Vice President and Director, Governance Studies
Founding Director, Center for Technology Innovation
By Mohana Ravindranath
Nextgov | July 12, 2016
The same technology that lets people securely exchange Bitcoin could be useful in protecting health records from intruders, some technologists say.
Perhaps in an effort to test this theory, the Health and Human Services Department is collecting ideas about ways blockchain — the automated, digital ledger system used to record Bitcoin and other cryptocurrency transactions — could be used in health care.
Proponents of blockchain — defined by HHS as a “data structure” that may be time-stamped “and signed using a private key to prevent tampering” — see its benefits in securing personal information. But critics think blockchain deployment would require large amounts of processing power and equipment, according to a Federal Register posting.
Still, “most would acknowledge blockchain’s potential . . . is still evolving and maturing, especially with respect to its applicability to the health care,” the notice says.
HHS is just the latest federal organization to express interest in blockchain. The Pentagon’s research and development team, DARPA, wants a secure messaging service based on the technology; the Postal Service’s Office of the Inspector General issued a report suggesting blockchain could help the agency transfer money more efficiently, or help it ascertain the identity of citizens logging into websites, notarizing documents, or signing digital contracts.
A successful white paper would need to address the cryptographical aspects of blockchain; how it could help disparate health records systems communicate with each other; and how the technology could benefit precision medicine, an effort to deliver medical treatment tailored to an individual’s genetic makeup and lifestyle, among other topics.
HHS is collecting white papers on blockchain until July 29. Winning authors will be invited to present their ideas at a workshop in September.
Federal health IT spending grew 27 percent annually from fiscal 2011-2015, with the market jumping from $2 billion four years ago to $6.5 billion in fiscal 2015, according to research from big data and analytics firm Govini.
Civilian health agencies fueled health IT spending the most. The Health and Human Services Department increased its annual health IT spend by a compound annual growth rate of 34 percent, with about half of its total obligations driven by the Centers for Medicare and Medicaid Services, which is preparing for a major modernization effort and call center upgrade.
Not surprisingly, the Veterans Affairs Department also upped its spending. Since 2011, health IT spending jumped an average of 25 percent annually, though some this growth
According to Govini, the health IT federal market is only going to get stronger. The Defense Health Agency, which actually spent less on health IT under sequestration constraints, is about to start shelling out money for its Defense Healthcare Management Systems Modernization contract, with a life cycle value of some $9 billion.
“DHMSM is now the marquee [electronic health records] program across the federal government,” the report states. “DHA will have a leading role in driving patient-focused systems modernization with DHMSM and other interoperability initiatives.”
Citing the Obama administration’s proposed fiscal 2017 budget, it appears other agencies aside from HHS – the big civilian spender at this point, shelling out $13 billion since 2011 – will follow suit. VA’s planned investments in health IT will rival those made at HHS, with $370 million allocated to providing information security to veteran health data. VA’s telehealth initiative calls for $1.2 billion, much of which will fund modernization and upgrades across the agency.
The growth of the federal health IT market has “profoundly reshaped” its industry competitors, with mergers and acquisitions – such as Leidos’ acquisition of Lockheed’s IT business in February – becoming the norm. Post-acquisition, Leidos is the top dog in health IT and has its paws in every federal health agency, capturing $2.5 billion in health IT spending since 2011.
While the civilian health agencies and industry players are more or less set, Govini’s analysis suggests the next few years will be interesting. Agencies are exploring alternative contracting options, including DHA’s decision to leverage Alliant 2 to satisfy its health IT needs rather than release its own contract.
The “Blockchain and Its Emerging Role in Healthcare and Health-related Research.” Ideation Challenge solicits white papers on the topic of Blockchain Technology and the potential use for Healthcare. Winners will be invited to present their submission at an upcoming industry-wide workshop co-hosted with the National Institute of Standards and Technology (NIST). The statutory authority for this Challenge is Section 105 of the America COMPETES Reauthorization Act of 2010 (Pub. L. 111-358).
Award Approving Official: Karen DeSalvo, National Coordinator for Health Information Technology.
Debbie Bucci, firstname.lastname@example.org (preferred), (202) 690-0213.
A blockchain is a data structure that can be timed-stamped and signed using a private key to prevent tampering. There are generally three types of blockchain: Public, private and consortium. Potential uses include:
Proponents of blockchain suggest that it could be used to address concerns regarding the privacy, security and the scalability of health records. Critics ascertain that it would take enormous processing power and specialized equipment that far exceeds the benefits. Although most would acknowledge blockchain’s potential it is still evolving and maturing, especially with respect to its applicability to the health care.
This Ideation Challenge solicits White Papers on the topic of Blockchain Technology and the Potential for Its Use in Health IT and/or Healthcare Related Research Data.
This nationwide call may be addressed by an individual investigator or a investigator team. Interested parties should submit a White Paper no longer than 10 pages describing the proposed subject. Investigators or co-investigators may participate in no more than three submissions. A limited number of these submissions will be selected. The selection of a White Paper will result in an invitation to present at an upcoming industry-wide workshop on September 26th-27th at NIST Headquarters in Gaithersburg, MD.
The goal of this Ideation Challenge is to solicit White Papers that investigate the relationship between blockchain technology and its use in Health IT and/or Health Related research. The paper should discuss the cryptography and underlying fundamentals of blockchain technology, examine how the use of blockchain can advance industry interoperability needs expressed in the Nationwide Interoperability Roadmap, patient centered outcomes research (PCOR), precision medicine, and other health care delivery needs, as well as provide recommendations for blockchain’s implementation.
In lieu of a monetary award, challenge winners will be provided the opportunity to present their White Papers at an industry-wide “Blockchain & Healthcare Workshop” co-hosted by ONC and NIST.
Include a White Paper, not longer than ten (10) pages in length, that:
○ Describe the value of blockchain to the health-care system;
○ Identify potential gaps;
○ Discuss the effectiveness of the solution and the solutions ability to function in the “real world.” This discussion may include information regarding meeting privacy and security standards, implementation and potential performance issues, and cost implications. Risk analysis and mitigation would be appropriate to include here as well.
○ Discuss the solution’s link to the stated objectives in the Nationwide Interoperability Roadmap, PCOR, precision medicine and other national health care delivery priorities.
Challenge participants will have five (5) weeks from the date of the posting of this Notice. Those submissions must comply with the requirements provided above. Up to eight submissions may be selected as winners. The names of the winners will be posted on the Challenge.gov Web site, as well as the names of any participants receiving an honorary mention. Honorary mentions may be given to highly ranked submissions.
To be eligible to win a prize under this Challenge, an individual or entity:
1. Shall have registered to participate in the Challenge under the rules promulgated by the Office of the National Coordinator for Health Information Technology.
2. Shall have complied with all the stated requirements of the Blockchain and Its Emerging Role in Healthcare and Health-related Research Challenge.
3. In the case of a private entity, shall be incorporated in and maintain a primary place of business in the United States, and in the case of an individual, whether participating singly or in a group, shall be a citizen or permanent resident of the United States.
4. May not be a Federal entity or Federal employee acting within the scope of their employment.
5. Shall not be an HHS employee working on their applications or Submissions during assigned duty hours.
6. Shall not be an employee of the Office of the National Coordinator for Health Information Technology.
7. Federal grantees may not use Federal funds to develop COMPETES Act challenge applications unless consistent with the purpose of their grant award.
8. Federal contractors may not use Federal funds from a contract to develop COMPETES Act challenge applications or to fund efforts in support of a COMPETES Act challenge Submission.
An individual or entity shall not be deemed ineligible because the individual or entity used Federal facilities or consulted with Federal employees during a Challenge if the facilities and employees are made available to all individuals and entities participating in the Challenge on an equitable basis.
In order for a Submission to be eligible to win this Challenge, it must meet the following requirements:
1. No HHS or ONC logo—The Solution must not use HHS’ or ONC’s logos or official seals and must not claim endorsement.
2. Functionality/Accuracy—A Solution may be disqualified if it fails to function as expressed in the description provided by the participant, or if it provides inaccurate or incomplete information.
To register for this Challenge, participants can access http://www.challenge.gov and search for “Blockchain and Its Emerging Role in Healthcare and Health-related Research.”
Winners will be provided the following:
Prize will be paid by contractor.
The evaluation process will begin by removing those that are not responsive to this Challenge or not in compliance with all rules for eligibility. Judges will examine all responsive and compliant submissions, and rate the entries. Judges will determine the most meritorious submissions, based on these ratings and select up to eight (8) finalists. Honorable Mentions may be included and announced, along with the winners on Challenge.gov.
The judging panel will rate each submission based upon the effectiveness of the overall concept to help foster transformative change in the HealthIT culture, the viability of the proposed recommendations, the innovativeness of the approach, and its potential for achieving the objectives of ONC.
Up to eight (8) submissions will be selected as winners. Winners will be awarded with the opportunity to present their White Paper at a two-day Blockchain & Healthcare Workshop. In lieu of a monetary prize, finalists will be provided with full expenses for travel to the Workshop, which will be held at the NIST Headquarters in Gaithersburg, MD.
At the end of the submission period, Submissions will be posted on the challenge Web site and will be reviewed, graded, and voted on by a steering committee.
General Conditions: ONC reserves the right to cancel, suspend, and/or modify the Challenge, or any part of it, for any reason, at ONC’s sole discretion.
Intellectual Property: Each participant retains title and full ownership in and to their Submission. Participants expressly reserve all intellectual property rights not expressly granted under the challenge agreement. By participating in the Challenge, each entrant hereby irrevocably grants to the Government a limited, non-exclusive, royalty-free, perpetual, worldwide license and right to reproduce, publically perform, publically display, and use the Submission to the extent necessary to administer the challenge, and to publically perform and publically display the Submission, including, without limitation, for advertising and promotional purposes relating to the Challenge. This may also include displaying the results of the Challenge on a public Web site or during a public presentation.
By entering the Challenge, each applicant represents, warrants and covenants as follows:
(a) Participant is the sole author, creator, and owner of the Submission;
(b) The Submission is not the subject of any actual or threatened litigation or claim;
(c) The Submission does not and will not violate or infringe upon the intellectual property rights, privacy rights, publicity rights, or other legal rights of any third party;
Participants must indemnify, defend, and hold harmless the Federal Government from and against all third party claims, actions, or proceedings of any kind and from any and all damages, liabilities, costs, and expenses relating to or arising from participant’s Submission or any breach or alleged breach of any of the representations, warranties, and covenants of participant hereunder. The Federal Agency sponsors reserve the right to disqualify any Submission that, in their discretion, deems to violate these Official Rules, Terms & Conditions.
National Coordinator for Health Information Technology.
[FR Doc. 2016-16133 Filed 7-6-16; 8:45 am]
BILLING CODE 4150-45-P
The Health and Human Services Department has filled its long-vacant chief information officer seat.
Beth Anne Killoran, previously the acting deputy CIO and executive director of HHS’ Office of IT Strategy, Policy and Governance, will take on the title, according to an HHS blog post. Frank Baitman, the previous CIO, stepped down in November.
Killoran will direct efforts related to cybersecurity and privacy protection, according to the HHS blog post written by Mary Wakefield, HHS’ acting deputy secretary.
HHS had posted the position on USAJOBS in February, months after Baitman’s departure. According to that posting, the CIO’s duties would involve implementing the Federal Information Technology Acquisition Reform Act — legislation passed in 2014 that gives CIOs more authority over budgets — and creating a 5-year strategic IT investment plan.
Killoran’s priorities will include a “Cybersecurity Communication, Awareness, Response and Education” program that sends staff weekly tips about guarding against cyberthreats; running simulated phishing attempts to reduce the effectiveness of those campaigns; and pilot projects that would help HHS build a workforce “as tech-savvy as possible,” Wakefield wrote.
“To protect all of our IT systems — from desktops to the personally identifiable information and protected health information our department works with — we need more than an investment in funding or new technology. We need a cyber-savvy workforce,” the blog post said.
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Killoran joined HHS in 2014 from the Homeland Security Department, where she held several positions over 11 years.
O’Reilly Media specializes in books, courses and online services in technical innovation. This week, it released a new, comprehensive study on IT in Healthcare: The Information Technology Fix for Health (PDF). It’s written by O’Reilly editor Andrew Oram, who frequently writes on healthcare IT’s trends and issues. Oram takes on four basic, health IT areas in this cogent review:
In doing so, he brings a sound knowledge of health IT current technology and issues. He also brings a rare awareness that health IT often forgets its promise to combine modern tools with an intimate doctor patient relationship:
In earlier ages of medicine, we enjoyed a personal relationship with a doctor who knew everything about us and our families—but who couldn’t actually do much for us for lack of effective treatments. Beginning with the breakthroughs in manufacturing antibiotics and the mass vaccination programs of the mid-twentieth century, medicine has become increasingly effective but increasingly impersonal. Now we have medicines and machinery that would awe earlier generations, but we rarely develop the relationships that can help us overcome chronic conditions.
Health IT can restore the balance, allowing us to make better use of treatments while creating beneficial relationships. Ideally, health IT would bring the collective intelligence of the entire medical industry into the patient/clinician relationship and inform their decisions—but would do so in such a natural way that both patient and clinician would feel like it wasn’t there. P. 4-5.
by Lisa Rapaport
23 May 2016
(Reuters Health) – Technology makes it possible for patients to access medical records online, but a thicket of legal issues may still keep people from always seeing everything in their chart, some doctors say.
The Health Insurance Portability and Accountability Act (HIPAA) gives U.S. patients the right to access their medical records and control who else has access to the information, physicians note in an essay in the Annals of Internal Medicine.
But in reality, the contents of electronic records may be limited by doctors’ concerns about disputes with patients about what the records say, fear of malpractice litigation, and questions about how much information to give certain individuals like minors and people with mental illness, these physicians argue.
“I think the default should be for patients to have complete access to their electronic medical records, and the benefits would likely greatly outweigh any harm,” said lead author Dr. Bryan Lee of Altos Eye Physicians in Los Altos, California, and the University of Washington in Seattle.
As patients increasingly read their medical records, they will disagree with content, find errors and request changes, Lee and colleagues point out. While doctors may have the final say over what they add to records, patients may want to add information of their own, and the legal status of patient-created content is unclear.
In another point of legal murkiness, parents generally have control over minors’ medical records and can prevent children from accessing online notes. Providers can deny parents access if they suspect abuse or think parental involvement isn’t in a child’s best interest – but this, too, is an area where laws vary and liability concerns may color doctors’ decisions, the authors argue.
With mental illness, HIPAA prevents patients from accessing psychotherapy notes in some circumstances, but some state laws allow broader access to these records, the authors note.
While patients can benefit from access to records in most cases, there are some exceptions, and psychotherapy notes may be one of them, said Ann Kutney-Lee, a health policy researcher at the University of Pennsylvania School of Nursing in Philadelphia, in email to Reuters Health.
“There are certain clinical situations where providing access may cause more harm to the patient than good – e.g. psychotherapy notes for a patient that is suicidal,” said Kutney-Lee, who wasn’t involved in the essay.
For many patients, though, reviewing records may make them more proactive about their health, said Daniel Walker, a family medicine researcher at Ohio State University in Columbus who wasn’t involved in the study.
“It can make them feel more a part of the healthcare experience, and empower them to engage in shared decision making,” Walker said by email.
Preventing errors is another big advantage of electronic records, said Dr. Dean Sittig, a researcher at the University of Texas Health Science Center in Houston who wasn’t involved in the essay.
“Without an electronic health record, it is very difficult if not impossible to check whether the right medications were given at the right time, to the right patients,” Sittig said by email.
SOURCE: bit.ly/1i46lF7 Annals of Internal Medicine, online May 23, 2016.