Bio: As Vice President of Strategic Initiatives for Allscripts, Rich Elmore works on innovations, managing exploration and execution of strategic partnerships and acquisitions. During 2011-12, he took a leave of absence to lead the Query Health initiative for the Office of the National Coordinator for Health IT (ONC), US Department of Health and Human Services. He also led ONC’s initiative for Consolidated CDA and Transitions of Care, served as a workgroup leader for ONC’s Direct Project, and was a founding member of the CCHIT Interoperability workgroup. Previously, Rich ran the Flowcast Hospital business for IDX (before the company’s merger with GE Healthcare) and served on the IDX Corporate Strategy Board. Rich has degrees from Dartmouth College (BA) and New School University (MA Economics). He serves on the Scientific Advisory Group for Innovations in Monitoring Population Health Using Electronic Health Records – a multi-year research initiative of the Primary Care Information Project. He also serves on the advisory board to the Sudan Development Foundation, building health clinics in the world’s newest nation (South Sudan), and is Vice President on the Board of Directors for the King Street Center, serving kids and families in need in Burlington, Vermont.
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- Patients take pictures of their infections with their phone and send them via SMS to their doctor. Regardless of the policy problems with this, you do it because you need help NOW. And you hope you get the phone number right to avoid a really embarrassing moment!
- Patient frustration is heightened by healthcare organizations requiring communication by snail mail or fax. Really? In 2012?? As Allscripts CEO Glen Tullman asked when the Direct Project was launched (while holding up his iPhone): “when was the last time you asked your kids to send you a fax?”
- Patients expect to collaborate in their care, use many electronic means to engage, and expect their clinicians to effectively use their Electronic Health Records through care transitions.
- The head of the Office of Civil Rights gets up in an ONC convened presentation and says “you absolutely have a right to request your health record.” This emboldens the patient to seek the information they need to be an engaged participant in their care. It’s no longer just “the doctor’s information.” It’s also the patient’s information.
Last week, five health IT vendors came together to announce the CommonWell Health Alliance, a nonprofit focused on developing a national secure network and standards that will:
1. Unambiguously identify patients
2. Provide a national, secure record locator service. For treatment purposes, providers can know where a patient’s records are located.
3. Enable peer-to-peer sharing of patient records requested via a targeted (or directed) query
4. Enable patients and consumers to withhold consent / authorization for participation in the network
Unambiguous patient identity matters
In banking, without certainty about identity, ATM machines would not give out cash. And in healthcare without certainty about identity, physicians are working with one hand tied behind their backs.
This problem will never be solved by the Feds. In fact, Congress has restricted any spending on it by the government at all. Industry working together may be the only practical alternative.
CommonWell doesn’t intend to create a national patient identifier. Instead it will use practical, robust identity mechanisms that a patient or consumer could provide to each physician or caregiver. That might be based on a one-way hash of a cell phone number, an email address or a swipe of a driver’s license. The Alliance members will decide on this as part of its standards.
Locating data is critical to clinical decisions
Imagine a cancer patient with a primary care doc they visit in a family practice, a surgical oncologist in private practice, a plastic surgeon and medical oncologist at one academic medical center and a second opinion oncology team at yet another academic medical center.
Chances are those caregivers all using different EHRs, and they may even be in different geographies. The physicians don’t know where the records are. Yet each physician needs real-time access to ALL of the patient’s information with critical clinical decisions hanging in the balance.
CommonWell intends to address these gaps by delivering a secure national record locator service and standards for peer-to-peer targeted queries. Data that is returned to the physician are not stored on the CommonWell network, nor is the data normalized.
Founding members want every health IT vendor to join CommonWell Health Alliance
Those of us in the Alliance are aligned in our desire to be inclusive and welcoming to all. The founding members are making significant commitments of money and product developer time for the good of each patient and physician.
I have personally worked with the thought leaders of this effort over several years on ONC initiatives, including the Direct Project and Meaningful Use standards for Stage 2, and I can vouch for their integrity, goals and expertise. They’ve thought this approach through carefully, not only technically, but also in connection with governance, policy, privacy and security.
Allscripts and the CommonWell Health Alliance are committed to practical, standards-based solutions that can make healthcare safer and more responsive to the physician and patient. To that end, the Alliance looks forward to working collaboratively with the Office of the National Coordinator for Health IT, other vendors and with standards bodies to achieve these objectives.
Editor’s Note: This post originally appeared on The Health Care Blog.
This past year, I completed a tour of duty with the Office of the National Coordinator for Health Information Technology (ONC). I served as coordinator for standards related to Consolidated CDA, quality measures (HQMF) and results reporting (QRDA) that are now part of Meaningful Use Stage 2. These standards, along with Direct Project and standardized vocabularies, will contribute to Health Information Exchange that works.
I’m proud of the ONC and the community that delivered these standards. It’s a breakthrough with significant benefit to the United States. But it’s also only a start.
The need for better Health IT solutions hits home
Three days after completing my work with ONC, my wife Julie found out she had breast cancer. We have spent every day since in the struggle for her health and survival.
We had the usual frustrations with coordinating her care with a team spread across organizations — using different electronic health records, having to schlep images on DVDs, courier-ing reports for second opinions, and seeking out lab results that never made it to her patient portal. Of course, Health IT can ultimately help improve these countless operational issues.
But this is all secondary to another issue we confronted: the limitations of clinical knowledge. We were initially excited to learn that Julie’s cancer was HER2 positive. What was a killer 10 years ago was now one of the most treatable kinds of breast cancer.
But our second opinion team came to a different conclusion: it was ambiguous as to whether she was HER2 positive and the alternative outcome would mean that she was “triple negative” – the worst form of breast cancer. Other tests were done and the results remained unclear. We were in uncharted territory with no idea of efficacy of treatment options.
There weren’t any applicable studies. And there was no way to learn from others’ experiences – to understand signals from the experience of others in the same boat.
We desperately wanted to know more, but there was no more to know. There is no targeted or distributed query standard that could ask and answer questions of the electronic health records around the country.
Query Health standard offers new possibilities to share EHR knowledge
In a somewhat cruel twist, I had just led efforts at ONC to establish just such a standard. The Query Health standard, built off of Meaningful Use Stage 2 technologies for quality measures and results reporting, is underway in pilots around the country:
The Primary Care Information Project (PCIP) within the New York City Department of Health and Mental Hygiene (NYCDOHMH) and the New York State Department of Health (NYSDOH) will use the Query Health system to investigate and allocate appropriate resources for chronic and acute disease monitoring.
The FDA Mini-Sentinel project is an ongoing distributed network to support public health surveillance of the safety of medical products and the pilot entails adding a new clinical data source at Beth Israel Deaconess.
The Massachusetts Department of Public Health Network (MDPHnet) pilot includes the creation, operation and management of a distributed health data network for public health surveillance of diabetes, influenza-like illness and ad-hoc menu-driven querying.
MDPHNet’s Query Health pilot is live and in production. New York and FDA pilots are going live shortly. All three will be demoing at HIMSS13 in the Interoperability Suite.
Collective data can better inform individual patient care
Julie and I have seen the very best that the healthcare system has to offer. It’s a profoundly good system in the direct treatment and care for the patient. But it’s also a system restricted by the knowledge of a limited number of clinical studies from a relatively small group of patients, many of which cannot even be reproduced, and none of which were directly applicable to her condition.
There is an urgent and compelling national need to leverage the investment we are making in electronic health records (EHRs) — to make visible, within the constraints of patient privacy and security, the experiences of others to provide signals and knowledge that informs each patient’s care. This is the challenge and opportunity that Health IT must deliver. This is truly the “fierce urgency of now.”
Editor’s Note: This blog post was inspired by an invitation to participate in HIMSS13 Blog Carnival, where health IT community can discuss the most-pressing industry trends.
You may recall from my last post that I’m a huge proponent of Health IT. You may also recall that it’s personal. My wife has breast cancer. She and I have seen HealthIT’s tremendous benefits and recognize much of its untapped potential. Today I am happy to report that the Office of the National Coordinator for Health Information Technology (ONC), in conjunction with the National Cancer Institute (NCI), recently launched the Cancer Care Video Challenge. The goal of the challenge, according to its website is “to generate personal stories that will motivate and inspire others to use health IT and consumer eHealth tools to achieve better health.”
This challenge is a great call to action. It will further help an industry already trying to improve patient outcomes. Do you have a personal story about cancer and Health IT? Share your story below, or enter the challenge. Just record a video of your story and submit it by December 21.
EDITOR’S NOTE: HIMSS recently invited members of the health IT blog community to share their responses to the question, “How will health IT make a difference a year from now at the next National Health IT Week?” (HIMSS will launch its inaugural #NHITWeek Blog Carnival Sept. 10 in support the seventh annual National Health IT Week).
We asked Rich Elmore, former ONC Query Health coordinator, now Allscripts Vice President of Strategic Initiatives, to do the honors.
When we look back one year from now, we’re going to find that the patient has truly taken center stage in our healthcare system, largely due to the impact of Health IT on the culture and practice of medicine.
You know there’s a massive culture shift underway when:
Last October, I had the great fortune to speak (warning: PPT download) at ONC‘s Annual Meeting alongside Laura Adams, president of the Rhode Island Quality Institute. Laura was in D.C. on the business day before her surgery for breast cancer. She was in D.C. to publicly describe the many challenges that she faced due solely to limitations of Health IT. She described how she dropped her imaging CD-ROM in her driveway and almost ran over it with her car. And she recounted many other unimaginable moments that could have been solved with better Health IT and health information exchange.
All she really wanted was to take care of her breast cancer. She wanted the system to just work so she could focus on her own care. She wanted to better understand her disease and how it affected other patients like her. But there she was in D.C. making the case for a better system for everyone else. Her passion gripped everyone in the room – – it was so impactful and so immediate, so urgent and so real. Laura is so brave, so ready to stand up for what really matters. In that one instant, everyone in the room felt in a new way why what they do in Health IT MATTERS.
Then two months ago, this became much more personal, as the light of my life came down with breast cancer. We’ve been going through many of the same systemic challenges that Laura experienced. And we have the same desire for a system that’s more effective, high quality, transparent and enabled through Health IT. And like Laura, my wife has been brave, thoughtful, engaged and passionate in the face of these challenges. She’s truly inspiring.
We are working with some of the most amazing dedicated clinicians. But they’re limited by the tools they have to collaborate. They’re limited by existing clinical knowledge. They’ve been limited by the small number of patients enrolled in clinical trials and the slow progress of those trials. If we had the data, the experience of millions of patients, might we know more? We have found ourselves in uncharted territory – the evidence just isn’t there for many questions about treatment options and outcomes for just this one beloved patient and this one disease.
We’re already better off for the ability to use EHRs to safely manage our care in this messy, fragmented health system. And we’re much better off for the insights and clinical evidence that have already been established.
But as patients we know that it can be much, much better. We want more and we want it now. Better quality. Faster. More collaborative. More coordinated. Better insights. More transparent. More responsive. And we want it when we’re sick, not in the distant future. Better yet, before we’re sick.
So that’s what it’s all about. Health IT is so important. Fortunately, it is opening a door to a cultural revolution that engages the patient more fully in their own care, leading to better outcomes. This coming year, for the first time, we will find the patient truly coming into the center of his/her care.
It’s about time.
EDITOR’S NOTE: Be sure to listen to Rich Elmore being interviewed by Healthcare Informatics in this podcast on population health.
This past year, I took a leave of absence from Allscripts to serve as the Office of the National Coordinator for Health IT (ONC) coordinator for Query Health, an Open Government Initiative that is establishing standards, policies and services for distributed population queries of clinical records. It comes at a unique moment in time – at the confluence of broad deployment of Electronic Health Records, the compelling need for standards for secondary use of that healthcare information, and a Stage 3 Meaningful Use strategy that focuses on a “learning health system.” That is, a system in which the vast array of health data can be aggregated, analyzed, and leveraged using real-time algorithms and functions.
I’m thrilled to be back and sharing what I learned about what we can do to implement a learning health system that benefits patients on a national scale.
Our work began in August 2011 in Washington D.C., with a “Summer Concert Series” environmental scan of the best work on distributed queries happening around the country. I collaborated with some of the top folks in the industry from the more than 100 member organizations. It was energizing to be engaged with colleagues so deeply committed and passionate about improving health care.
My job was to lead the overall initiative representing ONC. Clinical, operations and technical workgroups, each with around 40 members, delivered the functional and operational requirements, the technical approach, the proposed standards and reference implementations. We actively engaged with the National Coordinator, the HIT Standards Committee, the HIT Policy Committee and the Privacy and Security Tiger team to ensure that Query Health aligned with broad national priorities and strategies.
Understanding Population Health
Distributed population queries can be applied to a variety of secondary uses. Distributed population queries enable an understanding of population measures of health, performance, disease and quality, while respecting patient privacy, to improve patient and population health and reduce costs.
Distributed population queries are a central component of ONC’s strategy for a learning health system. These queries “send questions to the data” and return aggregate population measures that keep patient-level information protected at the source.
We use distributed population queries today for a variety of purposes. For example, public health tracks diseases, including flu-like illness, and evaluates optimization of scarce resources. The FDA evaluates signals related to drug safety once drugs are released to the market. Researchers compare the relative effectiveness of drugs and treatments.
Putting It into Practice
There are five Query Health pilots kicking off this Summer and Fall.
- The New York City and State public health departments are sending questions to both provider practices and RHIOs related to diabetes and hypertension.
- The Food and Drug Administration is sending questions to a clinical data source at Beth Israel Deaconess Medical Center to evaluate which post-market drug surveillance questions can be supported by clinical data.
- The Massachusetts Department of Public Health is sending diabetes-related questions to community health centers and provider practices.
- The Centers for Disease Control is applying Query Health standards to its BioSense 2 cloud-based distributed data repository for situation awareness and disease syndromes.
- Allscripts is testing the applicability of Query Health to dynamically query for clinical quality measures.
Query Health standards are being prepared for standards ballot by HL7 and ONC’s Office of Science and Technology. The standard for Queries is based on an improved, more parsimonious version of the Health Quality Measure Format or HQMF. The standard for Results is the Quality Reporting Document Architecture or QRDA (Categories 2 & 3). The target data is aligned with the S&I Framework Clinical Element Data Dictionary, the National Quality Forum’s Quality Data Model and the HL7 Consolidated CDA.
You can find more information about the project at QueryHealth.org.
What’s your take on how the Query Health initiative can improve how we use health IT for the benefit of patient and patient populations? Do you have new ideas we haven’t yet considered? Share your thoughts below.