Day 1 of ONC’s Interoperability Forum

With help from Arthur Allen (@arthurallen202) and Darius Tahir (@dariustahir)

DAY 1 OF ONC’S INTEROPERABILITY FORUM: The HHS agency kicked off its annual interoperability extravaganza with a slew of updates on internal projects and collaborations with CMS intended to make the exchange of health data seamless. Some takeaways from the event, which runs until Wednesday:

— CMS pledges to make providers fax-free by 2020: CMS head Seema Verma said during her keynote Monday that she plans to make providers fax-free in the next two years, though the agency has not shared additional details on how exactly that would be achieved.

“Once information is freely flowing from the patient to the provider, the advances in coordinated value-based and patient centric care will be even greater than anything we can imagine today,” Verma said during her speech.

— CHIO search still ongoing: CMS announced earlier this summer it planned to hire a chief health informatics officer to oversee interoperability efforts, and the position is still open, Verma said. A CMS official told Morning eHealth in June that the CHIO would eventually head up an “interoperability tag team.”

— BlueButton 2.0 conference happens next week: As Morning eHealth’s Arthur Allen scooped last month, CMS is hosting its first-ever developers conference next week dedicated to Blue Button 2.0, a system that lets Medicare beneficiaries download their own health data.

Hundreds of developers are signed up for the Aug. 13 event, CMS officials said Monday.

Mark Scrimshire, who has led Blue Button for a couple years, told forum attendees that 2.0 can access the data of 53 million beneficiaries’ inpatient, outpatient and pharmacy data from the last 4.5 years, though the agency is thinking of expanding the timeframe.

About 500 organizations and 700 developers have expressed interest in experimenting with that data — “a vibrant community of people out there who are looking to deploy apps,” he said.

CMS developers made sure to coordinate with the Sync for Science protocol that lets patients export their EHR data to researchers, he added.

— Information blocking rule is a ‘work in progress’: ONC head Don Rucker said the agency — tasked under the 21st Century Cures Act to define exceptions to the ban on information blocking — is still working on the rule. The rule’s release has been delayed several times and is now expected in September. The HHS inspector general cannot enforce the ban on information blocking until that rule is released.

But properly defining which behaviors do and don’t constitute information blocking is “hard to sort out,” and the rule is a “work in progress,” Rucker said Monday.

Rucker emphasized Monday that his goal is to make protocols and standards that would let large amounts of health data flow easily between health providers, not just individual patient charts. He and other officials emphasized that ONC’s work is all being done within the confines of HIPAA.

But health IT groups are antsy. Some think ONC is taking far too long to issue a proposal rule and sent a strongly-worded letter to the agency ahead of the forum.

“The administration has had 601 days to draft and publish clear information blocking regulations ... it is past time for a proposal to be made,” reads the letter co-signed by several groups, including Health IT Now, the American Academy of Family Physicians, the American Academy of Ophthalmology, the American Medical Informatics Association, Oracle, Research!America, and the United Spinal Association.

“Every day that the administration delays implementation of these critical provisions places patients at risk of harm,” the letter says. "[T]he lack of clear rules of the road needlessly creates uncertainty for vendors and providers alike.”

AMIA president Doug Fridsma said in an emailed statement that the rule should be “part of a larger conversation” about the technical, business and policy reasons that might result in information blocking.

eHealth Tweet of the day, quoting from Verma’s Interoperability Forum keynote: Administrator Seema Verma @SeemaCMS “Now, if my phone knows what podcast I might want to listen to next based on my purchase history, shouldn’t our medical decisions be fully informed by our medical history?” #Interopforum
#Interoperability

It’s TUESDAY at Morning eHealth where your author is thinking of expanding her plant collection beyond the monstrous aloe taking over her kitchen. What can grow indoors and doesn’t need much light? Thoughts and news tips to [email protected]. Reach the rest of the team socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

MEET THE TECH COMPANY BEHIND ‘ALL OF US’: Your correspondent made the trek to Fairfax, Virginia, last week to visit the software company powering the technology for NIH’s million-person health study, known as “All of Us.”

Vibrent is the recipient of a $75 million NIH grant to build out the “Participant Technology Systems Center” underlying the study, and it is creating the applications that will enroll volunteers in the research program and return them data about their health.

The company began as a consumer-focused startup without any background in health, and its roots could be its biggest asset, says CEO Praduman Jain.

Its challenge, with the NIH officials overseeing the project, is how to use digital tools to keep a million or more people engaged and participating in a project that will take decades to complete. Most of the early joiners were motivated by “excitement and altruism,” Jain told Morning eHealth. “‘It can help me, it can help my family, it can help my children.’ But that only goes so far, people lose interest over time.”

Around 91,000 people have joined so far in a beta phase and since the program’s official launch in May. The challenge, Jain said, is to meet NIH’s goal of encouraging the long-term participation of a cross-section of Americans, including groups who are suspicious of science and government and generally shun such activities.

To get this vast group to continually share biospecimens, EHR data and feeds from wearable devices, “you have to keep giving them value,” he said. That’s where the company’s roots in consumer technology could come in, Jain says. Vibrent got its start almost a decade ago, funded mostly by Jain himself and by federal Small Business Innovation Research grants to study how patients process information about their health.

Jain, who describes himself as an “outsider to health care,” learned about consumer technology adoption in previous jobs at Sprint, Nextel and AOL. In lieu of health care expertise, he and his team have an “understanding of systems, understanding of how to make something really large scale that can impact the masses,” he said.

As All of Us continues enrolling participants, some of the Vibrent employees working on the program are dreaming up ways to give participants useful insights about their own health in a manner they find useful. Those might include designing health records that clearly display the information donors have submitted, or presenting genomics data so participants better understand their health risk factors, Jain said. Pros can read the rest of the story here.

FCC WATCHDOG SAYS COMMENT SYSTEM WASN’T ATTACKED: The FCC’s internal watchdog found there was no cyberattack on the agency’s commenting system during the net neutrality debate last year despite claims from FCC officials that a distributed denial of service attack took the system down, our colleague Margaret Harding McGill reports.

FCC Chairman Ajit Pai announced the inspector general’s report, which has not been made public, in a statement Monday. When the FCC’s commenting system sputtered in May 2017, former FCC chief information officer David Bray said the agency was the target of multiple DDoS attacks, in which a site is flooded with fake traffic to force it offline.

The investigation found that there was no attack, and the chairman was given faulty information, an official with the FCC inspector general’s office confirmed. Instead, the official said, the system struggled to handle a large amount of traffic after HBO comedian John Oliver suggested viewers file comments on Pai’s proposal to roll back net neutrality regulations.

The cyberattack claim had previously drawn skepticism from net neutrality activists and Democratic lawmakers. Pros can read the rest of the story here.

FDA ISSUES NEW OPIOID GUIDANCE: The FDA on Monday issued draft guidance that it said could encourage new treatments for opioid use disorder, based on a broader definition of when such treatments are considered effective, Pro’s Sarah Owermohle reports.

The agency recommended that studies on these types of treatments assess not just whether a patient stops or reduces opioid use, but also if the medicines help reduce relapse, overdoses and infectious disease transmission, or help patients resume work or school.

The FDA said today it is also interested in assisting researchers who want to address other measures that can help physicians understand patients’ experiences, such as “cravings” or “urge to use.“ This follows an April meeting when the agency heard directly from patients on their experiences and challenges being treated for opioid use disorder.

WHAT WE’RE CLICKING ON:

— An opinion in Stat News about the downsides of medical crowdfunding

— An NYT Upshot piece on flawed research on employee wellness programs

— Rock Health’s report on ‘next generation payers and providers’