Consortium News

  • 23 Feb 2015 8:29 AM | Brian Kelley (Administrator)
    from FierceHealthIT.com  |  February 20, 2015 | By Katie Dvorak

    It's time for ICD-10 to be implemented, and added delays are not likely to motivate organizations any more than the others ones did, says pediatrician Michael Lee, the director of clinical informatics at Atrius Health.

    The past delays didn't help the industry, and only served to hinder forward momentum, Lee writes at Physicians Practice. In July, the U.S. Department of Health and Human Services finalized Oct. 1, 2015, as the new compliance date, the third time the transition has been delayed since 2009.

    Atrius Health, a nonprofit multi-specialty medical group based in Newton, Massachusetts, is ready for the new coding system, according to Lee. The organization has moved its front-end systems to ICD-10 and partnered with the Massachusetts Health Data Consortium to test and troubleshoot the new codeset.

    A recent report by the Government Accountability Office found that the Centers for Medicaid & Medicare Services has taken positive steps to help prepare the healthcare industry for ICD-10.

    However, Lee says that with testing by the CMS coming this spring, it doesn't give providers much time to address problems.
    "There is still a great deal of uncertainty in the healthcare community about what is going to happen with ICD-10, especially with recent staffing changes at CMS," he says.
    But, he adds, that doesn't mean ICD-10 should be delayed again.
    "While it would have been wise for the government to move forward with an Oct. 1, 2014, launch ... halting implementation now would be a huge burden to the industry," Lee writes. "It's not time for another delay; it's time to get to work."
    Healthcare providers are not the only ones who are ready for the transition to take place. Members of the House Energy and Commerce Committee's Subcommittee on Health made clear at a hearing examining ICD-10 implementation that they do not want to see the transition delayed yet again.


  • 19 Feb 2015 9:43 AM | Brian Kelley (Administrator)

    Retrieved from EHRintelligence.com 
    Author Kyle Murphy, PhD | Date February 11, 2015

    Over the past several months, healthcare association and industry reports have highlighted the importance of EHR usability to the success of healthcare organizations and providers providing efficient, effective, and safe patient care.

    In 2014, the American Medical Association (AMA) released a new framework comprising a multitude of priorities for creating more intuitive (i.e., usable) EHR technology. Shortly thereafter, Frost & Sullivan published a report detailing how limited EHR usability was impacting healthcare CIOs and their organizations. Other research even indicated that an emerging EHR monoculture — that is, the dominance of a single EHR technology — might benefit EHR usability, interoperability, and innovation.

    A leading health IT subject-matter expert, however, contends that much of the criticism of a lack of EHR usability could be missing the point.
    “I am always very cautious about the whole usability conversation,” says Micky Tripathi, PhD, MPP, President & CEO of the Massachusetts eHealth Collaborative. “When you look at the vendor market there are thousands of them and even hundreds of the certified EHR vendors, and there is nothing in meaningful use or any government regulation that force them to have their products architected or engineered in a particular way.”
    Obviously, regulation requires that certified EHR technology can perform certain functions, but it does not prevent EHR developers from coming up with innovative ways of doing say.
    “In a free market essentially with lots of technology options and no barriers to entry, how is it that no one is making usable products and that we could make general statements about every one of those vendors aren’t doing this or that?” he asks.
    A better explanation, claims Tripathi, is the fundamental concept of economics — supply and demand. “Technology is always going to reflect the underlying businesses. Maybe I’m too much on the free market side, but the supply side is going to reflect what the demand side is asking for,” he says.

    In the context of healthcare, Tripathi calls to mind two forces at work in driving EHR design and usability to this point. The first centers on purchasing power, which in healthcare has historically been controlled by large institutions.
    “One might be that users of the systems for a long time were large enterprises rather than small enterprises,” he explains. “That tends to dictate how software was being designed because it was the large enterprises primarily providing feedback — an institutional mode focused on routinized practices.”
    Likely more important than the first is the immaturity of much of the EHR market. “There is a whole bunch of new vendors not tied to any of that legacy stuff. For me more than anything else, it is still early in our market cycle — that there is not enough market and user feedback yet to make the products better,” adds Tripathi.

    And considering how long end-user feedback takes to become incorporate in new software, EHR adopters are more than likely playing a waiting game.
    “If you don’t like your software either you can work with your vendor or it’s going to be a ten-year process to get that feedback back into the market,” Tripathi explains. “The only way to make EHR products more usable is to have more users using them. No one can architect a perfect system particularly for something as complex as this.”
    What’s next in EHR design and usability

    If current EHR technology is not meeting the needs of healthcare organizations and providers, then what does the future of EHR design and usability hold? According to Tripathi, three emergent trends are starting to gather momentum.

    Given the growth of value-based care, EHR expansion to include population health and care management is the first:

    We are already starting to see care management and population health types of applications that are considered bolt-ons to existing EHR systems if developed by a new or third-party vendor. Increasingly, you have Epic, Cerner, eClinicalWorks, and other vendors reaching up-market essentially to build their own kind of those abilities and functions and integrate them back into the standalone EHR experience so that users have one continuous experience even though it is spanning the spectrum of care.
    Another entails a new but familiar approach at aggregating and displaying patient health data. “I imagine we would start to see is more of a Facebook-like experience to the extent that we will have different contributors to the patient record, including the patient ultimately, that will be seen more as an ongoing stream of those contributions that are both narrative and have the ability to be structured,” claims Tripathi.

    The last and most promising is similarly a capability already in use in other information technologies, using metadata and tagging elements.
    “Lastly, we’re starting to see some products that have more of that fluid experience similar to using a browser but also supporting more of a user-generated structure of data,” says Tripathi. “Rather than all your data being LOINC, coded, or pulled down from drop-down menus, you’re able to go through and tag different parts of the note that you define as a user. You can then perform searches, aggregations, or slicing and dicing — all of that — based on those tags.”


  • 18 Feb 2015 9:59 AM | Brian Kelley (Administrator)

    Retrieved 18-Feb-2015 from NYTimes.com written by Gina Kolata

    Suffering. The very word made doctors uncomfortable. Medical journals avoided it, instructing authors to say that patients “ ‘have’ a disease or complications or side effects rather than ‘suffer’ or ‘suffer from’ them,” said Dr. Thomas H. Lee, the chief medical officer of Press Ganey, a company that surveys hospital patients.

    But now, reducing patient suffering — the kind caused not by disease but by medical care itself — has become a medical goal. The effort is driven partly by competition and partly by a realization that suffering, whether from long waits, inadequate explanations or feeling lost in the shuffle, is a real and pressing issue. It is as important, says Dr. Kenneth Sands, the chief quality officer at Harvard’s Beth Israel Deaconess Medical Center in Boston, as injuries, like medication errors or falls, or infections acquired in a hospital.

    The problem is how to measure it and what to do about it.

    Dr. Sands and his colleagues decided to start by asking their own patients what made them suffer.

    They found several categories. Communications — for example, a doctor blurting out, “Oh, it looks like you have cancer.” Or losing a valuable, like a wedding ring. Or loss of privacy — a doctor discussing a patient’s medical condition where an adjacent patient could hear.

    “These are harms,” Dr. Sands said. “They elicit suffering. They can be long lasting, and they currently are largely unquantified, uncounted, unrecorded.”

    One way to quantify these harms is to observe and note them, which is part of what Beth Israel Deaconess is doing. Another is to supplement efforts with patient surveys. Patient surveys, of course, have been around for decades. And since 2007, Medicare has required short surveys after discharge.

    But patient surveys were usually not used by hospitals to measure suffering. Now they are. And even when a survey question does not directly ask about suffering, sharp-eyed administrators are seeing a suffering component.

    That is how Dr. Michael Bennick, the medical director for patient experience at Yale-New Haven Hospital, solved a problem. He noticed a question on a Medicare survey asking, Is it quiet in your room at night?

    Maybe, Dr. Bennick thought, what is really being asked is: Can you get a good night’s sleep without interruption? Is it really necessary to wake patients again and again to take blood pressure and pulse rates, to draw blood, to give medications?

    He issued instructions for his unit. No more routinely awakening patients for vital signs. And plan the timing of medications; outside intensive care units, three-quarters of drugs can be given before patients go to sleep and again in the morning.

    Then there were the blood tests. “Doctors love blood tests,” Dr. Bennick said, and want results first thing in the morning when they make rounds. That meant waking patients in the wee hours.

    “I told the resident doctors in training: ‘If you are waking patients at 4 in the morning for a blood test, there obviously is a clinical need. So I want to be woken, too, so I can find out what it is.’ ” No one, he said, ever called him. Those middle-of-the-night blood draws vanished.

    Without anything else being done about noise in the halls, the medical unit’s score on that question rose from the 16th percentile to the 47th nationally in the Medicare survey. Now the entire hospital follows that plan.

    “And it did not cost a penny,” Dr. Bennick said. “The only cost was thinking not from our perspective but from a patient’s perspective.

    Dr. Lee says he joined Press Ganey — he had been network president for Partners HealthCare System, a Harvard-affiliated hospital system — because one of its goals was to reduce suffering. At first, he said, he was a bit uncomfortable with the concept.

    “I wondered whether it was a tad sensational, a bit too emotional,” he wrote in The New England Journal of Medicine. Then he realized reducing suffering was one of the most important challenges in health care.

    Press Ganey administers detailed surveys to discharged patients, asking things like how well the medical staff responded to them and their emotional needs, and how well the doctors and nurses informed and educated them. The company also encourages hospitals to let doctors know the results.

    Surveys can be misleading, though, cautions Dr. Scott Ramsey, a health care economist and cancer researcher at the Fred Hutchinson Cancer Research Center in Seattle. Patients, worried about saying something bad about a hospital they depend on, may not reveal what they really experienced. Or they may look back and, not wanting to live a life of regrets, excuse a doctor who seemed not to listen.

    On the other hand, Dr. Ramsey said, the suffering issues are real, and if survey answers can get doctors and hospitals to change their ways, “that is great.”

    Although half the nation’s hospitals use Press Ganey surveys, it is not clear what many do with the data. But at some places, like the University of Utah, the survey and other efforts prompted significant change. One Utah doctor said he was stunned when his patients rated him in the first percentile nationally, about as low as a score can go. “I was thinking: That’s just crazy. Something wasn’t entered right,” said the doctor, James Ashworth. Then he decided to take the criticisms to heart.

    The next quarter, he was rated in the upper 90s. The big difference was slowing down and listening to patients, answering their questions.

    Utah began its program a few years ago by showing its 1,200 doctors, nurses and other workers their scores. Next, said Dr. Vivian S. Lee, the hospital system’s chief executive, they showed them how colleagues did. Then they posted individuals’ scores and patient comments online.

    There was an immediate and noticeable change. When the university began, it was in about the 30th percentile nationally on the Press Ganey survey. Now, half its providers are in the 90th percentile and 26 percent are in the 99th percentile.

    “It’s unbelievable,” Dr. Lee, the chief executive, said. “We were not like that before, I can tell you.”

    “People wanted to improve,” she added.

    The comments, she said, are more revealing than the scores. Not all are complimentary. “There are still cases where people say: ‘I loved Dr. So-and-so. Too bad I had to wait so long to see him,’ ” she said.

    At Stanford Health Care, said Amir Rubin, the president and chief executive, “we are reducing suffering.” To do it, the medical system changed its focus.

    “We train each and every staff member,” Mr. Rubin said. “We talk to staff, we talk to patients, we hear from patients directly.”

    Supervisors coach doctors and nurses, giving feedback every month.

    The initiative changed hiring, he said. Administrators tell job candidates: “These are our care standards. Do you think you can always do it for every person every time?” They carefully observe new hires to see if they can provide care that minimizes suffering.

    “Every patient visit is a high-stakes interaction,” Dr. Thomas Lee says he has learned. “It is a big deal for the patient and it is a big deal for you.”

    “And all you have to do is be the kind of physician your patient is hoping you will be.”

  • 06 Feb 2015 7:05 PM | Brian Kelley (Administrator)

    Retrieved from mobihealthnews.com Feb 5, 2015

    At least 14 hospitals are now either actively involved in a HealthKit pilot or in talks to roll one out, according to a new report from Reuters. Google and Samsung are beginning to approach hospitals to use their platform as well.

    Reuters didn’t name the 14 hospitals, but several have already spoken publicly about using HealthKit: Oschner Medical Center in New Orleans, Stanford Children’s Hospital, Penn Medicine, and Duke University Hospital. An earlier Reuter’s report named several others: Johns Hopkins, Mt. Sinai Hospital, and the Cleveland Clinic. And Beth Israel Deaconess CIO John Halamka has spoken at length about using the technology.

    Reuters reported that Oschner is already working with several hundred patients on a blood pressure tracking pilot and that Cedars-Sinai Medical Center in Los Angeles is developing “visual dashboards” to present patient-generated data to physicians. The chief technology officer at Epic Systems, Sumit Rana, told the publication that smartphone-connected patient-generated data was an idea whose time has come.

    “We didn’t have smartphones ten years ago; or an explosion of new sensors and devices,” Rana told Reuters.

    In a recent investor call, Apple CEO Tim Cook also addressed the adoption of HealthKit by hospitals, and also said that Apple is working with “more than 600 developers,” though he notably didn’t give numbers on hospitals or individual apps connecting to HealthKit. Last November, a MobiHealthNews analysis found 137 publicly available apps that connected to HealthKit.

    “There has also been incredible interest in HealthKit with over 600 developers now integrating it into their apps,” Cook said in the call. “Consumers can now choose to securely share their health and wellness metrics with these apps and this has led to some great, new and innovative experiences in fitness and wellness, food and nutrition and healthcare. For example, with apps such as an American Well, users can securely share data such as blood pressure, weight or activity directly with physicians, and leading hospitals such as Duke Medicine, Stanford Children and Penn Medicine are integrating data from HealthKit into their electronic medical record so that physicians can reach out to patients proactively when they see a problem that needs attention.”

    As for Google and Samsung, Reuters reports that Samsung is working with Massachusetts General Hospital in Boston and the University of California’s San Francisco Medical Center, while Google hasn’t announced any official partners. Reuters said a number of hospitals they spoke to are eager try a pilot of Google Fit, echoing the sentiments of Dr. Ricky Bloomfield at a recent mHealth Summit panel.

    “I think Google needs to do a little bit more to get it into the place where HealthKit currently functions, but I can’t wait until we can use Android devices as well as iOS devices, one to the other,” Bloomfield said at the time. “For me the most important thing is we give this ability to our patients. And I don’t care which device they have, I just want them to be able to give us the data so we can make good clinical decisions to help them out.”



  • 06 Feb 2015 3:11 PM | Brian Kelley (Administrator)
    ICD-10 Implementation and Medicare Testing
    Thursday, February 26, 2015
    1:30 PM - 3:00 PM Eastern Time

    Description
    CMS is offering acknowledgement testing and end-to-end testing to help the Medicare Fee-For-Service (FFS) provider community get ready for the October 1, 2015 implementation date. During this MLN Connects™ National Provider Call, CMS subject matter experts will discuss opportunities for testing and results from previous testing weeks, along with implementation issues and resources for providers. A question and answer session will follow the presentations.

    Participants are encouraged to review the testing resources on the Medicare FFS Provider Resources web page prior to the call, including MLN Matters® Articles and testing results.

    Agenda
    • Participating in acknowledgement and end-to-end testing
    • Results from previous acknowledgement and end-to-end testing weeks
    • National implementation update
    • Provider resources

    Target Audience

    Medical coders, physicians, physician office staff, nurses and other non-physician practitioners, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare providers.

    Presentation

    The presentation for this call will be posted at least one day in advance of the call on the MLN Connects™ National Provider Calls and Events web page. Select the call date and scroll to the "Call Materials" section to locate the slide presentation. A link to the audio recording and written transcript of this call will be posted under the "Call Materials" section in approximately 2 weeks following the call.

    Registration will close at 12:00 p.m. ET on the day of the call or when available space has been filled.


  • 05 Feb 2015 4:03 PM | Brian Kelley (Administrator)

    WASHINGTON, D.C.—The OpenNotes effort to allow patients access to their own records has grown significantly over the past few years and John Mafi, MD, discussed at the ONC 2015 Annual Meeting the recent $450,000 grant from The Commonwealth Fund to develop OurNotes, an initiative to promote active patient engagement in health and illness that invites patients to contribute to their own EMRs.

    Studies indicate that patients forget 40 to 80 percent of what their doctor just told them and of what they do remember, about half is wrong, said Mafi, a fellow in internal medicine at BIDMC. “The appeal with OpenNotes is that patients feel more in control of their own care and remember their plan of care better.”

    Two-thirds of OpenNotes users reported better medication adherence. By expanding the effort, “the hope is for freed up time during visits for shared decision-making. Patients can think about what really matters to them and contribute to the care plan.”

    The biggest hurdle, he said, is making sure clinicians are supported rather than adding to their workflow.

    Through the OurNotes grant, participating organizations will build, implement and pilot test patients and physicians co-generating their medical records. We think of this in three paths, Mafi said. Previsit data entry, during the visit and after the visit, particularly for people with chronic disease. “They can sign off on the plan and make sure it’s truly patient-centered and we can measure what that does to chronic disease care and patient and physician satisfaction.”

    Currently, Mafi said the team is measuring those things that are easily measured. “We’re finding that there are very few things where one size fits all.” They’re also working on promoting shared decision-making and getting the patient’s perspective into the record. “We currently don’t measure whether treatments are matching patients’ values. In fact, data show most don’t. Health IT needs the patient’s voice.”

    Studies show that 60 percent of patients would view their notes within 30 days and that level was sustained for two years, said Mafi. At Geisinger Health System, however, they stopped inviting patients to view their records and note viewing plummeted to about 10 percent. “The key difference is push invitations.” Although about 5 million patients have access to their records through OpenNotes, “no organizations are doing the invitation piece with the exception of two places. As we see OpenNotes spread rapidly, we’re probably going to see low viewing rates unless organizations are doing push invitations.”

    OurNotes will focus on chronically ill patients, he said. “We need to be intelligent about this. We need a multifaceted approach and policies narrowing healthcare disparities. On the ground level, we need an effort to engage these patients.”

    Researchers plan for OurNotes to allow patients to add topics or questions they’d like to cover during an upcoming visit to create efficiency for those visits, as well as review and sign off on notes after a visit to make sure patients and clinicians are on the same page.”

    The Commonwealth Fund grant will support work at five sites, including original OpenNotes study partners, BIDMC, Geisinger in Danville, Pa., and Harborview Medical Center in Seattle, Wash., and more recent OpenNotes adopters, Group Health Cooperative, also in Seattle and Mosaic Life Care in St. Joseph, Mo.

    retrieved Feb 4, 2015 from ClinicalInnovation+Technology.com

  • 30 Jan 2015 10:22 AM | Brian Kelley (Administrator)

    The federal health information technology coordinator released a wide-ranging report Friday morning on how to improve interoperability in electronic health-record systems.

    The report, “Connecting Health and Care for the Nation, A Shared Nationwide Interoperability Roadmap,” (PDF) calls for most providers to be able to use their systems to send, receive and use “a common set of electronic clinical information ... at the nationwide level by the end of 2017.”

    The common data set consists of about 20 basic elements, such as patient demographics, lab test results and identifiers for a patient's care team members. The plan is open for public comment through April 3.

    Accompanying the 10-year interoperability plan is a 13-page “advisory” to the health IT community on what the feds see as the best available healthcare information exchange standards and implementation specifications to facilitate health data information exchange. The ONC intends to keep the list updated periodically.

    Some health information is being exchanged among these EHR users, in regions, and among customers of the same EHR vendors, and through statewide health information exchanges, according to the report. These success stories should provide “best practice models we can look to where data and information is flowing,” said Dr. Karen DeSalvo, coordinator of HHS' Office of the National Coordinator for Health IT.

    But the agency also has heard from both insurers and providers that the level of health information exchange is insufficient for their needs, she said. Healthcare organizations wanting to exchange information have been hampered by a lack of consensus on which information exchange standards to use, how to configure computer systems to use them, and which rules and business practices to follow. 

    “What we don't see yet is a complete coalescing around the rules of the road” for a nationwide exchange network, DeSalvo said.

    The ONC's interoperability roadmap calls for a public-private partnership to create a “governance framework” for health information exchange. It also calls for more work to be done developing and harmonizing interoperability standards “that will allow us to facilitate the sharing without a whole lot of extra effort,” she said.

    The plan also calls for both government and private sector players to provide additional incentives for interoperability – beyond those in the EHR incentive payment program. And it sees a need to better educate providers and their health information exchange partners on federal privacy and security rules, which the report says should enable data sharing, rather than inhibit it as is often the case now.

    The 2009 economic stimulus legislation that created the EHR incentive payment program, specifically ordered the ONC to “establish a governance mechanism for the nationwide health information network.” Since then, the agency has been under increasing criticism from members of Congress and professional groups about the lack of interoperability of EHRs despite the substantial public investment in them.

    Improving interoperability of health information is a critical prerequisite for providers seeking to create patient-centered medical homes, population-based care management systems and accountable care organizations as both government and private sector payment reforms shift from fee-for-service to performance-based payment models.

    On Monday, HHS Secretary Sylvia Mathews Burwell announced that by 2016 the CMS wants 30% of Medicare payments to be linked to these payment reform models, and 50% by 2018.

    Wednesday, a coalition of providers, insurers and employers pledged to have 75% of their members' business switched to performance-based contracts by 2020.

    In 2013, six Republican senators chastised the ONC for multiple health IT program failings, including a “lack of a clear path toward interoperability.” That month, the ONC issued a formal “request for information,” about possible governance models for health information exchange, a move that was viewed fearfully by some healthcare IT players as a possible first step toward federal regulation of health information exchange.

    The ONC backed off in September in the face of industry pleadings to allow interoperability to develop, unregulated, through market-based approaches.

    Earlier this month, in a letter to DeSalvo, the American Medical Association and nearly three dozen other medical societies and associations took the ONC to task on its health IT program problems, including a lack of interoperability

    “Ensuring electronic health information follows patients during transitions of care is one of the most sought after, yet the least successful exchange paradigms in health care today,” the AMA letter said.


    DeSalvo insists the ONC roadmap isn't an attempt by the agency to become a national network regulator. A heading on a section of the roadmap refers to “non-governmental governance.”

    “We are not specifically calling for a new entity for nationwide governance,” DeSalvo said, but, “We still want to give guidance and a timeline” for meeting plan objectives.

    Veteran physician informaticist Dr. William Bria applauded the inclusion of priority use cases targeting electronic sharing of patient data with public health authorities and enabling patients to access to their own healthcare information, particularly on mobile devices. 

    “It strikes me that it's way past time to give the American public access to their own information and in a way they can actually use (it),” said Bria, president of the Association of Medical Directors of Information Systems. “They are the key customer that's really been left. It's overdue.”

    View the first release of the Health IT Roadmap here.

  • 30 Jan 2015 9:42 AM | Brian Kelley (Administrator)

    The Massachusetts Medical Society is presenting a live Webinar on Clinical Documentation Requirements for ICD-10 on Wednesday March 18, 2015 at noon.  

    ICD-10 is one of the most significant changes in our industry’s history, and with less than a year until the October 1, 2015 go-live date, now is the time to focus on preparing your practice and staff for the changes ahead. Accurate documentation of the patient encounter is critical to outpatient billing. Without it, providers may risk loss of revenue. Be sure that your documentation practices are ready for ICD-10 by signing up for this webinar today!

    As a result of participating in this activity, you should be able to:

    • Identify why detailed clinical documentation is important for the ICD-10 transition, including high-impact differences between ICD-9 and ICD-10
    • Plan and optimize your clinical documentation strategies
    • Apply best practices for educating and training your staff

    AMA Credit Designation Statement:
    The Massachusetts Medical Society designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    This activity meets the criteria of the Massachusetts Board of Registration in Medicine for risk management study.

    Accreditation Statement:
    The Massachusetts Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    Click here for Registration, prices and more information.


  • 22 Jan 2015 4:53 PM | Brian Kelley (Administrator)
    retrieved Jan 22, 2015 |  Boston Business Journal  |  Jessica Bartlett 

    Gov. Charlie Baker has appointed two people to manage the Health Connector and MassHealth, and has elevated the MassHealth role to a higher level in the organization.

    The new executives will be charged with leading two organizations that Baker has criticized for contributing to a $765 million state budget deficit, and that have seen significant turmoil over the last year as the state grappled with instituting the Affordable Care Act and a revised online health care marketplace.

    In a press release sent on Thursday, Baker said Daniel Tsai would run MassHealth, the state's medicaid system to help low income residents. His title will be assistant secretary, an elevated role that will answer to Health and Human Services Secretary Marylou Sudders.

    The move coincides with a December recommendation from the Massachusetts Medicaid Policy Institute to elevate the Medicaid director role to a higher decision-making authority.

    "This change in designation will allow for enhanced coordination between MassHealth and other state agencies and empower policy, payment and service reforms needed to benefit members and the Commonwealth," the administration said in a release.

    Tsai currently works as a partner in McKinsey & Company's Healthcare Systems and Services practice, and has co-lead the firm's Medicaid service line. He will replace Kristen Thorn.

    Louis Gutierrez was also appointed to be the next executive director for the Massachusetts Health Connector, the organization that oversees the website to sign up for health insurance.

    Gutierrez, who has spent the last seven years as a principal in IT consulting firm Exeter Group and on the board of directors of Harvard Pilgrim Health Care and the New England Health Exchange Network, will replace Jean Yang.

    Yang departed the organization on Jan. 16 after two years into the role, saying she would transition to a different role within the health care market.

    Gutierrez will serve under Administration and Finance Secretary Kristen Lepore, who serves as the chair of the Health Connector Board of Directors.

    "I am confident in Daniel's ability to fill this new and expanded role as assistant secretary to facilitate further cooperation among agencies who assist and care for our Medicaid population, and Louis' talent will be a welcome voice and mind for those families and individuals searching for quality and affordable healthcare," Baker said in a statement.



  • 22 Jan 2015 2:56 PM | Brian Kelley (Administrator)

    retrieved from Life as a Healthcare CIO  |  January 21, 2015

    As I travel across the country and listen to CIOs struggling with mandates from Meaningful Use to ICD-10 to the HIPAA Omnibus rule to the Affordable Care Act, I'm always looking for ways to reduce the burden on IT leaders.

    All have expressed frustration with the health information exchange (HIE) policies and technologies for care coordination. quality measurement, and patient engagement.

    As a country, what can we do to reduce this anxiety?

    Meaningful Use Stage 1 brought some interoperability especially around public health reporting. Stage 2 brought additional interoperability, with well defined content, vocabulary, and transport standards for transitions of care.

    Most CIOs have implemented certified EHRs and the required standards. Here’s a capsule summary of what I’ve heard

    HL7 2.x

    HL7 messaging addresses lab result and public health use cases very well. Lab results interfaces are straight forward, however there is still some need to reduce optionality in implementation guides so that the average lab interface costs $500 and not $5000. Public health transactions for immunizations, reportable lab, and syndromic surveillance are standardized from a content perspective but there is still a need to specify a single transport mechanism for all public health agencies.

    CCDA/Direct

    CCDA documents address transitions of care use cases reasonably well. CCDA is easier to work and parse than CCD/C32 because it has additional constraints and specifications, but there is still enough optionality that merging CCDA data into an EHR can be challenging. In addition, most EHRs generate a CCDA automatically and include all data that may possibly be relevant. In some cases, this leads to C-CDAs that are rendered at 50+ pages. We need to reduce optionality so that CCDAs are easier to generate correctly and parse. EHR workflow needs to better support the creation of clinically relevant documents with narrative and data more specific to transitions.

    Direct was a good first step for transport - we needed to pick something. We could have required sFTP, REST, SOAP, SMTP/SMIME or even Morse Code as long as it was completely standardized. Unfortunately, we picked multiple options. Some EHRs use XDR (a SOAP transaction) and some use SMTP/SMIME. Whenever standards have an "OR", all vendors must implement an "AND". XDR must be translated into SMTP/SMIME and SMTP/SMIME must be translated into XDR. The reality of Direct implementation has show us that this optionality provides a lot of plumbing challenges. Certificate and trust issues are still an ongoing project. Getting data from medical devices via Direct is challenging since devices tend to use heterogeneous transmission protocols. Finally, SMTP/SMIME was never designed for large payloads of multiple files, so sending datasets greater than 10 megabytes can be a struggle. The use of XDM for zipping files before they are sent is overly complex to use as part of a transport protocol.

    Although Direct works, it is often not well integrated into the EHR workflow.

    FHIR, as discussed in multiple recent posts, can help address these challenges and leverage the lessons learned. The FHIR concept is that every EHR will provide a standardized interface for the query, retrieval, and submission of specific data elements and documents using a web-based RESTful transport mechanism and OAuth security. This use case can easily support unique modules or “bolt on” application functionality to EHRs. It significantly simplifies the interfacing challenge, works for large payloads, and minimizes optionality. There are no multiple transport options, no certificates to manage, and the query/retrieve processes can occur behind the scenes, enabling smoother workflow.

    FHIR can even be helpful as a transition strategy while Direct is still used for pushing payloads between EHR. If FHIR/REST/OAuth replaced the XDR/XDM options of Direct, that provides a glide path to the eventual end to end replacement of Direct with FHIR

    Once FHIR is available, EHR vendors should design a user experience that follows the IEEE definition of interoperability - “the ability of a system or a product to work with other systems or products without special effort on the part of the customer. "

    In summary, think of HL7 2.x as good enough for messages pushed between systems, Direct/CCDA as suitable but challenging for pushing XML documents between systems, and FHIR as a means to integrate multiple platforms via the use of application program interfaces that support the simple query/retreat/submission of data among applications.

    FHIR will solve many of our interoperability challenges with appropriate support from EHR developers for clinically relevant workflow. We have to be careful not to oversell it, but for many use cases, FHIR is our best hope for the future.

    posted by Dr. John Halamka, "Life as a Healthcare CIO", Jan 21, 2015

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