The interoperability ‘Golden Spike’
With help from Darius Tahir and Mohana Ravindranath
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A STEP FOR THE COMMON MAN (AND WOMAN): CommonWell Health Alliance described its ability to connect any of its members to the Carequality framework Friday as a crucial step toward interoperability. And without a doubt it is encouraging. But don’t take the “golden spike” symbolism too far. Just a couple of years after tycoon Leland Stanford drove the ceremonial last spike linking the Central Pacific and Union Pacific railroads in Utah in 1869, you could take a train from coast to coast. Getting sensible data from any point in the health care system to another may take a little longer.
CommonWell’s vendors — Cerner, Allscripts, eClinicalWorks, Meditech, et. al. — still haven’t signed up the majority of their provider clients. Once they do, of course, they’ll be able to share consolidated care documents -- but even that’s not enough to produce First Class service along the rails. …
But there could be immediate benefit to providers and hospitals that use smaller vendors — say, Greenway Health practices, or critical access hospitals using Evident — when their patients are seen in an Epic hospital (Epic, of course, isn’t part of CommonWell). “There’s huge value for those type of hospitals because CommonWell wasn’t giving them good access to the Epic site,” says CommonWell executive director Jitin Asnaani.
The announcement “is a historic event that opens the technical door for almost any provider to exchange patient records with little or no cost or effort,” but “will only make a difference if everyone joins,” said Coray Tate, vice president for interoperability at Klas Research. “The onus now shifts to the vendors and their customer bases to figure out how to join en masse.”
The agreement should tell ONC that industry is moving toward a “single onramp” to interoperability even without government actions like TEFCA, Asnaani said. “My hope is that it demonstrates to ONC they should not try to start from scratch” with TEFCA. “But I also hope it puts wind in their sails.”
Tweet of the Day: Stefan Kertesz @StefanKertesz The PDMP debate short take: (a) I use one & sometimes find it helpful, but (b) if you don’t have care resources or relevant training in pain/addiction, then PDMP becomes a “tool for getting rid of liabilities"(i.e. people). FYI: “getting rid of liabilities” is _not_ health care!
Welcome to Monday morning eHealth, where we’re back from three days in Boston, enriched with better understanding of deep learning, Random Forest, and health IT options for the elderly. Send tips to [email protected] or, more securely, to arthurallen202 on Signal. Or pass along knowledge via Twitter @ravindranize, @arthurallen202, @dariustahir, @POLITICOPro, @Morning_eHealth.
TELEMEDICINE USE INCREASES IN MEDICARE, BUT NOT DRAMATICALLY: The report that CMS delivered to Congress on Friday, fulfilling a duty under the 21st Century Cures Act, found an increase of telemedicine use of about 50 percent in fee-for-service Medicare from 2014 to 2016. Most of the coverage was for chronic conditions and mental health in rural areas, as before. Groups like Health IT Now and the Alliance for Connected Care are pushing for legislation that will make the service more generally available to Medicare beneficiaries.
… CMS’s analysis of claims data during the period found about 90,000 of the 35 million Medicare fee-for-service beneficiaries used telehealth services. The report, which didn’t conceal Administrator Seema Verma’s bullish position on telemedicine, said that if just 1 percent of face-to-face encounters were switched to telehealth services already covered by Medicare, there would be a 13-fold increase in telehealth usage.
… Reimbursement rules limiting originating sites to clinics in rural areas are the greatest barrier to wider adoption, sayeth the report.
FINANCE GAVEL TO MOVE FROM ONE WRINKLED HAND TO ANOTHER: With Sen. Orrin Hatch, 84, retiring, Sen. Chuck Grassley, 85, will take over chairmanship of the Finance Committee, thereby gaining jurisdiction over a fair chunk of health care. Among other things, notes Darius Tahir, Grassley has been a longtime advocate for unique device identifiers — the FDA recently put offrequiring them for Class I and unclassified devices until 2022 — and the Open Payments database, which shows the dough flowing to doctors from pharma and device companies.
YELP BEATS CMS: At least when it comes to rating nursing homes, the humble crowd-sourced review site may be getting at something more important to residents and their loved ones than CMS’ Nursing Home Compare, which has been around since 1998. That was the conclusion of research presented during a poster session Friday at the annual science conference of the Gerontological Society of America in Boston. The research, from the University of Southern California’s school of gerontology, found a big disconnect in the ratings done by CMS and Yelp. While the Yelp results weren’t statistically significant — some were based on as few as five reviews of a facility — the reviewers were consistently most interested in qualities that CMS doesn’t measure, such as caring attitudes, responsiveness and cleanliness.
… CMS’ Nursing Home Compare — also known as the 5-Star Rating — includes measures of staff size and health inspections, but it doesn’t track customer satisfaction, and there is literature suggesting that nursing homes can game some of its measures, said Heather Davila, who presented related research she and colleagues conducted at the University of Minnesota. “The 5-Star Rating looks at a small set of measures based on an assessment that is a response to complaints or based on an inspection of a few days a year,” she said. ( This item was supported by a journalism fellowship from the GSA, the Journalists Network on Generations and the Silver Century Foundation)
GOOGLE HALTING SMART LENS DIABETES PROJECT: The project, which Verily announced in 2014 in partnership with Novartis, put sensors on contact lenses to measure glucose levels for people living with diabetes. But the company has decided to put the research on hold, Chief Technology Officer Brian Otis said in a blogpost Friday evening. The Smart Lens was developed to sense and transmit data to the eye and is also useful following cataract surgery, Otis wrote, but researchers found it difficult to get reliable correlations of tear and blood glucose levels because of “interference from biomolecules in tears.” That raised questions about whether the device could get FDA approval. Work on the smart contact lenses and intraocular lenses will continue, Otis said.
… Verily is also working with Dexcom on miniaturized continuous glucose monitors and with Onduo, a joint venture with Sanofi that has a diabetes management platform.
CMS ANNOUNCES AI CONTEST: How can AI help transform health care delivery and improve health outcomes? CMS has no idea, but will hold a competition next year to find out. More details here.
BIG IT CONTRACT CHALLENGE: Cognosante and GDIT have challenged Booz Allen’s $1 billion IT Operations and Services contract, which supports the VA’s office of information and technology on a variety of projects. This is not to be confused with Booz Allen’s $750 million change management contract with the VA for the EHR modernization project with Cerner….
NYTimes Magazine: Will AI and other technologies transform health care and humanity?
Vox: Men obviously designed most of the menstrual tracking surveillance apps
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