Feature Articles

Preliminary Thoughts on CMS Proposed MIPS IP Rule Changes: A Public Health Perspective

Well, here we go again. The Centers for Medicare and Medicaid Services (CMS) has now released a new Notice of Proposed Rulemaking (NPRM)...The purpose of this NPRM is to address proposed changes for Year 3 of the Merit-based Incentive Payment System (MIPS), the provider (as opposed to hospital) side of the Quality Payment Program. The part that is most relevant to public health is the Medicaid Promoting Interoperability (IP) Program for Eligible Professionals (EP)” (the EHR Incentive Programs have been renamed). A major goal of this NPRM is to synchronize as much as possible the EP program with the hospital-based program that was addressed in a previous NPRM just a few months ago.

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Eaten Alive: A Patients’ Perspective on De-Identification of Personal Health Information

In 2018, the majority of people do not know that their PHI, like their EHR data, prescription data, insurance claims, and genetic data via direct-to-consumer (DTC) tests, are de-identified and sold for research and commercial purposes at massive profits. Medical health data trading is a multi-billion dollar industry. The process of de-identification supplies data that may be aggregated for a variety of analyses, such as basic scientific discoveries, policy & legal reviews, process refinement, pharmaceutical marketing, and other efforts. Data de-identification isn’t new but it is rampant. I’m gravely concerned about the free-for-all that is de-identification. You should be too.

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An interoperability update: Do we need more carrots and sticks?

Earlier this year, the ONC released the Trusted Exchange Framework and Common Agreement (TEFCA), which responds to a mandate included in 2016’s 21st Century Cures Act and lays out principles, terms and conditions on which to base an interoperability framework that healthcare organizations can embrace. “This means patients who have received care from multiple doctors and hospitals should have their medical history electronically accessible on demand by any other treating provider in a network that signed the Common Agreement,” said National Coordinator for Health IT Donald Rucker in a recent blog post. To achieve that goal, TEFCA is divided into parts A, the principles, and B, the terms and conditions, which is also where the rubber meets the road for many who live in the healthcare IT world...

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CMS Goes Live with Blue Button - With Life and Cost Saving Applications for 53 Million Americans to Use

On August 13 at the White House in Washington, D.C., the Office of American Innovation and the Center for Medicare and Medicaid Services (CMS) will host the first Blue Button 2.0 conference. This event will highlight CMS’ strong investment and leadership in Blue Button as a patient driven means for interoperability, cost-effective care and patient safety. Eight years after President Obama’s announcement of the Blue Button initiative to give Veterans, military beneficiaries and Medicare beneficiaries “easy access to their health information” with the use of a “Blue Button”, CMS Administrator Seema Verma took action with “Blue Button 2.0” so that 53 million Medicare beneficiaries can now make use of CMS approved patient facing Blue Button applications, turning a four-year history of claim data into actionable longitudinal health records to prevent costly medical errors, unnecessary redundant care or other harmful and wasteful care.

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Is it Finally Time to Reinvent the Wheel?

When people talk about "reinventing the wheel, " it is often meant to discourage, even disparage. As in, "why reinvent the wheel?" It usually refers to a technology or a process that works well enough and is widely enough distributed that trying to replace it would be a fool's errand. Fortunately, the folks at DARPA aren't afraid of fool's errands -- and they are literally reinventing the wheel. Healthcare could use some fool's errands of its own. We all know what a wheel is. We know a wheel when we see one, we know what one does, we know how they do it. We've all traveled on wheels -- skates, bikes, cars, buses, whatever. It's hard to imagine a world before the wheel, before that beautiful circular shape, and it's hard to imagine improving on it.

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The Evolution of Blockchain - A Quick Guide and Why Open Source is at the Heart of It

It isn't uncommon, when working on a new version of an open source project, to suffix it with "-ng", for "next generation." Fortunately, in their rapid evolution blockchains have so far avoided this naming pitfall. But in this evolutionary open source ecosystem, changes have been abundant, and good ideas have been picked up, remixed, and evolved between many different projects in a typical open source fashion. In this article, I will look at the different generations of blockchains and what ideas have emerged to address the problems the ecosystem has encountered. Of course, any attempt at classifying an ecosystem will have limits—and objectors—but it should provide a rough guide to the jungle of blockchain projects.

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Holochain – the Perfect Framework for Decentralized Cooperation at Scale

Holochain is a new technology project with huge potential for the cooperative economy. Members of The Open Co-op have been promoting the idea that new software could, potentially, revolutionize both our failing democracies and our predatory capitalist economies, since 2004. Back then we weren’t quite so clear on exactly how the required information architecture should be designed – but we knew what we wanted it to do and how it should work. In 2004, I published a paper entitled Participatory Democracy Networks, which explained how I thought some new information architecture could facilitate participatory democracy worldwide.

OpenStax Provides Cheaper Textbooks and Better Access for Higher Ed Students

OpenStax was founded by Rice University engineering professor Richard Baraniuk in 1999 under the name Connexions. It started like most open source projects: To scratch an itch and address a problem. In this case, Rice University wanted to do something on the web related to education. A grad student suggested that they take the model used to develop Linux and apply it to create textbooks, and Connexions was born. They decided on a license that allowed for reuse with attribution—in essence, this was the first use of the Creative Commons license even before the license existed.

Major German research project chooses openEHR

I just returned from Heidelberg, where another very successful ‘openEHR day’ was held, this time by the HiGHmed research consortium, with 100 attendees. HiGHmed is funded with 20m€ by the German Federal Ministry of Education and Research (BMBF) under the “Medical Informatics” funding scheme, and has as its goal..... to develop and use innovative information infrastructures to increase the efficiency of clinical research and to swiftly translate research results into validated improvements of patient care...

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Towards a Fortnite Healthcare System or how Gen X and Millenials will demand Gamification in Medicine

The World Health Organization (WHO) just included "gaming disorder" as a new mental health condition, listing it is its 11th edition of the International Classification of Diseases. My first reaction was, oh, good, now I have a good excuse to write about Fortnite. A year ago I hadn't even heard of Fortnite. That's no surprise, because few had; it wasn't officially released until July 2017, and even then the free, most popular version -- Fortnite Battle Royale -- wasn't released until last September. It was an immediate sensation, with over a million players within the first month. It has been smashing numbers ever since.

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HLN Submits Comments to the CMS Quality Payment Program

On June 14, 2018 HLN submitted the following comments on the Centers for Medicare and Medicaid Services (CMS) 2019 Inpatient Prospective Payment System Notice of Proposed Rulemaking (NPRM) to Quality Payment Program based on our earlier comments...We are quite concerned by both the overall direction and the specific recommendations regarding public health objectives and measures in the NRPM. Regarding the changes to the proposed measures, CMS has not provided any explanation for why Syndromic Surveillance reporting was selected as the required measure. Other public health measures (e.g., Immunization reporting, Electronic Laboratory Reporting, Electronic Case Reporting) continue to require incentives for implementation.

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We Are Going to Need Bigger Post-ITs if We Want Design Thinking in Healthcare

When it comes to healthcare, we certainly have a lot of things that are big, and probably the only reason more aren't red has to do with that color-of-blood/code red thing. But when it comes to design that one would really call good...not so much. In NEJM Catalyst, Amy Compton-Phillips and Namita Seth Mohta reported on their Care Redesign Survey, which surveyed the NEJM Catalyst Insights Council. The survey found that there was strong support for design thinking (90%+), and was seen as valuable for a wide range of health care issues. Yet less than a quarter use design thinking regularly. When asked to list the top three barriers to applying design thinking to healthcare problems, respondents said:

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The Utopia of Unique Patient Identifiers

The subject of Unique Patient Identifiers pops up with clockwork regularity in the healthcare discourse. A recent article in the New England Journal of Medicine (NEJM) titled Has the Time Come for a Unique Patient Identifier for the U.S.? points out that HIPAA initially mandated patient identifiers. Reason prevailed and the requirement was abandoned. The article goes on to list, correctly, all the issues related to duplicates and split records and their dire consequence from financial costs to potential loss of life. Just a few short years ago the American Health Information Management Association (AHIMA) issued a petition calling for unique patient identifiers citing much of the same issues and making a proposal for a voluntary solution. That effort also failed to get much traction either. While the problems cited are very real, it is not at all clear how a unique identifier would solve the problem, in spite of the very bold claims.

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Healthcare: Cheater's Edition

If you grew up in the pre-video games era, you have probably played Monopoly. If you have, chances are you've probably cheated too; Hasbro's own research indicates half of players do. So they did what, in hindsight, seems like the obvious solution: they created a version of the game that explicitly builds in cheating. Monopoly Cheater's Edition launched June 1. My first thought was, gosh, what kind of game builds in cheating? Then it struck me: healthcare. Of course, healthcare is not a game, but there certainly are plenty of rules (some of which make sense, some of which don't), and plenty of, well, if not outright cheating, then at least gaming. And let's not minimize the outright cheating.

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A Public Health Perspective on the CMS Quality Payment Program

I have seen several pretty good summaries of the recently 0release Centers for Medicare and Medicaid Services (CMS) 2019 Inpatient Prospective Payment System Notice of Proposed Rulemaking (NPRM) to Quality Payment Program (one from AMIA, one from CDC). Here are just a few additional tidbits I picked out of the NPRM. Of course, this document is written like stereo instructions so I welcome any corrections or comments to my interpretation of what’s in the rule. I put page numbers (from final FBO version referenced above which has just been released) where relevant in parenthesis. And I apologize in advance as much of what’s here is cryptic to anyone who has not been exposed to this before and I don’t make much of an attempt to explain the context (or even the acronyms)...

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