eHealth Initiative (eHI) is a nonprofit group in Washington, DC that works to improve Health Information Technology (HIT) through stakeholder networking and advancing the national HIT dialogue. The annual eHI-sponsored “National Forum on Data & Analytics” was held May 21-22 in Washington, DC. This 2-day event attracted providers, payers, researchers, and industry representatives to a symposium designed for open discussion and information sharing. Hot topics at the conference included the use of Big Data for population management and predictive modeling, using data to support value-based healthcare models, and specific health organization use of data at the point of care. Twitter and other social media were discussed as a way to identify health trends.
The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONCHIT) provided the bookend presentations for the symposium. Niall Brennan, the Acting Director of the Offices of Enterprise Management for CMS, opened the conference with a presentation on “Using Analytics to Reduce Medicare Costs,” and Karen DeSalvo the new National Coordinator for HIT closed the conference with a talk on her approach to the National HIT agenda. The conference had interesting themes that I will mention in future blog posts, but I would like to pass along some highlights from Mr. Brennan and Dr. DeSalvo.
CMS: Analytics, value-based models, and reform
In his presentation, Niell Brennan highlighted 3 areas of HIT focus for CMS:
- Analytics should help to decrease healthcare cost
- CMS needs to transition from a payer of claims to a value-based purchaser
- Nationally we need delivery-system reform
CMS hopes that eventually data aggregation will help to transform U.S. healthcare delivery with projects like the Chronic Conditions Data Warehouse, which “provides researchers with Medicare and Medicaid beneficiary, claims, and assessment data linked by beneficiary across the continuum of care.”
CMS is aware that as providers move toward value-based models of healthcare delivery there will be a need for real-time claims data. CMS plans to provide a “monthly beneficiary claims feed” to ACOs and other risk-based entities to address the provider lack of information. Mr. Brennan noted that it is possible today to download 3 years of beneficiary data from the MyMedicare.gov portal. The CMS Blue Button allows individuals to download personal health information as an ASCII file.
A current CMS data project is the Medicare Chronic Conditions Dashboard which aggregates data from 2 billion Medicare claims to generate chronic condition flags for DM, CHF, lipids, HTN, and CVD. These data have been used to create chronic condition maps of the U.S. showing areas of high and low prevalence of selected chronic conditions. Today, 2012 data is published in 2014, but someday it will be real time or updated at least monthly. The local real-time population data should be useful to providers in supporting decisions about deployment of resources and areas of special health needs.
Mr. Brennan noted that CMS is aware that small providers are being “nickel and dimed” by vendors to meet ACO data demands. CMS has a goal to help provide “the right data, at the right time, for the right person, in the right format” to alleviate some of the burden of data collection and delivery. Mr. Brennan closed his remarks with a plug for the CMS Data Navigator, a search tool that can be used to find data published and “sprinkled” in the CMS website.
ONCHIT: Improving outcomes through Big Data
The conference closed with a presentation by Dr. Karen DeSalvo, the ONC National Coordinator, who was ticking off her 129th day on the job. An Internal Medicine physician from Louisiana, Dr. DeSalvo has previous experience as a health services researcher and as the New Orleans Health Commissioner.
Interested in creating opportunity for lower cost and better care for everyone, Dr. DeSalvo noted that accumulated data on individuals is important in improving outcomes. Nationally, she said, we are reaching a “tipping point” where aggregated data on individuals is impacting population management and increasing patient care quality and patient safety.
During her work as Health Commissioner in Louisiana, Dr. DeSalvo was involved in creating a data registry to identify people who are especially vulnerable during a disaster due to chronic illness. As part of this project, Big Data was used to identify “at risk” people by “mapping” data to locate people with certain diseases. Previously, Louisiana had a voluntary program allowing people to register to receive help in the event of a disaster. 15 people had signed up, but the data map identified over 600 “at risk” people. Dr. DeSalvo noted that in 2012, following power loss and destruction due to Hurricane Isaac, the health department proactively provided medical support and assistance to those in need and people were happy for the help.
With its commitment to EHR adoption, ONCHIT also supports the development of standards like a common “data dictionary” to improve EHR interoperability. Dr. DeSalvo noted that privacy and security will continue to be big issues, especially as Big Data adds to data complexity and volume. She expects that we will eventually have a “Superhighway Platform” to get everyone connected electronically and to enable patient matching. She predicts that EHR architecture will become more complex since the amount of data stored for individual patients will grow exponentially when genomics and proteomics data is captured.
As part of Healthcare 2020, ONCHIT will refresh the national HIT strategy to focus on improving health instead of the healthcare system. Priorities will be revealed in the Fall with the national agenda for HIT, but we should expect a focus on improving patient access to health data, including opportunities for individuals to contribute valued data to their health records.
In addition to the hot topics at CMS and ONCHIT, the eHI National Forum also covered some interesting real-life healthcare delivery stories from around the country. Stay tuned for more insights on how data is making a difference at the point of care.