Wednesday, February 04, 2015

This Is Almost Certainly One Of the Most Important Announcement For E-Health Globally In 2015..

This announcement appeared late last week:

ONC calls for interoperability by 2017

Posted on Jan 30, 2015
By Bernie Monegain, Editor-at-Large
The Office of the National Coordinator released this morning a draft roadmap, along with proposed actions to take in order to achieve interoperability and a learning healthcare system in the next two years.
The document, Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0 outlines steps "that will enable a majority of individuals and providers across the care continuum to send, receive, find and use a common set of electronic clinical information at the nationwide level by the end of 2017."
The "time has come for us to be more explicit about standards," said ONC Chief Karen DeSalvo, MD, in a Jan. 30 press call detailing the roadmap, a 150-page plus document addressing everything from governance, standards and certification to privacy and security. "Health IT that facilitates the secure, efficient and effective sharing and use of electronic health information when and where it is needed is essential to better care, smarter spending and a healthier nation," DeSalvo said.
ONC is accepting public comments and key commitments on the draft Roadmap for approximately 60 days, which will end at 5 p.m. ET on April 3, 2015.
In her letter at the start of the roadmap, DeSalvo emphasizes that several action steps will be needed on the road to interoperability. The works, she writes, will occur along three critical pathways:
  1. Requiring standards;
  2. Motivating the use of those standards through appropriate incentives; and
  3. Creating a trusted environment for the collecting, sharing and using of electronic health information
Lots more here:
Here is the direct link:
These couple of pages provide an idea of the scope of what is being addressed.

Appendix H: Priority Interoperability Use Cases

A use case is a descriptive statement that defines a scope (or boundary), interactions (or relationships) and specific roles played by actors (or stakeholders) to achieve a goal. The methodology is commonly  used to support the identification of requirements and is a simple way to describe the functionalities or needs of an organization
The following is a list of the priority use cases for nationwide interoperability  most commonly submitted  to ONC  by public and private  stakeholder s prior to release of the draft  Roadmap.
Coordinated  governance processes should help refine and prioritize this list to then prioritize development of  technical standards, policies and implementation specifications.
1. Public health agencies routinely use data derived from standards based connections with HIEs and EHRs and uses it to plan investments in public health activities.
2. Clinical settings and public health are connected through bi-directional interfaces that enable seamless reporting to public health departments and seamless feedback and decision support from public health to clinical providers.
3. The status of transitions of care should be available to sending and receiving providers to enable effective transitions and closure of all referral loops.
4. Federal, State, provider and consumer use of standardized and interoperable patient assessment data to facilitate coordinated care and improved outcomes.
5. Population health measurement is supported at the community level and includes data from all relevant sources on each patient in the population and is accessible to providers and other stakeholders focused on improving health.
6. Providers and their support staff should be able to track all orders, including those leaving their own organization and EHR, to completion.
7. Individuals integrate data from their health records into mobile apps and tools that enable them to better set and meet their own health goals.
8. CEHRT should be required to provide standardized data export and import capabilities to enable providers to change software vendors.
9. Providers should be alerted or have access to notifications that their attributed patients have had an ER visit, or an admission to or discharge from a hospital.
10. Quality measures are based on complete patient data across multiple sources.
11. Narrative components of the medical record are preserved for provider and patient use and augmented with metadata to enable effective storage, routing and searching for these  documents.
12. Providers are able to access x-rays and other images in addition to the reports on patients they are treating, re gardless of where the films were taken or housed.
13. Providers and patients have access to genomics testing and data which, when combined with clinical information about patient goals allows the personalization of care and therapies.
14. Patients routinely engage in healthcare encounters using electronic communications such as eVisits and telemedicine.
15. Researchers are able to use de-identified clinical and claims data from multiple sources with robust identity integrity.
16. Patients are routinely offered participation in clinical trials that are relevant to their particular needs and situation.
17. Patients receive alerts and reminders for preventive screenings, care and medication regimens  in a manner convenient to and configurable by the patient
18. Patients have the ability to access their holistic longitudinal health record when and where needed.
19. Patients audit their medical records, providing amendments and corrections and supplying  missing data such as health outcomes.
20. Patients, families and caregivers are able to use  their personal devices such as smartphones,  home BP cuffs, glucometers and scales to routinely contribute data to their longitudinal health  records and use it or make it available to providers to support decision -making.
21. Patients have access to and can  conveniently manage all relevant consents to access or use their data.
22. Those who pay for care use standardized transactions and interoperability to acquire data needed to justify payment
23. Payers should be able to receive notification automatically though the health IT system when a  beneficiary is admitted to the hospital.
24. Benefits communication needs to be standardized and made available on all plans through HIT  to providers and patients as they make health and healthcare decisions, in a workflow  convenient to the decision -making process.
25. Payer/purchaser requirements for payment, such as prior authorization, are clear to the  provider at time of order and transacted electronically and timely to support efficient care delivery.
26. All providers in a care team will have unique access, authorization and auditing functionality  from  health IT systems necessary to fulfill their role on the care team.
27. Data for disease surveillance, immunization tracking and other public health reporting are  exchanged automatically.
28. All health IT should provide access and support for disabled users including patients and providers.
29. Query based exchange should support impromptu patient visits in all settings.
30. Community systems electronically track and report shared risk pool data measures in support of payment reform and delivery
31. Payers use integrated data from clinical and administrative sources to determine  reimbursement in support of payment reform
32. Individuals are identified to participate in research opportunities through health data  interoperability
33. Providers have the ability to query data from other sources in support of care coordination (patient generated, other providers, etc.) regardless of geography or what network it resides in
34.Providers use genomic data to achieve personalized care 164
35. Individuals have electronic access to an aggregated view of their health information including their immunization history
36. Individuals integrate data from their health records into apps and tools that enable them to better set and meet their own health goals
37.Individuals regularly contribute information to their electronic health records for use by  members of their care team
38.Provider systems electronically track and report high value measures in support of payment reform and delivery
39. Primary care provider s share a basic set of patient information with specialists during referrals; specialists “close the information loop” by sending updated basic information back to the primary care provider
40. Hospitals automatically send an electronic notification and care summary to primary care providers when their patients are discharged
41. Providers and patients receive electronic laboratory results from laboratory information systems (LISs) inside and outside their organization
42. Providers can query or access case management information about patients’ care in outside organizations
43. System users have access to provider directory information that is developed to support healthcare communications as well as other use cases
44. Providers have ability to access information in PDMP systems before prescribing narcotics to patients
45. Care providers have electronic access to the information they need for the detection of domestic violence or child abuse
46. Authorized individuals have access to audit logs to ensure appropriate use
47. Disaster relief medical staff members have access to necessary and relevant health information so that they may provide appropriate care to individuals during an emergency
48.Patients routinely engage in mental health risk assessments using electronic communications such as eVisits and telemedicine
49. Emergency medical providers have the ability to query data from other sources while managing chronically ill patients after a disaster regardless of geography or what network the data resides in 50. Population health measurement is supported at the community level and includes data from all relevant sources on each patient in the population (including information on births, deaths and occupational health hazards) and is accessible to providers and other population health stakeholders
51. Population health measurement is supported at the community level and includes statistical data on smoking cessation programs, new patient medical visits and trauma related incidents in a particular area
52. At -risk patients engage in healthcare monitoring programs which can detect life threatening situations (such as patient down and unresponsive) using at home monitoring devices and electronic communications such as eVisits and telemedicine
53. Payers review clinical documentation for payment purposes
54.Payers  review clinical documentation for approval of services (prior authorization)
55. SSA includes functional criteria in some of the Listings of Impairments (the “Listings”) to provide an administrative expediency to screen adult disability claimants who are unable to do any gainful activity without consideration of age, education, and work experience. For claimants who do not meet the criteria in the Listings, SSA uses their functional data to perform residual functional capacity assessment to determine their ability to do work.
56. Individuals exercise their choice for consent and consent management policies and procedures are in place to enable the private and secure electronic exchange of behavioral health data.
(Page 163 on)
A close review of these use cases will make it clear just how ambitious the US is being and the likely impact this work will have.
Mandatory browsing in my view. Would be very interesting to see a NEHTA response to this!
David.

7 comments:

Anonymous said...

This is great for the me too leadership at NEHTA. The best they can ever do is be a poor copy of this, better than nothing though which is what you get now!

Bernard Robertson-Dunn said...

I'm sorry David but I can't agree with you about that document's importance. It's all about IT and even then it shows significant ignorance, even of IT.

For example, Appendix H is not a list of use cases.

As it says "A use case is a descriptive statement that defines a scope (or boundary), interactions (or relationships) and specific roles played by actors (or stakeholders) to achieve a goal." And then it ignores that definition and list a set of random requirements

Take the first item on the list:

1. Public health agencies routinely use data derived from standards based connections with HIEs and EHRs and uses it to plan investments in public health activities.

That does not describe a scope, interactions, roles or actors.

The same for most (it could be all, I haven't read them all) of the rest of the list.

The disturbing thing to me is that these so called experts are displaying gross ignorance and incompetence.

That document and "A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure"
http://www.healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf

talk glibly about "electronic health information" without any definition or discussion of what it is.

The PCEHR ConOps had exactly the same problem - no analysis/coverage/discussion of health information, just technology.

The document is out for review. In Questions on the Roadmap, it says:

Start************
As you review the Roadmap, please consider the following questions and submit your responses during the public comment period.
...
2. Priority Use Cases
1. Appendix H lists the priority use cases submitted to ONC through public comment, listening sessions, and federal agency discussions. The list is too lengthy and needs further prioritization.

Please submit 3 priority use cases from this list that should inform priorities for the development of technical standards, policies and implementation specifications.
End************

If these were really use cases, you wouldn't be asking people to prioritise and vote on them. They would all describe essential requirments.

This is madness.

Tom Bowden said...

Thanks David,

This is significant, however to put it in perspective, please bear in mind the Chillmark 2015 forecast that US Health providers will rapidly propel direct messaging forward this year, only to realise they are increasing rather than reducing the problems i.e. without focusing on content and data quality they will simply have created better and faster ways to move meaningless and unhelpful data.
I think we should also recognise the latest Brookings Inst paper which points out that it is the lack of a sustainable business model rather than lack of interoperability that is the real culprit in the US.

Terry Hannan said...

David, this is a very important posting. Finally some clarification by the ONC (and hopefully other nations e.g. Australia) on interoperability. Now is the time to get our hands dirty and make it work.

Bernard Robertson-Dunn said...

@Tom
"without focusing on content and data quality they will simply have created better and faster ways to move meaningless and unhelpful data."

Agree totally.
It should be all about the data, not the technology.

And having recently experienced first hand the NSW emergency/public hospital system, the problems with data quality are far more critical than any amount of IT.

IT, done badly, will just make things a) worse, b) worse faster and c) harder to correct.

Dr Ian Colclough said...

I agree with Tom who highlights the “the lack of a sustainable business model” and I would not argue with Bernard’s observations either. It reads to me like a high level aspirational document. It gives me no confidence that the ‘authors’ have any depth of understanding of the real world practicalities involved in implementing ‘solutions’ based on a sustainable business model and in such a way that the barriers that lie in the way of progress have been identified and understood, and that the strategies required to enable the ‘solutions’ to gain traction and become embedded in the fabric of the ‘target’ environment as part of ‘the’ sustainable business model have been defined.

K said...

"no confidence that the ‘authors’ have any depth of understanding of the real world practicalities"

Or that non-politicians have any depth of understanding of the constraints on a national program. That's more likely - the ONC is the kind of office that can afford to gather real experts, but then can't let them use their expertise.

The market is broken - the incentives are not aligned, and political programs get in their own way. It'sll require a crisis to get any real progress. Unfortunately, one of them is on the way.