§1. Supporting the shift

New programs – launched by government, local communities, and health insurance companies – are experimenting with ways to deliver health care that focus more on preventive and coordinated care. These new care delivery and payment models take advantage of the entire health care team to keep people healthy. They help reduce unnecessary care (such as repeated tests and procedures) or avoidable re-admissions to hospitals.

The overall purpose of these new health systems is to provide better health and better care at lower cost. Examples include:

  1. patient-centered medical homes;
  2. accountable care organizations;
  3. narrow provider networks; [Learn more here] and,
  4. other high-value care options [Learn more here.]
  • What steps can ONC take that would help consumers and providers use health IT to successfully manage the shift to these new health systems and programs?
§2. The role of consumer-focused health IT

Consumers have an active role in the successful implementation of these models, both in

  1. making decisions about where and how they receive health care, and
  2. choosing health options that are most appropriate in meeting their overall health goals and personal preferences.

Health IT and electronic exchange of health information between consumers and providers in various sites of care (such as hospitals, specialty clinics, labs, and rehabilitation centers) will be essential for these new models to work.

  • What role can consumer eHealth apps and tools play in supporting new health care delivery models?
  • What can the federal government do to help connect innovative technology developers with delivery systems where they can test their applications?

§ 3. Privacy & security

ONC recognizes that privacy and security concerns may impact the willingness of consumers and providers to use health IT to increase access to health information. Privacy and security are the topic of a separate section of the Strategic Plan (Goal 3), since these concerns cut across all areas of health IT. Although this public comment period is not targeted at updating Goal 3, ONC will be revising that section of the Plan and your discussion of these concerns, and ideas about addressing them, will help the federal government decide on appropriate future steps.

(You can read the current version of Goal 3 by clicking the Background Documents tab at the top of this page, and selecting 2011-2015 Federal Health IT Strategic Plan).

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March 27, 2013 1:11 pm

There are a number of health IT solutions that need to be focused on over the next 10 years to support the shift in programs, policy, care… e.g. Genomics, Predictive Health, Wearable Systems, and more. Several articles on Next Generation Health IT solutions can be found on Open Health News.

Use these buttons to endorse, share, or reply to the preceding comment by peter groen.
    March 27, 2013 10:13 pm

    Thanks for your comment, peter groen. Are you suggesting that if consumers had access to better technology, the transition to new eHealth systems would be easier? If so, what type of health IT would be most effective?

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March 27, 2013 1:27 pm

I think it would be helpful for ONC to support/commission development of curriculum that addresses communication skills, tools, vignettes from the consumer viewpoint & the provider viewpoint. It is my opinion that seek first to understand is a key/missing component in many provider-patient encounters. Perhaps we all just need a “refresher” on this very fundamental skill?

Use these buttons to endorse, share, or reply to the preceding comment by srtupper.
    March 27, 2013 10:14 pm

    Welcome to Planning Room, srtupper, and thanks for your comment. Are you proposing that ONC help develop education programs and curriculum to so that patients and providers can communicate with each other better? What do you think the biggest communication problems are?

    Use these buttons to endorse, share, or reply to the preceding comment by Moderator.
      March 28, 2013 11:54 am

      Yes. Development of education programs & curriculum for pts & providers that is specific to communication techniques, expectations would be great. I have witnessed communication challenges related to patient attitudes (“my provider knows best, I don’t want to insult them by asking a question”). I think active listening, reflective listening, humility are key skills to teach/learn for a pt/provider interaction. Thanks for asking.

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        March 28, 2013 12:45 pm

        Thank you for sharing this experience, srtupper. Could you tell us a little more about a time when you witnessed communication challenges related to patient attitudes?

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March 28, 2013 8:16 pm

People are often seen as unreliable suppliers of clinically-relevant data about themselves. This needs to be examined and, to the extent it is true, remedied.

For example, clinical vocabulary used by providers is more precise than how patients might speak of their health. How best do we bridge that semantic canyon? Similarly, many people do not understand how to determine when they need urgent care versus self-care or non-urgent care. How do we triage more effectively, involving the patient in the process?

Use these buttons to endorse, share, or reply to the preceding comment by glenfmarshall.
    March 28, 2013 9:25 pm

    Hi glenfmarshall. ONC is looking for information on how people supply clinically-relevant data about themselves in this section Patient Generated Health Data. Your comment would be helpful in furthering the discussion there.

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March 28, 2013 11:31 pm

My cat has a chip, if she gets lost. Why not me?

I value my medical information, and I would get a chip of my health data, so I had my data at the right time and place. Sandra

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    March 29, 2013 12:27 pm

    I’m a geek and that’s too “Big Brother” even for me.

    Use these buttons to endorse, share, or reply to the preceding comment by jherbert.
April 2, 2013 2:26 am

The government can create universal standards for types of data, as well as how it is communicated. Consumer eHealth apps and tools can collect data directly and create a data portrait of patients, that can be used to help patients manage their conditions and truly optimize provider-patient interactions; instead of unnecessary extra and annual visits, apps and tools can be part of a heuristic system that senses when people fall out of particular health parameters and should come into the healthcare provider office or hospital. Moreover, the information of how to get the proper access, how not to waste resources on redundant testing, could be integrated into this system (i.e. Google’s Android system integrating email, searches and other personal info while serving Just-In-Time info for… more »

…the user; Scanadu’s proposed model for health diagnostics and services) http://www.scanadu.com « less
Use these buttons to endorse, share, or reply to the preceding comment by gmathews71.
    April 2, 2013 1:18 pm

    Thank you for your comment, gmathews71. Could you describe what universal standards you think the government should create?

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April 6, 2013 2:54 pm

We are an NCQA Level 3 PCMH. We are part of a pilot that requires reporting on 18 adult CQMs. MU and PQRS also require CQM reporting. CQMs need to be unified and automated by EHR companies. Our EHR company is now trying to charge for data extraction on CQMs that should be automated. This poses added obstacles to the movement from data extraction to analysis to practice change.

We also find that some CQMs are CPT-based and can’t be generated by PCP offices. The insurance cos should use claims data to generate them and report back to PCPs. Example: mammogram and colonoscopy. We can use our registries to identify the actual patients in need of testing.

Finally, a KLAS rep informed me that EHR companies foresee statewide HIEs becoming obsolete. That would be the opposite of… more »

…what PCPs and our patients need. I hope ONC will use its clout to push back against privatization of HIE, especially as that has a large price tag and works against care coordination across regions where patients have freedom of choice, like Baltimore.

Thanks!!! « less

Use these buttons to endorse, share, or reply to the preceding comment by hrdahlman.
    April 8, 2013 9:17 pm

    Thank you for your comment, hrdahlman. Can you elaborate on how you foresee statewide HIEs supporting your practice and patients in the future?

    Use these buttons to endorse, share, or reply to the preceding comment by Moderator.
      April 10, 2013 8:49 am

      We are implementing the encounter notification service (ENS), which is still being tested by CRISP. Our hope is that our workflow can encompass the following strategy: use ENS to locate our patient in the healthcare system, go to the Provider Portal to access information, communicate provider-to-provider, obtain test results and discharge summaries prior to patient visit here, and see our patients within a week of discharge from the ER or a hospital.

      We are hopeful that CRISP will evolve a single login, embedded within our EMR, that will allow us to access all of the useful features of the HIE they envision: ENS, Provider Portal, secure platform for in-writing provider-to-provider communication, and MOLST/POLST form access/update.

      An added icing on the cake, which we believe is crucial,… more »

      …is interfacing small practices TO the HIE so our key information is accessible at the point-of-care for our patients (at ERs or hospitals). I believe this will help our hospitalists and specialists to esteem the role of primary care providers more and ensure they have the whole picture. Hopefully, electronic communication won’t totally replace phone calls, especially in urgent cases or where a more involved conversation would be of benefit.

      I agree with a recent comment that we are working with real patient, not an iPatient. Nothing will replace the in-person encounter. « less

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    April 11, 2013 9:03 am

    As a family medicine physician who until recently was working for a large hospital system and has experience after going through three electronic health records I can endorse the issues that Ms.Sinsky so aptly puts forth. This problem is common to all enterprise electronic health records at this point in time.
    The basic problem is that electronic health records have had two masters-the clinical part of the record which is important for patient care and the billing part of the record. Which one do you think has won out?
    The other overriding issue is how physicians and systems are paid. Most systems are still paid on an RVUs/piecemeal basis. The dirty little secret is that electronic health records could be excellent at “not seeing patients” and taking care of populations. By this… more »

    …I mean that they can be set up as a communication device to communicate with patients and take care of populations outside the office. However, in many if not most areas this is a losing proposition moneywise. « less
    Use these buttons to endorse, share, or reply to the preceding comment by lspikol.
      April 11, 2013 10:21 am

      Welcome to Planning Room, Ispikol, and thanks for your comment.

      You note that electronic health records could be set up as a communication device to take care of populations outside the office. In your experience, have you seen any services that do this effectively?

      Use these buttons to endorse, share, or reply to the preceding comment by Moderator.
    April 11, 2013 9:21 am

    Welcome to Planning Room, christine.sinsky. Thank you for your comment. How can the federal government best encourage development of EHRs with improved usability for practices which have developed a team based model of care?

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April 11, 2013 11:26 am

I do not personally have any experience with organizations that use computers effectively to take care of populations outside the office environment, however from what I have read organizations such as Kaiser, health Cooperative of Puget Sound etc. are much further along in this process as they seem to have a logical, system-based organization that are well aligned.

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April 16, 2013 4:41 pm

Applaud previous poster who is NCQA Recognized level 3 PCMH.

EHRs are currently very helpful in tracking patients over time and comparing results across patients and providers in a practice. This is very important for implementing the medical home model that emphasizes chronic disease management.

Where EHRs need to move towards is helping providers get information from other providers, with the specific challenge being lack of interoperability and tracking patients across different care settings. Complex patients that have 5+ care plans – none of which are shared across the care team – are a symptom of this problem. I would encourage ONC to continue to support addressing these gaps in EHR capabilities through MU standards and certification.

Use these buttons to endorse, share, or reply to the preceding comment by willr.
    April 16, 2013 8:47 pm

    Welcome to Planning Room willr, and thank you for your comment. Can you elaborate on what specific challenges there are relating to interoperability and tracking patients across different care settings?

    Use these buttons to endorse, share, or reply to the preceding comment by Moderator.
      April 17, 2013 4:54 pm

      Thanks for your question. Not all providers are eligible for HIT incentives and under existing payment schemes are not encouraged to adopt HIT. This includes important care centers for complex patients, like long term care facilities. Changing that would require a legislative fix, so I’m not sure it is appropriate for this strategic plan, but it is still critical.

      Even for those providers that have adopted HIT, their systems often do not communicate. For example, when a PCP sends a referral document to a specialist, their systems may be unable to process it. Hospitals may be able to communication electronically with their own outpatient providers, but not with providers outside of their system. These gaps in the technology make it difficult to track patients across care settings, do medication… more »

      …reconciliation and maintain shared care plans – all of which are important for coordinated, effective care.
      « less
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April 25, 2013 3:09 pm

Recent HHS/ONC Challenges are shifting culture and attitudes among innovators in the HIT marketplace. “What can the federal government do to connect innovators with delivery systems where they can test their applications” is a great question. Many innovations are designed to substantially bend the cost curve. Challenges with “shared risk and benefit” could be structured where HCO, ACOs, PCMHs, Payers “host an innovator”, mutually determine potential savings, advance seed money and internal organization resources to facilitate speed to value. Impact and results monitoring of shared savings could be distributed to challenge organizers, innovation company and “host” organization. Cycle also should include spread plan to rapidly seed cost bending efforts to other “host” organizations.

Use these buttons to endorse, share, or reply to the preceding comment by susanchull.
    April 25, 2013 4:55 pm

    Welcome to Planning Room susanchull and thanks for your comment. What do others think about this system of ONC challenges that encourage HCOs, ACOs, PCMHs and Payers to work with innovators?

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May 8, 2013 8:15 pm

Many new health care delivery models such as the patient-centered medical home and accountable care organizations rely on the platform of health IT. If the digital divide and access barriers for diverse and underserved populations are not addressed and reduced, then the continued implementation of these models will only INCREASE disparities in health care and health. At the same time, the “safety net” hospitals, physicians, community health centers, pharmacists, labs, and other health care providers for these diverse and underserved populations often have the least capacity and resources to implement health IT and are among the slowest adopters of health IT. As these new health care delivery models continue to be implemented, it is vital that ONC and its federal partners continue to… more »

…monitor, and provide financial and technical assistance support, for the actual adoption of health IT by these safety net providers.
-California Pan-Ethnic Health Network « less
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