeSalvo, M.D., the national coordinator for health IT, also spoke at the Senate committee meeting on Oct. 1, but didn’t directly respond to Alexander’s stage 3 meaningful use plea. She mentioned making electronic health information more available, creating a health IT safety framework and simplifying regulatory requirements to cut down on providers’ administrative tasks as the current goals of ONC. Encouraging interoperability, reducing information blocking and promoting patient engagement were also listed by DeSalvo as areas in which ONC can help control how health IT data is used.
Senator Alexander’s comments targeted stage 3 of meaningful use, something that DeSalvo hardly mentioned in her testimony. She brought up ONC’s proposed 2015 Edition Health IT Certification Criteria, but only as it related to improving care coordination and population health. DeSalvo mentioned meaningful use when she shared how ONC tailored part of stage 3 in response to advisory committees’ calls for ONC to use application program interfaces and Health Level 7’s Fast Healthcare Interoperability Resources (FHIR) standard in its interoperability efforts.
Alexander and DeSalvo both said that health IT should be designed with patients’ needs in mind. “The whole purpose of this [meaningful use] program is to benefit patients,” Alexander said.
Don’t take this the wrong way.
The 2015 AHIMA Convention & Exhibition, held earlier this week in sultry New Orleans, was a productive conference.
A few thousand health information management (HIM) and health IT professionals and dozens of vendors had a great time, educated themselves, did business and celebrated the coming of ICD-10 a day after the American Health Information Management Association conference ended.
But attendance was down from last year, with fewer attendees and fewer vendors on the floor (though nobody seems to have a precise count, which in itself kind of shows how slow things were).
Ironically, it’s pretty apparent that the ICD-10 conversion on Oct. 1, the very milestone that the great majority of those present were celebrating, was the culprit.
While the official line from countless pro-ICD-10 AHIMA members in NOLA was “if you’re not ready for ICD-10 by now you’re not going to be ready by staying home,” it became increasingly clear over the three days I was there that many did, indeed, stay behind at their jobs at healthcare organizations, payers and health IT and HIM companies.
They were undoubtedly hustling to do last-minute preparations for ICD-10.
On the brighter side, the show also saw a lot of warped humor about ICD-10. I glimpsed one T-shirt with a bunch of jagged lines saying: “This is your brain on ICD-10.” An AHIMA official joked from the stage that she hoped everyone would enjoy New Orleans “both pre- and post-apocalyptic.”
And most people, while slightly amused by the Twitter accounts, Web sites and jokes making fun of some of ICD-10’s nuttier codes — such as being injured by an Orca whale, to cite just one well-known example — actually tended to poke fun at the naysayers and critics in the anti-ICD-10 camp. Certainly they had little patience for them.
In any event, one sure sign that this AHIMA confab, the venerable organization’s 87th, wasn’t quite as hoppin’ as usual was the absence of high-octane luminaries from the health IT and entertainment worlds.
Last year, movie star heartthrob Rob Lowe drew throngs of AHIMA-ites to San Diego’s PETCO Park stadium and ONC chief Karen DeSalvo, M.D., roamed the halls and attracted rapt audiences.
This time around, no ONC people were on hand in any official capacity. And among the invited guest speakers were a deputy assistant secretary for manufacturing from the U.S. Department of Commerce, futurist Joe Flowers, and Robin Roberts, co-anchor of ABC’s Good Morning America.
Next year, the first post-ICD-10 AHIMA conference will be in Baltimore.
A recent survey by Surescripts — a health information network provider — found that 29% of Americans, close to 70 million individuals, still fax or physically transport their test results, X-rays or health records from one doctor’s office to another — and it’s because of the lack of electronic communication between doctors and patients.
In such cases, ultimately patients have to connect the medical records dots themselves, making it challenging for Americans to manage their health, according to the survey. While millions of people across the United States are open to using technology for a variety of healthcare needs, that survey found that the health system is not yet living up to their expectations.
And Regina Holliday, patient rights advocate and founding artist at the Walking Gallery, has experienced this first hand when her 39-year-old husband died of metastatic kidney cancer in 2009, which she recently spoke about in a keynote at the annual Allscripts Healthcare Solutions, Inc., user conference. Holliday believes that the combination of a late diagnosis, unresponsive and impersonal healthcare providers, and the cumbersome system of printed health records contributed to her husband’s death.
Holliday said in her keynote: “There are computers all over the hospital and you can’t show us the medical record?”
“Dangerous voids in health information sharing can easily be solved through the use of digital communications and technology. This survey proves patients take notice and are ready for a change,” Tom Skelton, CEO at Surescripts, said in a press release. “As an industry, we need to come together to connect the nation’s healthcare system — to enhance the patient experience while improving quality and lowering the cost of care.”
Consumers eager to review cost and healthcare quality data before making a care decision are in luck. If they are covered under the Blue Cross and Blue Shield (BCBS) umbrella, that is.
All 36 BCBS companies pledged to pool their cost and healthcare quality data to the BCBS Axis, the Blue Cross Blue Shield Association announced. The BCBS Axis is a database of healthcare information containing data from 96% of U.S. hospitals, covering 2.3 billion yearly procedures. BCBS companies can distribute this data, which is derived from every U.S. zip code, to its affiliated physicians and patients.
The cost aspect of this announcement shouldn’t be overlooked, especially now that the U.S. healthcare industry is moving towards a value-based care model. SearchHealthIT contributor Evan Albright looked into this development at this year’s Healthcare Financial Management Association conference. He learned that providers that adopted population health care models learned they need to be more precise is their pricing estimations when formulating their budgets. They might find that easier if they had access to a database such as the BCBS Axis.
The BCBS Axis should allow BCBS companies to provide patients with even more information to help them locate the best physician to treat them and make more personalized care decisions, though it doesn’t appear patients will have direct access to the data they desire. The BCBS Association’s announcement stated that by using BCBS Axis data, “BCBS companies also help consumers gain access to reliable and accurate information on more doctors, hospitals and procedures.”
The BCBS network — which covers one in three Americans, contains data from 92% of U.S. physicians and hosts more than 700,000 patient reviews — is the “largest aggregated data resource” in the American healthcare industry, the association said. “Through our actionable data, and the speed at which it is available, we are leading a transformation of the healthcare system to improve the quality and affordability of care,” Scott Serota, president and CEO of BCBSA, said in a release.