Did you realize that the ONC for Health IT released its new five year plan for 2020-2025? Released November 2020, they made the 2020 goal by 2 whole months. Understanding this document and its upcoming regulatory vision will important if you want to understand health IT from a health research or hospital perspective.

Today we’re going to dive into Goal 1 of 4

1a Strategies
·      Enable individuals to access their health information
·      Promote greater portability of eHealth Information (EHI)
·      Improve access to smartphones and other technologies
·      Build the evidence base on the use of EHI
·      Improve consumer health IT literacy

1B Strategies
·      Promote healthy behaviors and self-management
·      Leverage individual- and population-level data
·      Advance use of validated evidence-based digital therapeutics

1C Strategies
·      Advance standardization and interoperability of Social Determinants of Health and social service data
·      Capture and integrate Social Determinants of Health data into Electonric Health Records and clinical decision support
·      Promote engagement between providers
·      Modernize and strengthen communities’ health IT infrastructure
·      Foster greater understanding of how to use health IT

Health care providers will see quite a few driving forces that will require changes. The small ones may have the largest impact on actual clinical practice. Currently a wide variety of Social Determinants of Health (SDOH) data is not widely collected or standardized. Promoting healthy behaviors may be as simple as having standardized scripts and placing an order for monitoring and followup but its likely to have far more wide ranging changes.

Giving patients access to their information, portability, and access falls squarely on the IT shops and vendors. The API’s for SDOH.

As someone in research its got quite a few provisions that I look forward to seeing made available. Social determinant of health data will help us isolate and improve interventions. Individuals having greater access to their data will mean that they could donate that data to research giving us greater access across health systems than we could imagine today. Leveraging individual and population level data will be driven by researchers as the vision is still nebulous.

Read the full report: https://www.healthit.gov/sites/default/files/page/2020-10/Federal%20Health%20IT%20Strategic%20Plan_2020_2025.pdf

For those who weren’t around in the healthcare industry circa 2009-2016 HITECH was part of the ARRA stimulus package. The overriding goal was to use health IT to enable better health care quality, greater affordability, and improved health care outcomes for all Americans. Sound Familiar? These are still aspirational goals we’re striving to achieve.

“Those who cannot remember the past are condemned to repeat it.”

I’m a proponent of exploring the past to understand the future. April 2020 saw one of the biggest breaks in precedent we’ve seen where the federal government gave money directly to businesses without expecting something in return. That’s unlikely to continue with a new stimulus package, President Elect Biden lived through the last recovery and saw the programs that worked and those that did not. HITECH has stood the test of time by helping raise the ability for improved health outcomes across the nation. If we hadn’t invested in widespread electronic adoption of our health systems a decade ago we would have a far poorer response to the pandemic, far more fragmented, one that is far less centralized and cooperative.

If we hadn’t invested in widespread electronic adoption of our health systems a decade ago we would have a far poorer response to the pandemic

HITECH itself isn’t likely to see all the same capabilities revisited, when everyone is already on an electronic health record why would you incentivize them to adopt them again? However, quite a few of the programs with further efforts could drastically improve our capabilities to address pandemics and deliver high quality health. Hospitals are floundering as COVID19 patients are filling their halls and their normal margins and care models are thrown out the window. The government is likely to ask for specific capabilities to be demonstrated with a bailout. Many will probably mirror the agenda of the ONC with patient access (Information blocking), as a betting person I’d wager installing and applying machine learning, centralized reporting and enhanced screening will also be on the agenda.

I’d wager, patient access (Information blocking), installing and applying machine learning, centralized reporting and enhanced screening will be high on the next agenda.

Below are the original goals of the HITECH program if you don’t recognize the terms below it might be worth a few minutes to familiarize yourself with them. If you didn’t live through this wild time period you won’t remember that this redirection of attention and effort had great positive impact but also resulted in negative impact as well. Research in EHR’s frequently ground to a halt. We saw the EHR vendors consolidate to a handful of major players from a robust market as meeting government requirements and timelines proved too much for smaller players. Not every goal was achieved and we frequently saw quick shifts from one target to another. Overall though, we wouldn’t have been in the place we are in 2020 without this act and I suspect we will see something similar in the near future.

ONC Programs:

1. Health Information Technology Extension Program/Regional Extension Centers (REC)
2. State Health Information Exchange Cooperative Agreement Program
3. Strategic Health IT Advanced Research (SHARP) Program
4. Beacon Community Program
5. Health IT Workforce Training Programs

• Community College Consortia to Educate HIT Professionals
• Program of Assistance for University Based Training
• Curriculum Development Centers
• Competency Exam for Individuals Completing Non-Degree Training Program

I taught a class today on telehealth and specifically mHealth, a term that went out of favor 7 years ago. I thought it might be amusing to remind us all how far we’ve come as an industry in just a few short years and why Telehealth is so much more accessible today.

In 2010 we were still talking about people using PDA’s, palmtop computers, or personal data assistant

In 2010 we were still talking about people using PDA’s. A personal digital assistant. The built in camera for laptops at the time was .3 megapixels. The iPhone 4 revealed June 7, 2010 front facing camera was .3 Megapixels. In comparison the Iphone 12 just released is 12 megapixels. Over the past decade we’ve seen drastic improvements in technology and bandwidth. The US Bandwidth alone has gone from 2010 average of 3.87Mbps to Mobile device average is 47 and broadband is approaching 200Mbps. Almost all devices now contain a bluetooth chip and many devices contain cellular opportunities.

We’ve seen tele programs like stroke, specialist care, and surgery drive capabilities in our health systems forward over the past decade. However, we’ve never had an external impetus like the pandemic this past year. It drove adoption rates through the proverbial roof. Health systems that might have done a handful of encounters a month experienced a 10,000% increase in visits. https://www.ibj.com/articles/a-tsunami-of-growth-in-telemedicine

We have driven adoption of remote monitoring, drug dispensing, infection control, and improved patient outcomes

We have driven adoption of remote monitoring, drug dispensing, infection control, and improved patient outcomes. The biggest driving factor we’ve faced that has prevented adoption of telehealth has been payment. As we’ve watched things loosen and tighten this year surrounding payment for telehealth visit you can see a direct correlation in how many encounters are done through this mechanism. Speaking as a patient I have appreciated the flexibility when meeting with specialists.

I was reading Beckers and decided my response deserved more than a tweet. Merriam-webster defines Imitation as something produced as a copy. Perhaps Oscar Wilde has the most famous quote:

“Imitation is the sincerest form of flattery that mediocrity can pay to greatness.”- Oscar Wilde

https://www.beckershospitalreview.com/ehrs/epic-s-ceo-says-hospitals-should-have-a-chief-imitation-officer-and-its-new-initiative-will-help.html

Healthcare is an interesting field, constantly pulled between those who think its an art vs science. Those attempting to protect everything intellectual they do and those that want to just impact and improve lives. Those that want to organize everything into a single approach (clones) and those that want to innovate to improve the status quo. Our innovation is often perceived as stillborn from other industries because we operated with a mandate of first do no harm.

Our innovation is often perceived as stillborn

Vendors are a different breed. They fiercely protect their intellectual property (IP) but want the systems they serve to share their own widely. They view it under the argument they were formed to be a services company and need IP but healthcare organizations were formed to treat people and their focus should be narrowed to just that and if they can help others than they should disseminate that widely. In situation after situation hospital IT departments implement an approach that no one has envisioned before and share as widely as possible because it helps improve real patients lives.

In situation after situation hospital IT departments implement an approach that no one has envisioned before and share as widely as possible because it helps improve real patients lives.

Imitation though has some real downsides. See the clone troopers above, they didn’t understand what they were doing, they were programmed to follow their commanders. When we introduce imitation without understanding it frequently results in poor outcomes.

I have spent years publishing in industry circles without attempting to wrap intellectual property around what I’m doing pushing the cutting edge of research implementations and analytics in EHR’s because I believe these approaches will allow us to make the world a better place. It gives me a unique perspective though as some of those processes become standard and some fall to the wayside. I watch some of my largest successes fall away because they relied on complicated infrastructure or logic that others couldn’t replicate.

I watch some of my largest successes fall away because they relied on complicated infrastructure or logic that others couldn’t replicate.

Should we imitate? Yes. We should also innovate, we should be an industry that the best and brightest should flock to not due to the monetary rewards but because what we do should have a positive impact on the world.