healthcarereimagined

Experts say the database of carefully curated medical guidelines is one of a kind, used constantly by medical professionals, and on July 16 will ‘go dark’ due to budget cuts.

07.12.18 5:11 AM ET

The Trump Administration is planning to eliminate a vast trove of medical guidelines that for nearly 20 years has been a critical resource for doctors, researchers and others in the medical community.

Maintained by the Agency for Healthcare Research and Quality [AHRQ], part of the Department of Health and Human Services, the database is known as the National Guideline Clearinghouse [NGC], and it’s scheduled to “go dark,” in the words of an official there, on July 16.

Medical guidelines like those compiled by AHRQ aren’t something laypeople spend much time thinking about, but experts like Valerie King, a professor in the Department of Family Medicine and Director of Research at the Center for Evidence-based Policy at Oregon Health & Science University, said the NGC is perhaps the most important repository of evidence-based research available.

“Guideline.gov was our go-to source, and there is nothing else like it in the world,” King said, referring to the URL at which the database is hosted, which the agency says receives about 200,000 visitors per month. “It is a singular resource,” King added.

Medical guidelines are best thought of as cheatsheets for the medical field, compiling the latest research in an easy-to use format. When doctors want to know when they should start insulin treatments, or how best to manage an HIV patient in unstable housing — even something as mundane as when to start an older patient on a vitamin D supplement — they look for the relevant guidelines. The documents are published by a myriad of professional and other organizations, and NGC has long been considered among the most comprehensive and reliable repositories in the world.

AHRQ said it’s looking for a partner that can carry on the work of NGC, but that effort hasn’t panned out yet.

“AHRQ agrees that guidelines play an important role in clinical decision making, but hard decisions had to be made about how to use the resources at our disposal,” said AHRQ spokesperson Alison Hunt in an email. The operating budget for the NGC last year was $1.2 million, Hunt said, and reductions in funding forced the agency’s hand.

Not even an archived version of the site will remain, according to an official at AHRQ. A report from the Sunlight Foundation’s Web Integrity Project found the agency announced the site’s retirement, as well as that of a related but less trafficked “Quality Measures” site, this Spring. Some of the NGC’s pages are preserved in a third party archive, but no comprehensive backup of the site’s contents or search functions exists.

Part of what makes NGC unique is its breadth, King explained. Drawing on research from all over the country and the world, from professional organizations and research institutes, the site offers a free, and virtually comprehensive, body of guidelines in a centralized and easily searchable location. Rather than seeking out guidelines from dozens of individual publishers, King said, the NGC allows researchers to find the full range of resources in one stop.

The site plays another critical role, King said: that of gatekeeper. Because medical guidelines are produced by such a vast array of organizations, they vary widely in quality.

“In times past, there were an awful lot of, let me put air quotes around this — ‘guidelines’ — that weren’t of good methodologic quality,” King said. “They were typically just expert opinions, or what we jokingly refer to as BOGSAT guidelines: ‘bunch of guys sitting around a table’ guidelines.”

The NGC has a screening process designed to keep weakly supported research out. It also offers summaries of research and an interactive, searchable interface.

That gatekeeping role has sometimes made AHRQ a target. The agency was nearly eliminated shortly after its establishment, in the mid-90s, when it endorsed non-surgical interventions for back pain, a position that angered the North American Spine Society, a trade group representing spine surgeons. A subsequent campaign led to significant funding losses for AHRQ, and since then, the agency as a whole has been a perennial target for Republicans who have argued that its work is duplicated at other federal agencies.

The vetting role played by the NGC is a critical one, says Roy Poses, with the Patient-Centered Outcomes Research Institute.

“Many guidelines are actually written mainly for commercial purposes or public relations purposes,” said Poses, and can be subtly shaped to promote a given course of treatment. A guideline written for the treatment of depression, for example, may emphasize pharmaceuticals over talk therapy.

“The organizations writing the guidelines may be getting millions of dollars from big drug companies that want to promote a product. The people writing them may have similar conflicts of interest,” Poses said. NGC’s process provided a resource comparatively free of that kind of influence.

Underscoring how medical research like that maintained by the NGC can be politicized, AHRQ drew the ire of then-congressmember Tom Price in 2016 when it published a study critical of a drug manufactured by one of his campaign donors. According to ProPublica, one of Price’s aides emailed “at least half a dozen times” asking the agency to pull the critical research down. Price was the first director of HHS, AHRQ’s parent agency, under the Trump Administration, before resigning under pressure last year over his spending on chartered flights.

The current director of AHRQ, Gopal Khanna — a Price appointee — is the first non-scientist to head the agency. His résumé includes mostly positions in information technology management, in state government in Minnesota and Illinois, and a brief stint in the George W. Bush White House. Shortly after he was hired in 2017, he announced that data dissemination as one of his central priorities at the agency.

Mary Nix, Deputy Director of the Division of Practice Improvement at the Center for Evidence and Practice Improvement within AHRQ, cited budget cuts as the driving force behind NGC’s retirement. The site was most recently supported by a fee on some health insurance plans, which was instituted as part of the Affordable Care Act but is set to sunset in 2019. Nix estimates that the site would cost a “few hundred thousand” dollars per year to maintain even as a static archive.

Nix has been helping coordinate an effort to get some outside stakeholder to take over the site’s operations. She said she’s still hopeful, and even days before the site’s scheduled demise, AHRQ spokesperson Hunt told the Daily Beast that the search continued.

“Losing [the NGC] is really losing a valuable resource,” said Ana Maria Lopez, President of the American College of Physicians. She said the NGC is a primary source for her organization’s research, and noted that digital repositories like the NGC are only more critical today. “We’ll be thinking through what role we might be able to play here in helping to protect access to scientific information.”

Article link: https://www.thedailybeast.com/hhs-plans-to-delete-20-years-of-critical-medical-guidelines-next-week

June 29, 2018

Martha Hostetter and Sarah Klein

If eventually approved by the Secretary of Health and Human Services, the alternative payment models would offer physicians per member per month fees, shared savings, or other payment methods to manage care differently. These and other value-based payment approaches would overcome two main hurdles to reforming care delivery under the fee-for-service system: lack of payment for services, such as hiring nurses to triage problems, that can improve health outcomes; and the potential loss of revenue to providers who help patients avoid unnecessary care.

The physician-proposed alternative payment models also seek to redress what some see as a shortcoming of bundled payments, which cap payment for an episode such as total joint replacement but don’t offer guidelines on what providers might do to reduce spending. And unlike global payment approaches, they offer new financial support for particular services — often simple, proactive steps — that are likely to produce downstream savings. “The path to higher-value care should start by asking physicians where they see opportunities to improve care and reduce costs and then paying them in ways that enable those changes to be made,” says Harold D. Miller, president and CEO of Center for Healthcare Quality and Payment Reform and a member of the PTAC.

In this issue of Transforming Care, we look at new approaches to delivering and paying for care developed by physicians: some have been piloted through grants from the CMMI and/or submitted to the PTAC for consideration as new Medicare payment models, while others have gained support from private insurers or are being spread by physician entrepreneurs.

Source: A Guide to Physician-Focused Alternative Payment Models, American Medical Association and Center for Healthcare Quality and Payment Reform, http://www.chqpr.org/reports.html.

Engaging Patients in Shared Decision-Making and Avoiding Unnecessary Cardiac Procedures

Many people who go to their primary care doctor or cardiologist with complaints of periodic chest pain that might suggest cardiovascular disease end up receiving tests and interventions that are not in keeping with clinical guidelines, pose risks, and drive up costs.¹

The Wisconsin and Florida chapters of the American College of Cardiology led a CMMI-funded pilot that brought together several decision support, patient engagement, and performance feedback tools in an effort to promote appropriate treatment for patients whose chest pain appears to be related to stable ischemic heart disease. The aim of the Smarter Management and Resource Use for Today’s Complex Care Delivery (SMARTCare) pilot was to reduce inappropriate stress tests and imaging (e.g., angiograms to view blood vessels in the heart) as well as reduce inappropriate percutaneous coronary interventions, an invasive procedure that carries risks of bleeding and other complications. It also sought to increase the number of patients who change their behavior to reduce their risks of developing severe heart disease.²

To achieve these goals, its developers embedded evidence-based guidelines into electronic health record systems at 10 cardiology practices in Wisconsin and Florida and leveraged them to guide decision-making at the point of care. The tools didn’t dictate treatment but instead helped physicians customize guidelines to make them relevant to their patients. “Some so-called decision support tools are really documentation support: if a doctor wants to order a stress test they have to supply a reason why,” says Thomas J. Lewandowski, M.D., a cardiologist in Appleton, Wis., and principal investigator of the SMARTCare pilot. “By contrast, the SMARTCare tools ask doctors to enter in a particular patient’s symptoms and then [the tools] map each to different indications, so it helps them verify whether what they’re doing fits with clinical guidelines.”

Physicians participating in the pilot also educated patients about their unique risk factors, engaged them in shared decision-making, and collected feedback on their care experiences. At the Medical College of Wisconsin, patients were shown an educational video explaining the risks and benefits of various cardiac procedures before meeting with a cardiologist. They also completed the Seattle Angina Questionnaire to assess their symptoms and severity (at other sites, patients completed the Heart Quality of Life questionnaire). Cardiologists drew on the survey data and videos to help patients understand their risks and options — putting some guide rails around what can be a highly charged conversation. Without information, “patients often push for more invasive procedures,” says Nicole Lohr, M.D., a cardiologist at Medical College of Wisconsin. “They say, ‘Doc, it’s my heart; you better do something about it because I don’t want to die.’”

The SMARTCare Pilot Demonstrated Giving Patients a Greater Say in Treatment Decisions Led to Less Regret

Thomas J. Lewandowski et al., “Unlocking the Power of Data: Information Technology Implementation for Smarter Management and Resource Use for Today’s Complex Care Delivery,” poster published by the American College of Cardiology Foundation, 2017.

The reality is most primary care doctors and even some cardiologists who order cardiac diagnostic tests don’t always choose appropriate, evidence-based testing because of the time constraints within an office visit and a lack of exposure to changing guidelines.  Nicole Lohr, M.D. Assistant Professor of Medicine, Cardiovascular Division,Medical College of Wisconsin

Some SMARTCare participants also used the IndiGO tool, a simulation model that calculates a patient’s risk for having a heart attack or stroke based on their cardiovascular disease history, comorbidities, body mass index, and lifestyle behaviors. It then models the potential benefits of behavior changes (e.g., smoking cessation or weight loss) and medications. Cardiologists used the tool to encourage patients to make behavior changes and identify where they had opportunities to intervene. “Take a 75-year-old whose coronary disease, diabetes, and blood pressure are under control, and who exercises and does not smoke: there is nothing left to do with that patient to reduce their risk,” says Lewandowski. “But the role of IndiGO is to identify which patients have risk factors that we still have ability to affect. That is something that our current tools don’t do.”

Data on patients were collected throughout the course of treatment, enabling clinicians to benchmark their performance against peers and receive rapid feedback on health outcomes and costs.

The SMARTCare pilot was prompted, in part, by data from Wisconsin’s all-payer claims database showing wide variation in cardiology resource use, information that also caught the attention of the WEA Trust, a self-insured plan that covers 110,000 Wisconsin public employees. WEA Trust is now encouraging health systems to negotiate for payment to embed the system as a means of offsetting the revenue they may lose from avoiding stress testing, nuclear stress testing, and catheterizations. “Payment is a signal of what we value,” says Tim Bartholow, M.D., vice president and chief medical office at WEA Trust. “If we want better medical decision making, we need to increasingly focus payment on team-based decision making and more realistic, cost-based reimbursements for commodities such as imaging, laboratory tests, and drugs.”

Heading Off Complications for Oncology Patients

In 2014, cancer care accounted for $87.8 billion of health care spending for noninstitutionalized Americans; of that, roughly 28 percent went to emergency department and hospital care. Barbara McAneny, M.D., a New Mexico oncologist and president of the American Medical Association, says a large portion of the hospitalizations and emergency department visits are to treat fevers, dehydration, and other complications of chemotherapy that could be avoided with closer management in outpatient settings, where patients typically receive chemotherapy infusions. Avoiding unnecessary hospitalizations may also prevent further deterioration, she says. “In addition to the risks of infections and bed sores, if you take someone who isn’t healthy and can’t rebuild muscle mass, and you put them in a hospital bed for a few days, they end up with less muscle tone and a reduced quality of life.”

The problem is that oncology practices can’t bill Medicare or most private insurers for services like educating patients on how to recognize warning signs or hiring a nurse to answer calls and triage problems. At the same time, patients may be reluctant to trouble physicians when they first notice symptoms.

Through a grant from CMMI, McAneny led a trial of an alternate approach. From 2012 to 2015, the Community Oncology Medical Home (COME HOME) tested whether providing advanced access to patients and closer care coordination could lead to earlier detection of problems and avoid hospitalizations. Seven cancer centers offered on-demand visits, including on nights and weekends, for emergent issues such as pain, dehydration, nausea, or fevers; hired a nurse to respond to patients’ question and triage problems; and implemented 37 unique care pathways for diagnosis, treatment, and symptom management of different types of cancers. “We make our triage pathways available, so people can figure out which patient with left-sided pain is having a heart attack and needs to go to hospital and which has bony metastasis and doesn’t need their fourth cardiac workup,” McAneny says.

An evaluation of the pilot found this approach led to significant reductions in emergency department visits and hospitalizations for ambulatory care–sensitive conditions, as well as significantly lower average cost of care ($601 less per patient per quarter). McAneny says that practices that enabled nurses to execute standing orders to address patient complications achieved the most dramatic reductions in hospitalizations; at her own practice, hospitalizations were cut in half.

This February, McAneny submitted a proposal to the PTAC for consideration of an alternative payment model to support COME HOME, and 16 practices have agreed to participate, should it be funded. Notably, the practices have also agreed to share clinical and claims data to feed into a software platform that would be leveraged to create customized treatment plans for patients and offer real-time physician education and performance feedback. Eventually, the goal is to use this pooled data to cluster cancer patients according to their risks and disease severity, then compare variations in spending and outcomes in each of the clusters; such information could help Medicare and other payers develop appropriate alternative payment models.

“Right now, nobody has the ability to accurately predict costs for a cancer patient who has x, y, and z characteristics,” McAneny says. “Even if you have multiple patients with stage 4 colon cancer, some are going to cost a whole lot of money and some will cost much less. We hope to learn which factors make the difference and to identify things that are modifiable through better coordination or different types of care.”³

Improving Quality and Reducing Costs for Back Pain Treatment

Back problems are among the most common reasons people visit a doctor, leading to more than $47 billion a year in medical costs. A review of 10 years’ worth of medical visits for back pain found ample evidence of overtreatment: instead of starting with anti-inflammatory drugs and physical therapy, as recommended by clinical guidelines, physicians have increasingly prescribed narcotics, ordered imaging, and referred patients to specialists. Overuse of opioids, in particular, has fueled the epidemic of addiction.

Andrew Haig, M.D., a physiatrist (a physician specializing in rehabilitation) and active emeritus professor of physical medicine and rehabilitation at the University of Michigan, thinks clinicians in his field are well positioned to manage back pain by serving as “midfield players”: given their expertise, they are better able than primary care clinicians to explore the many potential causes of patients’ suffering and may be less wedded to high-cost interventions, like surgery and injections.

In 2008, Haig partnered with the Michigan insurer Priority Health to test this approach: all patients who were referred by their primary care physician to a surgeon for back pain were first required to see a physiatrist. The health plan waived members’ copayments for this visit, and physiatrists were given a $50 bonus, on top of the visit fee, to help patients talk through options. “I hold up five fingers and say, ‘When you leave here you are going to put something in your shopping cart: surgery, injection, pills, some kind of therapy, or doing nothing,’” Haig says. Without such guidance, patients may hold out hope there’s a magical solution to their problem. “It’s important for patients to leave with a finite sense of their options,” he says.

Over two years, Priority Health saw a 25 percent reduction in spine surgery among its members, as well as a 12 percent reduction in overall spine-related costs per member per month and continued member satisfaction, compared with the year before implementation of this approach.

Haig has since developed and tested other parts of a continuum of back pain management and has spun off a consulting firm to encourage providers and health plans to adopt the “Operation FastBack” model.

Under Operation FastBack, all patients with chronic back pain, for example, would be screened by a physiatrist. Those whose pain does not appear to be related to a serious medical condition (e.g., cancer) would then receive a multidisciplinary team assessment that can consider the wide range of factors and available treatments. Haig’s research found that psychological factors like depression, fear, and avoidance, as well as poor physical conditioning, are common among patients with back pain. The team includes a physical therapist to consider anatomical issues; an occupational therapist to explore how disability affects people’s lives; an exercise specialist to explore the role of physical conditioning; a psychologist to consider contributing psychiatric factors; and a representative for complementary/alternative medicine to consider such therapies. After their initial assessment, the team would work with a physiatrist and the patient to develop a holistic care plan. In a trial of 500 patients who underwent these team assessments, 17 people who received one type of complex intervention (functional restoration) had less work disability, fewer diagnostic tests, and fewer surgeries than those who were recommended this treatment but did not receive it.

Haig is now working with Blue Cross and Blue Shield of Vermont to develop the infrastructure to support this model, starting with creation of a hub at one hospital that has the full staff and other resources to assess back pain patients, treat the ones with the most complex needs, and refer others to treatment at local clinics. Hub clinicians also would support the local clinics in providing best practice care in three regional emergency departments and primary care settings. Haig and Blue Cross and Blue Shield are tracking expenses and outcomes under this approach, with the goal of modeling how a bundled payment might support it.

Evidence-Based Prescribing to Control Costs for Rheumatoid Arthritis Treatment

Rheumatoid arthritis plagues some 1.3 million Americans with chronic joint pain and other problems. While biologic drugs have helped many patients who don’t respond to other types of medication, their price is much higher (around $50,000 a year) than traditional antirheumatic therapies (e.g., methotrexate, which can cost around $100 to $200 a year).³ This has raised concerns among some payers as well as patients, who may have to shoulder high copayments for a lifelong condition. Articularis Healthcare, which has 12 specialty rheumatology practices in South Carolina and Georgia, collaborated with a local insurer to develop a rheumatoid arthritis treatment pathway to ensure lower-cost medications are effectively tested before doctors recommend more expensive treatments.

Under the pathway, rheumatologists are prompted by their electronic health record system to follow American College of Rheumatology guidelines, which generally suggest an initial period of treatment with a traditional antirheumatic drug prior to escalating therapy to a biologic agent. The pathway also reminds physicians to periodically measure the effects of drug treatment on disease activity using a validated tool — another clinical guideline but one that may not be followed in all cases.

The “traditional medication is slow acting, and patients may not feel relief initially,” says Colin Edgerton, M.D., who practices at Articularis’s Low Country Rheumatology clinic, in Charleston. “A doctor may react to patients’ lack of relief and suggest switching to the biologic without really having a good metric built into the system to realize, ‘Oh, it’s only been six weeks. We should wait a bit longer to see if it can work.’”

Edgerton says this approach led to a 10 percent to 20 percent decline in the use of high-cost biologics, mainly achieved by identifying more patients whose conditions responded to the lower-cost medication. The local insurer pays Articularis a per member per month case management fee (around $500 to $1,000 a year) to defray the cost of staff required to implement the pathway and educate providers in its use; the two parties share in the savings that result from reduced use of biologic drugs.

Challenges to Spreading Physician-Led Alternative Payment Models

As these examples make clear, changing how care is provided and paid for in health care must begin by integrating new tools into electronic health record systems. This can be expensive and cumbersome; McAneny, for example, has struggled to enlist her electronic health record vendor in making changes needed to aggregate data across practices.

Those who are able to overcome technological challenges may find it hard to gain the attention and support of payers. While Medicare has called for new proposals, it has not yet acted on any of PTAC’s recommendations. Private payers have also been slow to support new care models. Edgerton, for example, has found it hard to enlist support from large national insurers for the rheumatoid arthritis pathway, perhaps because it has only been tested among a small number of patients. Banding together across practices, as is being proposed under the COME HOME model for oncology, could create the critical mass of patients needed to demonstrate efficacy for new care models and garner support from payers to invest in them.

Lewandowski says that Medicare could encourage multipayer support for initiatives like SMARTCare, thus ensuring that payers share equally in developing and testing new care models. The Centers for Medicare and Medicaid Services could also require accountable care organizations to pursue new approaches to high-cost specialty care, including orthopedics and cardiovascular care, rather than just meeting benchmarks on a relatively small number of performance metrics to qualify for shared savings, he says.

Brian Klepper, Ph.D., founding principal of Orange Park, Florida–based Worksite Health Advisors, a consulting firm that advises self-insured employers on how to find high-value clinical partners, says physician innovators often succeed by going directly to employers and offering them a financial guarantee of savings. “Like Amazon, they make people an offer they can’t refuse,” he says.

Perhaps most important, it will be crucial to enlist support for new care models from physicians; some may feel new decision support tools or care pathways are too prescriptive, while others may perceive a threat to their revenue stream from efforts to avoid high-cost services. But some of the models could make some physicians’ jobs easier. “Doctors are burning out in droves, and we can’t keep adding to their plate,” says John Mafi, M.D., M.P.H., assistant professor of medicine and health services research at UCLA’s David Geffen School of Medicine. “Making the right thing to do the easy thing is really the promising way to get real change to happen. It’s easier said than done.”

Article link: https://www.commonwealthfund.org/publications/newsletter/2018/jun/focus-physician-led-efforts-promote-value

President Donald Trump’s choice to lead the veterans’ agency, Robert Wilkie, also says he would not privatize veterans’ healthcare if confirmed.

By Jessica Davis

But several representatives pressed the department on the “staggering” cost of the project during the VA House Committee meeting.

By Jessica Davis

June 26, 2018

The U.S. Department of Veterans Affairs’ EHR project will go live in the Pacific Northwest and be fully functional by March 2020, VA officials told the House Committee on Veterans Affairs on Tuesday.

The VA will ensure the effectiveness of its pilot sites early in the process, assessing the planned sites in Spokane, Seattle and American Lake, Washington in July, September and August, said Acting VA Secretary Peter O’Rourke.

In October, the VA will begin the EHR deployment to those sites.

But Committee Chairman Rep. Phil Roe, MD, R-Tennessee, weighed in on the scope of the project, outlining concerns about the cost and significance of getting the project right.

“$15.8 billion over 10 years, including $10 billion to Cerner, is a staggering number for an enormous government agency,” said Roe. “The EHR modernization effort is not just a technology project. It will have a major impact on how the Veterans Health Administration operates.”

“That means clinical and administrative workflows,” he said. “It also changes the culture, as VistA has.”

The EHR modernization project has been a long road already. Former VA Secretary David Shulkin, MD made the decision to sign with Cerner in June 2017. But the contract wasn’t signed until May 2018 — after a year of staffing changes, interoperability issues and concerns about aligning the project to match the Department of Defense as that project has hit its own technical issues.

Rep. Tim Walz, D-Minnesota shared those concerns and added that oversight and leadership will be crucial throughout the entirety of the project.

“There are going to need to be eyes on this all the way,” said Walz. “The Government Accountability Office should be in attendance at every single governing board member…. GAO must have direct and frequent access to VA, Cerner, and program management support contractors.”

Walz also wants the VA to provide the GAO with quarterly progress reports.

VA and DoD have been working closer than in previous attempts to align the EHRs. The idea is to take the lessons DoD has discovered during its own Cerner implementation — MHS Genesis — so that the VA can have a more seamless transition from its legacy VistA EHR to Cerner.

DoD and VA have already found areas where the two agencies can work closely together and share resources, while aligning DoD and VA EHR deployments especially at joint agency sites, explained Defense Health Agency Director Vice Admiral Raquel Bono.

Roe also formally announced the development of an oversight subcommittee that will oversee the EHR implementation to help with this process. And O’Rourke said the agency has set up five programmatic, technical and functional teams to support the project.

Those groups include a legacy EHR Modernization pivot workgroup, steering committee, governance integration board, a functional governance board and a technical governance board.

Walz expressed support of these groups to manage the project, but railed on the VA officials over the continued lack of permanent leadership.

“We still don’t have a confirmed secretary, deputy secretary, undersecretary for health, or chief information officer: Pretty important those positions be filled with some stability,” said Walz.

Rep. Jim Banks, R-Indiana reiterated that point, referencing a Politico report that claimed Genevieve Morris, Department of Health and Human Services principal deputy coordinator of health IT would lead the EHR project: “If that’s true, when was the decision made, and why isn’t she testifying today?”

While O’Rourke called her a candidate, stating she’s “perfectly qualified,” he didn’t confirm those reports.

Indeed, VA leadership has seen an incredible amount of turnover in the last six months. Following negative reports on Shulkin, his Chief of Staff Vivieca Wright Simpson retired. President Donald Trump fired Shulkin shortly after, which began a long line of turnover.

A recent Congressional letter pointed to a loss of 40 senior staffers in the last five months, including its acting CIO Scott Blackburn — a crucial role for any major EHR project.

But O’Rourke said he was confident in the agency’s EHR plan, as they’re working closely with DOD.

“We’re listening to advice from respected leaders in healthcare,” he said. “We’re fully engaged with Cerner regarding all critical activities: establishing governance boards, conducting current state reviews, and optimizing the deployment strategy.”

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com

Topics:

Electronic Health Records (EHR, EMR), Government & Policy

Article link: https://www.healthcareitnews.com/news/va-congress-first-cerner-ehr-install-will-go-live-2020

The amount averages about $1 billion a year, less than the projected $16 billion for the Cerner platform — which Congressional members say doesn’t encompass the whole price tag.

By Jessica Davis

The blockchain revolution has made its way to the healthcare industry, and it’s only the beginning of what’s possible. Healthcare Rallies for Blockchain, a study from IBM, found that 16% of surveyed healthcare executives had solid plans to implement a commercial blockchain solution this year, while 56% expected to by 2020. Healthcare companies, tech innovators and the rest of the healthcare industry are grappling with what’s possible now and what blockchain could solve in the future.

The overall vision for blockchain to disrupt healthcare in the future would be to solve many issues that plague the industry today to create a common database of health information that doctors and providers could access no matter what electronic medical system they used, higher security and privacy, less admin time for doctors so there’s more time to spend on patient care, and even better sharing of research results to facilitate new drug and treatment therapies for disease.

What is blockchain?

While blockchain principles were first applied in the financial world as the technology that allowed Bitcoin to operate, it has applications for many industries including healthcare. Blockchains are distributed systems that log transaction records on linked blocks and store them on an encrypted digital ledger. There is no one central administrator, but it has unprecedented security benefits because records are spread across a network of replicated databases that are always in sync. Users can only update the block they have access to, and those updates get replicated across the network. All entries are time and date stamped.

What are potential uses of blockchains in healthcare?

Although there are some incredibly exciting ways blockchains can enhance healthcare operations, it won’t be a cure-all for the industry today, but it would certainly be a step in the right direction. The healthcare industry is drowning in data—clinical trials, patient medical records, complex billing, medical research and more. Adoption and implementation of blockchains will be an evolution over time as blockchains applications are vetted and adopted as well as the industry coming together to determine collaboration and governance issues. As it always is with new technology, the full possibilities of what may transpire in the future is unknown at this time. However, as quoted in a Wired article, “Now is probably the right time in our history to take a fresh approach to data sharing in health care,” says John Halamka, chief information officer at Boston-based Beth Israel Deaconess Medical Center.

Here are the most likely applications:

Medical Data Management

MedRec, one prototype using blockchains, is intended to improve electronical medical records and allow patients’ records to be accessed securely by any provider who needs it solving the waste of time, money and duplication in procedures, confusion and sometimes even life-threatening issue of records being distributed across many different facilities and providers. The goal with MedRec is to give patients and their providers one-stop access to their entire medical history across all providers they have ever seen. Additionally, if patients wish to grant access to their personal medical records to researchers, their data would be provided anonymously to be used in research which could make medical breakthroughs possible faster than they are now. This pioneer in the field shows the potential for how dramatically things could change in healthcare by deploying blockchains.

Drug Development and Supply Chain Integrity

Not only could blockchains facilitate new drug development by making patient results more widely accessible (if the patients give their permission), it could help reduce the counterfeit drug implications that currently cost pharmaceutical companies an estimated $200 billion in losses annually.

Claims and Billing Management

Medicare fraud caused more than $30 million in losses in the United States in 2016, and blockchain-based systems could help minimize it. In addition, it could reduce admin costs for billing by eliminating the need for intermediaries with automated activities and more efficient processing.

Survey shows only about half of Americans would have money to pay for an unexpected medical bill of $1000.