I am proud to be a member of The Walking Gallery. If you are not familiar with Regina Holliday and her unique brand of health care activism, you should be. See her blog, and follow the links in the sidebar to more Walking Gallery details. By way of example, she has written a blog post describing each hand-painted jacket in the gallery and its connection to the wearer's health care story and his or her connection to health data liberation. You can start with her post about my jacket, Friendship Pins.
Check out the newly-released video about this ongoing project below, and join the movement:
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.
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.
Health care diagnostic and treatment tools are on a trajectory of development that is making science fiction of five decades ago into fact. Two current examples: The X Prize contest to develop a real “tricorder” – a handheld wireless device that monitors and diagnoses health conditions – comes to us courtesy of Star Trek (the original U.S. television series was set in the 23rd century) and the recently-announced prototype of a miniaturized implantable continuous blood monitor the size of a 1.5 cm length of pencil lead developed by a team at EPFL in Lausanne brings to mind the movie Fantastic Voyage, in which a surgical team in a submarine was miniaturized and injected into a patient’s bloodstream.
I spoke yesterday at the StrataRx conference in Boston, as part of the data liquidity track. This was sort of a blue sky presentation (as you can tell from the first slide); the thought was to explore the notion of building big data analytics on top of a data store populated by health record information obtained as a result of patient requests. Why? Because doing it that way would bring the data out from under HIPAA and HITECH regulations. Patients could contribute as much or as little of the data as they wish, patients could be compensated for their contributions, and other pesky HIPAA restrictions would fall by the wayside. I used one company's newly-announced service as an example, but there are others in this space as well.
Your faithful HealthBlawger will be out and about at a number of conferences and events over the next month or so, mostly in Boston, speaking, moderating and just hanging out ("on air" and in real life).
I hope to see you at one or more of these. See descriptions below for links to registration and in some cases, discount codes.
For years, a common refrain in the health care space has been that regulations are constraining innovation.
The latest in a long list of rules that constrain health IT development are the HIPAA/HITECH regulations. (Read all about them here on HealthBlawg.)The Federales begin enforcing these regs on September 23, 2013
HIPAA was not intended to make things worse, but the rules can lead organizations to be very conservative in their actions.
If patients want to use email, standard SMS, non-HIPAA compliant consumer device data, or applications that run on the cloud - they should be able to. Fortunately, there is a way to make this possible.
The object of the Hacking HIPAA project is to create crowdfunded legal forms based on crowdsourced ideas from the Health IT developer community as well as the health care provider and more traditional health IT communities.
When CMS recently released hospital chargemaster and payment data for the 100 hospital codes most frequently billed to Medicare, there was much written and said about the significance of the data release.
Some found this to be significant; others (including your humble HealthBlawger), not so much.
Leonard Kish summed up and addressed the critiques of the value of the CMS open data, and others whose judgment I also respect found that the release was overall a good thing. Gilles Frydman, for one, in a listserv exchange, opined that the release was a net positive because it thrust the irrationality of hospital pricing into the public eye, and that "[i]f enough people get angry, a public push for more transparency will follow."
I can accept the proposition that data will be valued differently by different parties. However, I want to throw something else into the mix: We are collectively trying to move away from fee-for-service medicine. As the saying goes: the future is already here; it just isn't evenly distributed. Some are further down the path than others. I think that our time and effort is better spent on ensuring that value-based purchasing systems are up and running, rather than on improving the pricing transparency of FFS medicine.
Eighty-two percent of health plans responding to a recent survey consider payment reform a ‘major priority.’ Nearly 60 percent forecast that more than half of their business will be supported by value-based payment models in the next five years. And, of those, 60 percent are at least mid-way through implementation, according to a study published May 9 by Availity, a health information network.
The Health Plan Readiness to Operationalize New Payment Models study delves into the progress of the country’s commercial health plans, as they migrate from fee-for-service to value-based models of compensating physicians, according to a news release by Availity. The study highlights the consensus among plans that information sharing with physicians must be automated – primarily in real-time – for these models to achieve success.
There's a system-wide bet that's been placed on value-based payment. Historical amounts charged and paid shouldn't really enter into the construction of this framework, and that's part of what underlies my negative reaction to the release of the chargemaster and payment data. We should be more focused on things like: revaluing primary and preventive care, global budgeting for episodes of care, adoption and refining of meaningful quality measures and quality-based payment systems (even though not all VBP schemes are working) -- all to the same end as the end sought by those who have been cheering the release of the charge and payment data: transparency and a clear connection between payment and delivery of value.