October 2021 Newsletter

Roy Amara was an American researcher, scientist, futurist, and president of the Institute for the Future best known for coining Amara's Law on the effect of technology. Amara's Law states that we tend to overestimate the impact of technology in the short run and underestimate the effect in the long run.

The electronic medical record promised a better-connected and more manageable health system but instead reduced data liquidity, burdened clinicians, and saddled health systems with enormous technical debt. While healthcare will realize the benefits of digitizing the health encounter as these technologies improve, the short-term impacts have been rough.

That's why interoperability is so important. It is the only means to enable consumers to make informed health decisions and solve some of the industry's most challenging problems. Moving the locus of information from a plan or a provider to a person forces the industry to collaborate, reduces redundant investment in costly and balkanized technologies, and shifts the focus from how to manage a hospital or health plan to how to engage the patient or the member based on what's most important to that individual both clinically and financially.

In the coming weeks, MHDC will be hosting presentations that highlight the kind of innovation possible when every patient (member, person) is at the center of their own health data. We will explore a framework for charting pathways to health system success that adapts to ongoing changes in patient perspectives, health care laws and policies, and information technology advancements. We will discuss innovations in authentication and identity and understand how a visual health history can support patient-clinician communication. We will also understand more the critical role of family caregivers and how a national health plan moves its members to the center of their health data.

We look forward to seeing you on this journey.

Denny Brennan, Executive Director

Please let us know what you think of our newsletter at newsletter@mahealthdata.org and look for our next issue. Thank you for your continued support and participation!

MHDC Events

Meetings this month:

  • Board of Directors: October 21, 8-10am
  • DGC Steering Committee: October 13, 3-4:30pm
  • DGC Working Group: October 6, 13, 20, 27, 11am-12:30pm
  • Leadership Dinner: October 26, 6-9pm
  • NEHEN Business Users Group: October 7, 9-10am
  • NEHEN User Reception: October 19, 6-7pm
  • Spotlight Users Group: October 26, 2:30-3:30pm
  • Vantage Point: October 5, 12-1pm
  • Webinar: Imprado: October 7, 10am-12pm
  • Webinar: Pictal Health: October 13, 1-3pm
  • Webinar: Humana: October 27, 2-3:30pm

Want to learn more about any of these meetings? Email info@mahealthdata.org

Dolores L. Mitchell Investing in Information Award

MHDC is pleased to announce the 2021 Dolores L. Mitchell Investing in Information Award winners:

Alexandra Mugge

Director and Deputy Chief Health Informatics Officer, CMS

Lee Green

Chief Architect, Enterprise Technology, Blue Cross Blue Shield of MA

Alex has been instrumental in determining and communicating the rules and implementation parameters of the CMS components of the 21st Century Cures Act. Lee has been leading interoperability at BCBSMA and promoting MHDC efforts in this area through his involvement on the MHDC Board of Directors and the Data Governance Collaborative Steering Committee. We congratulate them both on this well deserved honor.

MHDC Webinars

Join us for our upcoming webinars: 

A Comprehensive Approach to Health Care Transformation presented by Alix Goss of Imprado on October 7 from 10am-noon.

On October 13 from 1-3pm join us for Visual Health Histories with Katie McCurdy of Pictal Health.

Plus, Moving Integrated Care Delivery Forward with FHIR presented by Patrick Murta of Humana on October 27 from 2-3:30pm.

Missed any of our webinars in 2021? Click here to see what you've missed! 

Interested in holding an MHDC webinar or have an interesting topic you'd like to present? Contact us at webinars@mahealthdata.org

The Vantage Point Series

Join us for exclusive interviews with some of healthcare’s most recognized leaders as they reveal how and why they chose their careers, what they learned on their journey, and how to apply these insights to the everchanging future of healthcare.

Our next Vantage Point Series interview features Alexandra Drane on October 5th from noon-1pm.

Missed our previous Vantage Point Series interviews? You can find recordings here.

Spotlight Analytics Update

Spotlight Business Analytics helps healthcare organizations run custom analytics on health data including market share, patient origin, disease prevalence, cost of care, and comparative costs and outcomes for acute care hospitals.

We are working on some enhancements to Spotlight that include incorporating new datasets. We should have more information on this at our next Spotlight User Group meeting on October 26. Please register here to join us. Meanwhile, we're planning to hold meetings with current Spotlight users to discuss how these changes can help and meet the different needs and objectives of each user.

The current data status is:

Loaded & available for use:

  • Massachusetts Hospital Inpatient Discharge Data FY19
  • Rhode Island Hospital Inpatient Discharge Data FY19
  • Massachusetts Emergency Department Discharges FY19

Received & ready for use soon:

  • Rhode Island Hospital Inpatient Discharge Data FY20
  • Massachusetts Observation Data FY19

Future planned data:

  • Massachusetts Observation FY19
  • Massachusetts Hospital Inpatient Discharge Data FY20
  • Massachusetts Emergency Department Discharges FY20
  • Massachusetts Observation FY20
  • New Hampshire Facility Discharge Data Sets (Application pending)
  • Maine Hospital Inpatient and Outpatient Data (Application pending)

Please feel free to drop us a line with any questions or comments at spotlight@mahealthdata.org. In the meantime, thank you for being a Spotlight Analytics user and a member of this community! Feel free to visit our Spotlight Business Analytics page or email us at the address above for more information.

DGC Update

The Data Governance Collaborative (DGC) at MHDC is a collection of payers and providers throughout the region exploring ways to better exchange health-related data incorporating industry standards and automation as much as possible.

The DGC expects to move to the implementation phase of the code mapping service soon. This system will be available to anyone (with a discounted rate for DGC members).

We held an Eye Care Deep Dive on September 15th and learned about FHIR resources for corrective prescriptions, quality measures, and encounter-related data as well as quite a lot about what else we need to learn. We barely touched the surface on eye care data and workflows so we may revisit this topic in a future deep dive. We plan to have our next deep dive on Advanced Directives and similar documents sometime in October - watch our Twitter account or email us at deepdives@mahealthdata.org to be notified when the details are set.

Membership in the DGC is open to any payer or provider with business in Massachusetts - big or small, general or specialist, traditional or alternative. Want to know more? Email datagovernance@mahealthdata.org

NEHEN Update

NEHEN reduces administrative burden through the adoption of standardized transactions. It is a cornerstone service for payer and provider trading partners wishing to exchange industry standard X12, HIPAA compliant transactions in a real-time, integrated manner using APIs. Because of our unique governance, non-profit status, and membership-based model, NEHEN is able to offer very competitively priced services relative to the market.

NEHEN's mission is to offer high value (low cost) per transaction rates while providing reliable and efficient service. As such, NEHEN strives to keep the cost of administrative transactions as low as possible so we periodically review the net patient/premium revenue of our members (used to determine rate tiers and associated fees) and adjust accordingly to ensure fees are applied fairly to all. NEHEN had deferred any individual rate adjustments throughout the COVID-19 pandemic in recognition of the exceptional effect it has had on everyone. Given the easing of the pandemic at this time, NEHEN will work with each participant to fairly assess and communicate possible rate changes needed.

As a thank you to our users NEHEN is hosting a reception on October 19 from 6-7pm - location to be announced soon.

For information about NEHEN please contact us at members@nehen.org.

Electronic Prior Authorization Initiative 

This project is a prototype implementation that automates prior authorization transactions using the industry standard, open platform methods developed by the HL7 DaVinci Prior Authorization workgroup. This project will be compliant with the three related implementation guides which utilize open, FHIR based API exchange methods. This will allow each payer and each provider to implement a single prior authorization process and format for exchange so long as all of their exchange partners adhere to the same standards.

We are still waiting for final participation agreement signatures so we can move into a more active phase of the project. That said, good progress is being made on organizing around the spirit of the agreements and we are ready to take next steps immediately upon agreement execution.

Concurrently, the industry has continued to make progress on prior authorization including behind the scenes work by the regulating bodies (ONC, CMS, CAQH) and some alignment of regulating bodies on the standards and operating rules for adoption. Specifically, there is a provision in the CAQH attachments (for claims and prior authorization) draft operating rules for non X12 payloads to be sent using the Core connectivity API's. This means that many types of payloads could be sent in the electronic prior authorization transactions once CAQH Core operating rules are finalized.

To clarify information that may have been less clear before, the exception to the requirement of using X12 275/278 for prior authorization granted to DaVinci applies only to the specific test projects being run directly by the DaVinci Prior Authorization working group and is not conferred on other DaVinci members or on people participating in the group working on other projects. Any other project, organization, or entity wishing to process prior authorization using non-X12 transactions would need to apply for the exception and follow the requirements of the exception program, if granted.

For more information email us at epa@mahealthdata.org.

Industry Events

Interested in webinars and online conferences through October? Here are some we recommend (they're free unless otherwise noted):

We do periodically post webinars we plan to attend on social media, so feel free to follow us on Twitter (@mahealthdata) and LinkedIn for more webinar ideas and for our take on interoperability, data, health equity, telehealth, APIs, and other topics of interest.

Have an upcoming event next month to suggest? Write us at newsletter@mahealthdata.org - no self-promotion please.

Perspective Matters

We all see the world from our own perspectives built from our personal histories, knowledgebases, priorities, and other factors. This is one reason why clearly defined terminology is so important - when interfacing with others, be it individual-to-individual or organization-to-organization or anything in between - we need a common framework of understanding to have clear conversations where all sides understand each other.

Sometimes this hits us in unexpected ways. This came home to roost during the recent DGC Eye Care Deep Dive. We wrote the slides from a data perspective, trying to understand the different variations and factors that can affect what data is available and the workflows and processes by which they are collected and shared. We had attendees from different walks of life including eye care providers, technologists, data experts, and others.

From a data perspective, an optometry clinic associated with an optical shop likely has close ties to the shop whereas one inside a major hospital might be using the same EHR system as specialists in other areas. As we prepared for the conversation, we did not think we were commenting on the licensing standards or ownership of these clinics. However, some of our audience members felt that these were important aspects to discuss. They were not directly relevant to our data focus but they were still important and we needed to acknowledge that in order to move forward with the aspects that were important to us. In order to address data we had to address culture first.

This is one reason why we ask member organizations to detail folks with different roles and perspectives to attend DGC meetings. We want to hear about business operations concerns just as much as the technical limitations of current development tools and the specific data elements and formats expected for various use cases and features. People working with quality measures data have different needs and concerns than people working on processing claims have different requirements than people overseeing care management programs. All of these perspectives are important; the more of them we have in the room the more likely we are to create something useful that we can apply consistently across a wide swath of data and people and organizations. Doing so sometimes requires greater understanding and the ability to sort through unexpected disconnects and differences of perspective. When time is limited this can feel like an inconvenience, but it's important to do it anyway.

Getting the clinical perspective from folks on the ground is also important, even if sometimes the language of data and the language of practice collide in unexpected ways as happened at the Eye Care Deep Dive. We're committed to continuing this community-wide outreach through deep dives that explore both specific types of data and specific types of care using use cases that may - or in some cases may not - have subtle differences from each other. We're hoping to increase the different types of roles represented at these conversations and thus widen the scope of the discussion and reach better outcomes.

National Disability Awareness Month

According to the CDC, 26% of all adults in the United States have some form of disability. Nearly 14% of adults have a mobility disability affecting their ability to walk or climb stairs and almost 11% of adults have a cognitive disability affecting their memory, concentration, or ability to make decisions. 5.9% have some type of hearing loss and just under 5% have a visual disability. Most of these numbers are slightly lower in Massachusetts with cognitive disability being the most prevalent at the national average of 11%.

Compared to national averages, adults with disabilities are more likely to be obese, to have heart disease, and to have diabetes. They are less likely to have a usual health care provider or regular access to care and more likely to need extra attention or accommodation to get adequate care if they do have access.

Here are some resources that can help us improve health care for disabled individuals

The Pacific ADA Center is also a good resource for all things disability related. Among many other services, they offer monthly webinars on the intersection of disability and healthcare.

Wrapping Up

Before we go, here's a reminder of upcoming data exchange deadlines from ONC and CMS (including the CMS rule that's currently frozen, as noted by *):

And that's it, folks. Loved it? Hated it? Have an idea for next time? Send us feedback and suggestions about this newsletter at newsletter@mahealthdata.org or send us feedback and suggestions about anything else at info@mahealthdata.org.

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