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April 26, 2013 1:52 pm

Serving on the National Partnership for Action to End Health Disparities, I have been advocating use of new tools to enable patients to drive the needed changes. Many health care disparities can be eliminated by deploying a new consumer-focused technology platform for the underserved populations. I think the following applications are urgently needed on a single platform:

1. ACA preventive screening application: Any patient can use it at home to self-check risk and understand what preventive services are recommended and covered under ACA specifically for him/her. This app needs to support all minority languages because many patients do not speak English. This tool will increase use of ACA-covered preventive services.

2. Multilingual education website for ACA insurance enrollment. Millions… more »

…of eligible consumers from underserved population don’t speak English. They can use this tool in any language to understand the insurance marketplace, estimate insurance cost, and compare different plans. Currently, education contents and tools on federal and state websites support limited Spanish. A fully-functional website supporting all minority languages will help non-English speaking consumers understand the complex enrollment process and increase enrollment on ACA insurance marketplace.

3. Multilingual After-Visit Summary application. Non-English speaking patients can use this application to view or print AVS in any language they understand. This app will improve patient engagement and compliance, which is tied to Meaningful Use stage 2 and 3 objectives.

In addition, this platform needs to be free for patients, community health workers and community health centers.

HHS has done great job with developer challenges. I hope HHS will also challenge developers and social entrepreneurs to build more comprehensive platforms for the underserved populations. (An example is described above.) Because the business model is not clear in this public health market, HHS would need to figure out ways to attract talents and startups to work in this space, and provide assistance for startups to succeed. For examples, connect startups to existing programs that can potentially test or use the new tools developed by the startups

Coming from IT industry, I understand how critical it is to focus on scalability, adoption, and sustainability in order to win the battle against health disparities. I think ONC understands this very well and hope ONC will continue to partner with industry to achieve the common goals.

AJ Chen « less

April 28, 2013 9:23 pm

I have not seen anything close to the platform I’m advocating. This platform idea came from the feedback I’ve got from talking with many people as well as my industry experience. It’s also pretty obvious that you have to apply disruptive technology approach to build it and make it adopted across the safety net. Traditional approaches are too costly and can’t be scaled up. To demonstrate this is possible, I’m building prototypes and

April 29, 2013 12:14 pm

continue my thoughts…

I’m building a prototype to demonstrate it’s feasible to cost-effectively build the comprehensive patient engagement services and provide it for free to patients and the safety net.

The language barrier is a typical example to illustrate how disruptive thinking is essential. We know we have to have health professionals to translate ACA enrollment education contents and tools to other languages in order to ensure the quality. Everyone will also tell you this is a very very costly and time-consuming process, particularly when you are talking about all common minority languages. In one word, impossible.

But, as I talk with people at Palo Alto Medical Foundation’s cultural competency group, Asian & Pacific Islander American Health Forum,… more »

…Kaiser Family Foundation, I see commitment from public health organizations and care providers to translate ACA enrollment education tools and doctor visit summary to serve their patients better. To me, the question really becomes: How can we provide an information system to engage these health professionals and harness their translations for the benefit of everyone? For example, navigators will explain how insurance marketplaces work in whatever languages their clients understand. Is it possible to give the navigators a tool to make the translation process super-efficient for everyone? I bet it is entirely possible to build a website with ACA enrollment education and tools fully functioning in all common minority languages just in time when the enrollment starts. « less
May 1, 2013 6:19 pm

PCORI has the right thinking for doing patient outcome research. I’d just like to add on it. From the success of Internet consumer businesses like Amazon and Google, I know we have the technologies required to create cloud-based patient services with real time research capabilities in super-large scale. To me, this really means that it’s possible now to build real-world scalable systems that can guarantee reaching the goals of improving patient outcomes across a large population. Such new research approach will not suffer from hit-or-miss and hard-to-scale issues facing the traditional research approaches. If HHS could encourage and fund more research projects that apply this new approach, we may see more bang for the buck.

There are several requirements for this new research approach… more »

…to work. I want to mention three here:

(1) The proposed solution must be designed to be scalable right from the start. Scalability here means that you can deploy the solution from one clinical setting to another or across the whole population with no or minimal additional cost. This upfront design requirement is absolutely critical because the technologies you choose to build a large scale system vs. a small scale system can be very very different!

(2) The system must enable real-time patient outcome research on real time data, lots of data. Automation is a key. Readily available big data analytics makes this possible.

(3) The system must also be able to deploy the research results rapidly so that the system can be iterated and improved rapidly.

In a nutshell, I think the healthcare reform is transforming healthcare to a patient-centered and data-driven learning health system. Government funding policy would need to shift accordingly in order to see more research going to that direction. « less

May 1, 2013 8:13 pm

Personalized health care is the ultimate dream to patients. I think, starting from human genome project, and now healthcare reform plus ACA, we are on our way to realize that dream. In late 90’s, human genome project made me realize that we can actually have a complete biological picture of a patient, which opens the possibility to personalize medicine for each individual. I spent several years in leading genomics companies and saw great progress toward the dream, although it would take much longer than everyone originally thought.

Then, the healthcare reform set out to connect patient data from everywhere, creating another historic opportunity to get a complete health picture of each patient. ONC’s health IT strategic plan provides a pretty good direction and framework for building… more »

…the needed infrastructure. The only thing I’d like to add is regarding the implementation. Since we are at the beginning of healthcare transformation, be open-minded because what will get us there at the end may not be the traditional EHR and HIE technologies. You never know what new disruptive technologies will come up surprisingly, which are able to connect patient data much cheaper and faster.

To get a taste of personalized health care sooner, I would suggest government to put some focus along this line:

1. Foster creation of large scale patient engagement platforms, where patient is at the center and control of assembling his/her complete clinical and living data. See my comment to the topic “decreasing disparities through health IT”.

2. Fund more large-scale patient outcome real time research that will lead to creation of real-time patient-centered and data-driven learning health systems. See my comment to the topic “Using health IT to enable research and inform practice”.

3. Experiment with new care delivery model that stacks a learning system (from #2) on top of a patient platform ( from #1). A successful model will be able to generate new knowledge of personalized care and deliver such personalized care to patients at the same time.

Personalized health care has the potential to deliver better care at lower cost to individual patients. I also hope ONC will talk more about it in public campaigns because consumers can relate to it easier than to technical jargons like data interoperability and health information exchange. « less

April 27, 2013 11:42 am

Welcome to Planning Room, ajchen, and thank you for your comment. Do you have examples of platforms like this that would guide ONC in developing something similar? How could ONC overcome problems like inaccurate translations?

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