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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.
Harmonizing standards (across regulations, certifications) for PGHD is a high priority, including developing minimum data sets and semantic interoperability across current modalities (e.g. EMRs, PHRs) as well as new mobile and virtual health apps. Several efforts are in play, e.g. the MOHR project, eQueri. Of concern with the rapid proliferation of mobile apps, we are already defining healthy behaviors, such as sleep, risky drinking, eating habits, societal determinants of health, in different ways. See current work underway, Estabrooks, Paul A, et.al., “Harmonized patient-reported data elements in the electronic health record: supporting meaningful use by primary care action on health behaviors and key psychosocial factors, J Am Med Inform Assoc 2012;19:575-582 doi:10.1136/amiajnl-2011-000576
As new tools emerge supporting consumers to enter, maintain, share and update their PGHD, consumers should have rights to carry mobile, portable granular consent for determining which categories of information they are willing to share, at different points in time, across different care settings,with defined care team members. Audit tools should be in place, to provider consumers, the level of information desired, similar to current credit reporting tools, whereby consumers can see who has Viewed, Downloaded and Transmitted their PGHD.
Person centric profiles, maintained and updated by consumers, can support personalized preference sensitive care for the individual, and mass customization of care for cohorts or groups. The same profile data can also support outcomes analytics for us to learn, learning health system, on what are unique combinations of profile characteristics that support improved adherence and outcomes, as well as unlocking the engagement puzzle. mobile health apps that support F2F and virtual visits off much promise here.
We have achieved tremendous momentum of the Meaningful Use of HIT within the 4 walls of hospitals and eligible providers, e.g. traditional health care encounters. Given what we know about where health happens, in the in between, in our homes, neighborhoods and communities, we should consider interesting incentives the promote virtual care and mobile care, and significantly lowers the cost of overall care. For example, 48 hour shared care plans, 30 day shared care plans with virtual support of reminders, medication filling, adherence could be automatically triggered through mobile phones. Thinking outside the box (the 4 Walls) should be encouraged for simple low cost interventions. These experiences will require ‘attitude” adjustment as providers gain experience relying on the voice of person @ the center care.
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?
Thanks for your comment susanchull. Several other commenters have noted problems of interoperability with PGHD. Could you describe the work being done by the MOHR Project and eQueri to deal with the interoperability problem in Section 1: Benefits and challenges?
Thanks for your comment susanchull. What can the federal government do to support the development and adoption of person-centric profiles maintained and updated by the consumer?
Thank you for your comment susanchull. Does anybody else have ideas for incentivizing virtual and mobile care outside of the 4 walls of hospitals?
The platforms have to be standardized to allow for consumers and various providers to easily enter and extract data – or shared-care plans fall apart. The permissions piece is key. Consumers need to be educated on who (providers/payors/caregivers) can see what (health data). This is especially important in the areas of behavioral health.
Data entry on the consumer side should be simple, simple, simple and driven from mobile apps . This should include the ability to scan a Rx by snapping a picture from the phone, etc. etc.
There are so many vendors doing all of this – the question is really one of subtraction at this point. I like the idea of Blue Button being the common denominator (platform) that developers and consumers can work with.
In regards to the third bullet, ONC should continue to promote interoperability standards and certification criteria across the continuum of care. This will allow important information to flow freely for research, quality measurement and other ‘big data’ analysis purposes.