CMS Announces New Data Sharing Tool

In a move that advances the Obama administration’s work to make the health care system more transparent and accountable—and to help meet the pressing challenge of health care delivery system reform—the Centers for Medicare & Medicaid Services (CMS) today announced the launch of the CMS Virtual Research Data Center (VRDC) at the White House event Data to Knowledge to Action: Building New Partnerships.   Part of the President’s Big Data Research and Development Initiative, which aims to improve researchers’ ability to extract knowledge and insights from large and complex collections of digital data, the VRDC is a secure and efficient means for researchers to virtually access and analyze CMS’s vast store of health care data.

Researchers using the VRDC will access CMS data from their own workstations and will be able to perform analyses and manipulate data within the VRDC.  Historically, CMS has filled researchers’ data requests by preparing and shipping encrypted data files.  However, given the rapidly growing demand for timelier Medicare and Medicaid data, the agency needs a less resource-intensive means of responding to data requests from researchers.  The VRDC will help CMS meet these demands while also ensuring data privacy and security and reducing the cost of data access for most users.

“We’re acutely aware of the huge potential that CMS data holds for creating a more efficient, higher quality health care system, and researchers play a large part in this transformation,” said CMS Administrator Marilyn Tavenner.  “By providing researchers with secure, timely, and affordable access to CMS data, the agency is making it easier to do the important research that will lay the foundation for better quality and lower costs in the health care system.”

The VRDC offers researchers several advantages over the traditional shipped encrypted data files.  First, researchers will be able to access Medicare data at a significantly lower cost.  Physical delivery of a large sample of Medicare Parts A, B, and D data can cost more than $100,000 for just one year of data.  In contrast, using the VRDC, a single researcher conducting one project over the course of the year can access as much Medicare data as he or she needs for approximately $40,000.

Second, researchers will not need to maintain expensive data infrastructures of their own because they will access the data in a CMS environment by means of a secure virtual desktop.  Finally, researchers will not have to wait long for data when they use the VRDC.  Due to the time-consuming nature of physical data delivery, CMS generally only has shipped data to researchers on an annual basis in the past.  However, researchers using the VRDC now will be able to refresh their data analyses routinely.

The VRDC also offers greater security for CMS to share data with researchers.  The protection of beneficiary privacy continues to be a priority for CMS when sharing data.  Under the VRDC model, sensitive individually-identifiable information about beneficiaries remains in the CMS data environment, which helps safeguard against breaches or unauthorized uses of the data.

For more information on the VRDC, visit the ResDAC webpage at: http://www.resdac.org/.

First posted Centers for Medicare & Medicaid Services Newsroom November 12, 2013

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Mobile Health Apps: Pass the Secret Sauce

By David Harlow

First Posted at HealthBlawg on 10/30/2013

The IMS Institute for Healthcare Informatics released a report on the ecosystem bloody mess of 40,000+ mobile health apps that are available today. Hat tip to Jane Sarasohn-Kahn for writing about it today at Health Populi.

From the executive summary:

Over time, the app maturity model will see apps progress from being recommended on an ad hoc basis by individual physicians, to systematic use in healthcare, and ultimately to an end goal of being a fully integrated component of healthcare management. There are four key steps to move through on this process: recognition by payers and providers of the role that apps can play in healthcare; security and privacy guidelines and assurances being put in place between providers, patients and app developers; systematic curation and evaluation of apps that can provide both physicians and patients with useful summarized content about apps that can aid decision-making regarding their appropriate use; and integration of apps with other aspects of patient care. Underpinning all of this will be the generation of credible evidence of value derived from the use of apps that will demonstrate the nature and magnitude of behavioral changes or improved health outcomes.

(Emphasis supplied.)

We are nowhere near this endpoint — integration of the use of health apps into health care management — right now, due to a number of factors.

Some of the issues highlighted by IIHI are not being addressed because of market failures. For example, systematic curation and evaluation of apps was a central part of the business of Happtique, but that has fallen by the wayside. HealthTap and Jiff have announced plans to carry forward this work, Cigna has its recently unveiled GoYou marketplace for Cigna members only, and Aetna has its CarePass platform. It remains to be seen whether any of these curation plays will be based on, or will meet, the criterion of generating credible evidence of value derived from the use of health apps.

There is a bias in the marketplace against the creation of walled gardens, but since the wished-for ecosystem is not ready for prime time, there are advantages to the curated walled gardens of apps that share a platform and that can share data with patients, with clinicians, with each other.

A foundational element necessary to any finding of efficacy and value — even assuming that there is some science or medicine backing up an app, which the IIHI report calls into question for most of the 40,000+ health apps out there — is the secret sauce of patient engagement. The vast majority of health apps are downloaded, used briefly, and then abandoned. If we are all glued to our smartphones, why can’t we be glued to our health apps? Until the addictive qualities of wildly popular apps are isolated in the lab and grafted onto health apps that seek to promote and reinforce healthy behavior change, we will continue to have 40,000 tail-chasers out there. (To be fair, some developers have focused on the fact that we are glued to our smartphones, and use their motion and activity as proxies for our health (e.g., ginger.io). This approach uses a different definition of “secret sauce.”)

Until these issues are solved, apps will not be recognized by payors and providers, and they will not be integrated with other aspects of patient care.

My clients, of course, are different :)  Not only are their apps perfect, but I have worked with them to solve the security and privacy issues in a manner that will ease their apps’ adoption by health care providers and by the general public.

Implementation of the recently finalized FDA mobile health app guidelines will affect a small subset of these apps, and the apps need to fit into a broader digital health ecosystem as well.

The broad push for “prescribable” apps has the potential to drive up prices without improving efficacy. Payors, providers and patients should all be concerned about ensuring an appropriate price to value relationship over the long term, and app developers need to be sensitive to this issue as well. As we move to broader adoption of global payment models, ACOs and similar risk-bearing entities will have a greater interest in testing apps and providing them at low or no cost to patients.

Bottom line: Health apps can help, the vast majority do not, and the opportunities for innovative, effective solutions are many. Collaborative patient-provider efforts to demonstrate efficacy (as Jane suggests) could help move the ball forward, andpatient-directed health data sharing that I have argued for could help facilitate that forward motion.

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Health 2.0 Silicon Valley: A Moment with Mike Painter MD RWJF

By Gregg Masters

One of the early physician adopters in social media who’s path I crossed on twitter circa 2008-ish pre ‘push’ marketing and relentless ‘look at me’ spamming blitz era we now find ourselves in, was Michael Painter MD aka@paintmd.

If memory serves me well, we first met ‘IRL’ on the campus of NIH at the IOM during Health Datapalooza 2011, and have been twitter colleagues ever since. Mike’s into cycling and I’m – being a Californian – am quite fond of, well, surfing. As such we occasionally comment on each others pics in the tweetstream but also banter now and then on health policy stuff. Though soft spoken, Mike is a thoughtful and effective curator of health reform and the associated narrative of the innovation or transformation imperative.

When our paths crossed most recently at Health 2.0 Silicon Valley I invited Mike to sit down with my colleague and HealthInnovation Media cofounder Dr. Pat Salber to update us on some of the many programs in the health innovation incubator of the Robert Wood Johnson Foundation. Mike called particular attention to both Aligning Forces for Quality (@AF4Q) et sequelae challenges and the ‘culture of health‘ vision. For a recent blog post see: ‘A Giant Step Toward a Culture of Health‘ by Robert Wood Johnson Foundation President and CEO Risa Lavizzo-Mourey, MD, MPH aka @Risalavizzo.

Meanwhile, enjoy this collegial chat with Mike and Pat.

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Health 2.0 Silicon Valley: A Moment with David Williams III CEO InvolveCare

By Gregg Masters

This chat with David Williams III is interesting on a number of levels. Dr. Pat Salber learns more about InvolveCare‘a family caregiving application’ from an entrepreneur who’s participated in the launch of Patients Like Me as the Chief Marketing Officer, Head of Business Development and now a startup who’s path is both supported and fueled by Healthagen, Aetna’s wholly owned payor and platform agnostic entry into the brave new world of emerging, sustainable, and dare I say it, ‘collaborative healthcare ecosystems’.

An ambitious venture in its own right the Healthagen website notes:

Our portfolio of innovative and growing businesses is delivering a number of technologies and services that are transforming health care today.. Through close collaboration with providers, payers and employers, we are:

Developing industry-leading health care technologies

Helping to create better quality of care through clinical analytics, population health management and advanced communication tools

Offering social and mobile tools that make it easy for consumers to get engaged and manage their own health

Driving efficiency and performance improvement to help reduce health care costs and build a more sustainable future

 

Learn more from this once again ‘skin in the game’ entrepreneur leveraging his experience for the benefit of the community of caregivers, their families and friends.

Bravo David!

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Hospital Employee’s Facebook Post Results in Identity Theft for Patient

By Christina Beach Thielst

First Posted at Christina’s Considerations on 10/22/2013

A hospital employee took a simple picture in his/her Emergency Department workspace for a Facebook post.  However, the picture also captured his/her computer screen and a patient’s personal information.

This simple data breach and HIPAA violation unfortunately has already lead to the patient’s identity being used by someone who now has her name, address and social security number. The patient describes this entire incident as a “nightmare”, so my guess is that her patient satisfaction scores for the visit will reflect the fear and frustration she is experiencing.

This report initially ran in the local newspaper and, I’m guessing, has created a bit of a public relations mess for the University of Arizona Medical Center, as well.

So lets review the costs to the hospital:

1. HIPAA penalities

2. Potential state fines

3. Lawsuit: Defense costs and settlement/award

4. Damage to brand and recovery costs

5. Additional training costs and potential recruitment costs (to fill a possible vacancy if the employee is terminated)

6. Lower patient satisfaction score and reduction in reimbursement

Hummm, wonder if the employee feels this was all worth a picture that was ultimately removed from his/her Facebook page.

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Electronic Health Records Benefits: An ePatient Story

by Alisa Hughley

First posted on Health IT Buzz 10/21/2013

Electronic health records benefits may be clear for providers – cutting redundancy of tests, coordinating care during discharges, etc. — but these benefits also will ultimately accrue to patients in the form of better health.

In July, I participated in the Tenth Annual Healthcare Unbound Conference. I was delighted to be invited to speak on an ONC panel dedicated to “Looking Forward to the Next Frontier in Public/Private Collaboration to Promote Patient Engagement.” More importantly, I was pleased to see a government entity interested in focusing on an area that has become a personal mission of mine.

When I began electronically consolidating my health information last summer, the definition for success was simple: Gather all paper records in PDF format. Academic medical centers easily processed my request within days and provided an option for electronic delivery. Community hospital capabilities, in contrast, remained stuck in the last century with policies that allowed 30 days for the delivery of records by fax or snail mail. Perhaps, my greatest disappointment came when a world-renowned health center where I was getting specialized care took three months to mail a hard copy of my records. While MRI results were saved on DVD, it required a second request and 30 more days to receive this vital component of my medical history.

Electronic health records benefits for patients include:

  • More timely consults.
  • Better coordination of care through data sharing.
  • Evidence-based decision support.

Do I want my physicians to have timely consults, sharing lab results and imaging studies with one another? Absolutely! This however is not yet the reality. I’m currently under the care of one generalist and three specialists. Over a lifetime, I expect this number will surpass 20. I know that each is extraordinarily busy spending long days with a high volume of patients, and overflowing voicemail or email inboxes. Physicians triage care when necessary. Weeks go by before consults actually take place. Necessity dictated I become proactive in coordinating my care.  An ability to share health information with providers at the point of care shortens the timeline and begins that consult. This is the solution Blue Button aims to achieve.

Meaningful use has been designed to enhance patient engagement. I implore physicians and healthcare executives from organizations of all sizes to consider access-view-download-transmit as the central dogma of care coordination and shared decision-making. These capabilities lay the foundation for well-designed EHR/EMRs and patient portals, giving patients and family caregivers the tools necessary to fully engage their health care teams. Yet, the aim should not be to elicit medical compliance in the traditional sense, but rather to ensure patient healthcare choices are informed by evidence-based medicine with the provider’s clinical judgment and then aligned to the patient’s own values. Bioethicists call this respect for patient autonomy. To ePatients, it’s good medicine.

While the mission to electronically consolidate my health information continues, I’m moving forward with better tools to help me accomplish this task.

Alisa Hughley is a patient advocate and healthcare consultant. She advises healthcare organizations in community engagement and promotes organ donation and advance planning including the use of advance directives. Alisa’s journey in patient engagement began when her family was thrust into navigating the health care system after her brother Carey Hughley III was murdered by a person with untreated paranoid schizophrenia. Her brother’s organs were donated to assist others patiently waiting on the donor list for critical organs. She has since dedicated much of life to empowering patients to be active participants in managing their health and using health information technology not only as a tool in that effort but also as a communication tool to enhance the patient-provider relationship.

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How does Healthcare.gov really work (Infographic)

By Eduardo Garcia @egpierro

After spending some time trying to shop for insurance for my parents, and facing the same issues everyone has been having, I decided to put on my developer hat and try to figure out how this web application works. Using my browser’s developer tools (I use Safari and Chrome) I was able to identify some of the various technical components of the application, and created the info graphic below. I also listened to the entire YouTube video and reviewed the documentation published on the U.S. House, Committee on Energy and Commerce.PPACA Implementation Failures: Didn’t Know or Didn’t Disclose?, Hearing, which aired on Thursday, October 24, 2013 – 9:00am.

Healthcare.gov Infographic - Breakdown & Technology Stack

 

According to the testimony from 4 of the main contractors associated with the Healthcare.gov project, specifically CGI Federal and QSSI/Optum, the “Federally Facilitated Marketplace” or FFM is a complex web application which serves as the face of the Obama Administration’s highly touted Affordable Care Act. From my review of the FFM, it appears it has been built using a combination of HTML5 technologies including Twitter’s Bootstrap Responsive Framework, jQuery, and Backbone.JS. The site also uses pingdom for monitoring, optimizely for testing and optimization, and virtual infrastructure provided by Amazon Web Services. The FFM was developed by CGI Federal under a $293 Million contract from the Centers for Medicare and Medicaid Services (CMS), a branch of the Department of Health and Human Services (HHS).

A key component that was cited as a source of ‘bottlenecks’ is the Enterprise Identity Management or EIDM, which was developed by Optum/QSSI under a $85 Million contract from CMS as well. In my initial review it was unclear what technologies this system is exactly built on, but it was clear that it has a RESTful API that provides authentication, authorization, and access to FFM and, presumably, other CMS applications. It would’ve made sense to use this system, especially if it was already in place prior to the development of the FFM, since, presumably, it already has integrations to other systems built, and existing user data. Cheryl Campbell, SVP of CGI Federal, in the aforementioned committee hearing, kept referring to EIDM as “the front door” of the application. However, EIDM appears to be acting more like a AAA gateway and/or proxy, providing secure access to all back-end systems.

Another critical component, and to me, the core of the Healthcare.gov web application, is the “Data Services Hub”. This system was also developed by Optum/QSSI, and acts as a transactional-based data integration and web services layer to all the insurers’ databases, CMS databases, and Equifax Income Verfication Services’ systems. Given some of the error messages that I was able to view during my interaction with Healthcare.gov, I can tell that this system consists of a JBoss Application Server with data access components and RESTful web services developed using Java. Given my prior experience with JBoss and Java, although they are great for middleware development, they’re known to be a bit slow.

Finally, CMS has contracted with Serco to process all paper-based applications, which get entered onto the FFM using the same interface as consumers use, sans the account creation process. Presumably, Serco has special accounts in the EIDM. Obviously, if the FFM is not working properly, those paper applications will not be able to get processed.

In closing, I look forward to the prompt resolution of all the bugs and infrastructure issues, and hope that this article provides everyone more clarity onto how Healthcare.gov really works. Please do share your comments on the section below.

Data Services Hub Errors
This appears to come from the Data Services Hub, which is running on a Jboss AS server. The 500 Internal Server Error was returned from this system, presumably, in response to a REST request from FFM.
Not a real export
This was pretty silly… when given the option to ‘export’ your application, the browser prompts you to save the page as HTML source. It appears as if the development team ran out of time and did not provide a proper PDF export option.
Data Services Hub Errors
This appears to come from the Data Services Hub, which is running on a Jboss AS server. The 500 Internal Server Error was returned from this system, presumably, in response to a REST request from FFM.
The UI clearly Needs some work
Spelling mistakes abound
500 Internal Server Errors from EIDM
It appears that there were issues (possibly) with the Enterprise Identity Management or EIDM, where 500 internal server errors were causing the front-end (Healthcare.gov) not to be able to submit my application.
Javascript errors abound
Line 18415 of individualApplication.js appears to have an issue with the firstName variable.

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Health2con Silicon Valley: A Moment with @AkhilaSatish CEO MyCyberDoctor.com

By Gregg Masters

I first met Akhila Satish (who incidentally gets my vote for best looking CEO hands down) at Health 2.0 in 2012, see earlier clip here. But don’t let her killer looks divert you, this is one smart woman who is determined to succeed in a market where many think they can break through and survive the ‘app-itis’ in the wellness and behavior change space. Learn more as her company put the value proposition through the rigors of a clinical trial and found significant cause for optimism in their platform and approach to regimen adherence.

In this session we hear about the launch of the platform ‘CyberDoctor‘ from the main stage at Health 2.0 Silicon Valley 2013.

More from the ‘about’ section on their website:

Founded in 2009, CyberDoctor focuses on quality of care principles to guide patient physician interactions in a new age of technology. We strongly believe that efficient and effective healthcare interaction tools will make a tremendous impact on the quality, cost and delivery of care.

For Akhila’s mainstage demo click here.

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Health 2.0 Silicon Valley: A Chat with WorldOne & Sermo CEO Peter Kirk

By Gregg Masters

Dr Pat Salber  (@docweighsin) chats with Peter Kirk, CEO of WorldOne and Sermo a go-to US centric though aspiring global physician community.

Health 2.0 migrated from familiar if not comfortable surroundings in the ‘city by the bay’ where the Hilton Union Square served as the principal gathering place for several thousand health innovators, disruptors and the people who love and/or sell to them, to the ‘silicon valley’. In 2013 the Santa Clara Convention Center adjacent to the future home of the San Francisco 49ers hosted it’s first – but in all probability not it’s last – fall classic.

In this clip, HealthInnovation Media co-founder, CEO of HealthTechHatch and curator of ‘The Doctor Weighs In‘ blog gets an update on the vibrant physician community Sermo as well as a history and overview of the parent company WorldOne Interactive.

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Health Reform Beyond the ACA – Are We Inching Towards Consensus?

 By Patricia Salber

First posted on The Doctor Weighs In on October 24, 2013

Most policy people will acknowledge that the Affordable Care Act is only the first step toward reforming our bloated, expensive, inefficient and often unfriendly health care system.  Much more will need to be done to ensure health care sustainability.

Jack Lewin,MD, Chairman of the National Coalition on Health Care

John (Jack) Lewin MD from the National Coalition on Health Care (NCHC) in Washington DC and former CEO of the California Medical Association and of the American College of Cardiology) and colleagues, Lawrence Atkins PhD of the National Academy of Social Insurance and Larry McNeally, also of the NCHC) have published an interesting “Viewpoint” in the October 23 issue of JAMA.  In this article they summarize key elements of plans to reform the US health care system from seven prestigious policy organizations:

  • Bipartisan Policy Center
  • Brookings Institution
  • The Commonwealth Fund
  • Kaiser Family Foundation
  • National Coalition of Health Care
  • Partnership for Sustainable Health Care
  • Urban Institute Continue reading
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