healthcarereimagined

March 22, 2019
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“Medicare for All” has captured a lot of attention, but there is a wide range of approaches to universal health coverage, as other countries show

Countries that have universal health coverage achieve it in different ways, with some relying more on public insurance and others on regulated competition among private plans

Last week, the Commonwealth Fund released an interactive tool to help people compare recent congressional bills aimed at expanding health insurance coverage and lowering the cost of health care in the United States. Using the tool allows you to see how much each bill would expand the nation’s public health insurance system, or those aspects regulated or run by state and federal government.

While “Medicare for All” has captured the most attention, a comparison of the reform proposals reveals that their approaches to achieving universal coverage are far more nuanced than this term would suggest. “Single payer,” meanwhile, is generally used to describe how other wealthy countries organize their health systems. But a closer look similarly shows a wider variety of approaches than this catchall term implies. Other high-income nations manage to insure all their residents and spend less per capita than the U.S. But some of them do that by covering everyone through a regulated system of health plans, while others truly have a single public plan for everyone.

Countries also diverge in their approaches to financing health care — relying on different combinations of taxes, premium contributions, and cost-sharing — and in how they control growth in overall costs. Finally, while nearly all the health systems feature a role for private insurance — a fact that might surprise many in the U.S. — its size varies considerably.

Let’s take a closer look at how eight of our peer countries get to universal coverage, how much they pay for their health care, and what role private insurance plays in each.

A Regulated System of Health Plans

One way to achieve universal coverage is through a system of competing private health insurance carriers. In the Netherlands and Switzerland, people are legally required to buy private insurance or else pay a fine. The Dutch choose between plans offered on a national marketplace, while the Swiss shop on regional marketplaces. These systems resemble the marketplaces introduced in the U.S. by the Affordable Care Act (ACA).1
But there are key differences. In the Netherlands, financing is shared between individuals and their employers, and insurance plans also cover dependents. But the Swiss pay the entirety of their plan costs, and children require the purchase of separate plans.

The Dutch also pay lower premiums, averaging around $115 to $150 per month, compared to $385 per month in Switzerland. In comparison, average employee premiums in the U.S. in 2017 were $118 for single-person plans and $435 for family plans. Approximately 40 percent of the Dutch, moreover, receive tax subsidies to purchase insurance, similar to the subsidies introduced by the ACA.

Cost-sharing is also lower in the Netherlands: there is none for primary care and preventive services, while copayments for other services are capped at $475 per year, after which they are free. By contrast, the Swiss face copayments for all services up to a deductible of their choosing, between $248 and $2,065. After this, 10 percent to 20 percent coinsurance applies on all services, capped at $579 per year for adults. All told, average annual out-of-pocket costs in Switzerland are nearly four times higher than those in the Netherlands ($2,313 vs. $605).

A Single Public Plan

In countries that have public insurance systems, also known as “single payer” systems, national, regional, or local governments are the main payer of health care. In the United Kingdom, the National Health Service is funded by national taxes, while other systems are decentralized, with revenues raised through regional taxes (Canada) or local taxes (Sweden). In Norway, funding is split: primary care is funded through municipal taxes, while national taxes pay for hospital and specialty care.

The House and Senate bills that would introduce a single public plan for the U.S., however, differ from the approaches taken in other countries in two important ways.
First, many of these proposals would impose no patient cost-sharing. This is in contrast to Scandinavia, where patients pay copayments for most services. Norwegians pay $17 (U.S.) for primary care visit, $39 for specialist visits, and up to $51 for prescription drugs. At the same time, total annual out-of-pocket spending is capped at $221 per year (as of 2017), after which services are free; also, vulnerable populations such as children and pregnant women are exempt from most cost-sharing. Even in countries where physician and hospital services are free, such as the U.K. and Canada, patients pay some portion of prescription drug costs.

Second, the single public plans that have been proposed in the U.S. so far would provide everyone with a wide range of benefits, including vision, dental, and long-term care. Most countries with universal coverage, however, cover vision and dental benefits only for targeted populations such as children and low-income adults. Similarly, long-term care is not typically covered. Instead, these services are financed separately, whether through national long-term care insurance or local taxes.

Private Coverage: A Bit Part or a Featured Role?

In all countries with universal coverage, at least some portion of the population has secondary private insurance, either to help pay for noncovered services like dental and vision care or physiotherapy or to provide quicker access to elective care or private providers.

While less common in England and Norway — where only one in 10 has private coverage — private insurance plays a large role in several other countries. In Canada, the majority of residents have private insurance for prescription drugs — which the national program doesn’t cover — and other benefits, paid mostly through employers.2

In Australia, the federal government has introduced strong financial incentives for adults to purchase private hospital insurance, such as premium discounts for younger adults, financial penalties for high-income earners who don’t purchase coverage, and rebates on premiums. As a result, approximately half of Australians have purchased such coverage.

One country allows its residents a choice between two systems. In Germany, everyone is mandated to have coverage, and the majority choose among 110 nonprofit insurers known as “sickness funds.” This type of coverage is financed by individuals and their employers through payroll contributions (cost-sharing is relatively low). But the government allows people to opt out of this system entirely.

About one in 10 Germans choose instead to get private coverage from for-profit and nonprofit carriers; they pay for it entirely themselves through contributions. This option is particularly attractive to higher earners and to younger adults, to whom insurers typically offer generous benefit packages and lower premiums.

Weighing Options

Several members of Congress have proposed — or plan to propose — ways to cover the remaining 28 million uninsured Americans, reduce the number who are underinsured, and lower the overall rate of cost growth. The health systems described here all get to universal coverage while paying less for health care — and often with better health outcomes — than the United States. If we as a nation aim to achieve similar results, it will be informative for lawmakers to carefully consider the full range of options these other systems represent.

1. Their insurance requirement also resembles the ACA’s individual mandate, although the penalty for not having coverage was eliminated by the Trump administration and Congress beginning January 2019.

2. Most Canadian provinces and territories also operate public prescription drug plans for targeted populations such as children, the elderly, or people receiving social assistance.

Article link: https://www.commonwealthfund.org/blog/2019/universal-health-coverage-eight-countries

The Department of Defense’s program to transfer management of its medical treatment facilities from individual military departments to the Defense Health Agency is helping to improve military patient access to care.

By Fred Donovan on July 08, 2019

The Department of Defense’s program to transfer management of its medical treatment facilities (MTFs) from individual military departments to the Defense Health Agency (DHA) is helping to improve military patient access to care.

Under the transfer program, which was mandated by the 2017 National Defense Authorization Act, DHA will be responsible for all MTFs with respect to budget, information technology, healthcare administration and management, administrative policy and procedures, and military medical construction.

The DoD’s MTFs include 51 hospitals, 381 ambulatory care and occupational health clinics, and 247 dental clinics.

As an example of the benefits of the transfer, Womack Army Medical Center has been helping out Seymour Johnson Air Force Base, which was understaffed in its radiology department, the Fayetteville Observer reported recently.

“We had some staff challenges that usually would take at least six months to resolve,” said Air Force Tech. Sgt. John Perez, the noncommissioned officer in charge of the radiology clinic.

Womack sent a radiology technician, Spc. Zachary Bevington, to help with the understaffing situation at Seymour.

“I have been performing diagnostic radiology because doctors constantly come in wanting to see what’s going on inside of their patients,” Bevington said. “I’m very happy to be able to come here and help. I love being a part of the patient healing process.”
Womack and other MTFs in the Carolinas are in the processes of transitioning administrative policies and processes to DHA.

“It’s great to have more people across the services that work in the same specialty care,” Perez said. “It’s very appropriate to have a standard across the board regarding military medicine.”

Womack Army Medical Center, Seymour Johnson Air Force Base, Pope Army Airfield, and other MTFs in the region have been assigned to the Coastal Carolina Market. They are included in the first phase of the transfer.

Other MTFs in phase 1 of the transition include Fort Bragg, NC; Naval Air Station Jacksonville, FL; Keesler Air Force Base, MS; Joint Base Charleston, SC; Walter Reed National Military Medical Center, MD; Ft. Belvoir Community Hospital, VA; and associated clinics.

Phase 2 of the transition is scheduled to be completed this October. Phase 3 will include remaining U.S. MTFs and will be completed in October 2020, while phase 4 will include overseas MTFs and will be completed in October 2021.

Add link: https://hitinfrastructure.com/news/amp/dods-transfer-of-mtfs-to-dha-designed-to-improve-patient-access

By Olga Khazan, The Atlantic  June 25, 2019

Americans waste time and money filling out paperwork and repeating tests in the doctor’s office. A small Baltic nation has found a better way.

The scene: a doctors’ office. You: frustrated, on lunch break from work, just wanting to get in and get out. It’s probably not your first visit to that provider. It might not even be your second or third. And yet, there you are, filling out byzantine papers attached to a clipboard, promising to pay if your insurance doesn’t, providing your Social Security number for the kajillionth time, and trying to remember your insurance-group number, which is not the same as the ID number.

“Every time I go to the doctor, I spend the first half hour filling out pages of information. Why isn’t that traveling with me?” asked a cancer survivor in the audience of a recent talk by Eric Topol, the chair of innovative medicine at Scripps Research, at Aspen Ideas: Health, which is co-hosted by the Aspen Institute and The Atlantic.

“It’s so real that you have to fill out the same forms all the time,” Topol responded. The American medical system is atrocious at keeping track of the stuff it does. According to Topol, 10 percent of all scans in the United States are repeated unnecessarily simply because patients can’t get ahold of their past records and scans. It amounts to billions of wasted dollars.

Instead of this current system, Topol recommended the U.S take a page from Estonia, the Baltic nation in which health records are digitized and travel with the patient. “You wouldn’t be filling out all these forms, because you could send your data [to the doctor],” Topol said.

Under the wonderfully named “E-Stonia Project,” much of the data behind Estonians’ lives, from doctors’ appointments to taxes, have migrated from dead trees to the cloud. Almost every person in Estonia has an electronic ID card that contains their entire health record. Doctors can see each others’ notes, as well as past scans and X-rays the person has had. “In an emergency situation, a doctor can use a patient’s ID code to read time-critical information, such as blood type, allergies, recent treatments, on-going medication or pregnancy,” the E-stonia site explains. Patients own their own health information; they can access it at any time. The health data is kept secure through blockchain technology, which takes note each time something in the record is changed. Even the country’s ambulances get downloads of the health data of the people they are rushing off to help.

The disparity between the United States and Estonia when it comes to electronic health records came to the attention of Estonia’s former president, Toomas Hendrik Ilves, during a trip to Northern California. “If you have to prove that you live where you live or get your child to be registered for school, you have to come in with a paper copy of your electricity bill,” Ives told PRI’s The World in 2017. “The reality of your sort of life dealing with bureaucracy, it is not touched by the digital revolution.”

Article link: https://www.nextgov.com/it-modernization/2019/06/what-us-medical-system-can-learn-estonia/157984/

The U.S. Coast Guard wasted $60 million and seven years developing a health IT system that resulted in no equipment or software that could be used and a return to paper medical records.

July 01, 2019 – The U.S. Coast Guard wasted $60 million and seven years developing a health IT system that resulted in no equipment or software that could be used, according to the Government Accountability Office (GAO).

This health IT system project and other federal IT projects have suffered from a lack of disciplined and effective management, such as project planning, requirements definition, and program oversight and governance, the GAO judged.

“Executive-level governance and oversight across the government has often been ineffective, specifically from CIOs. For example, we have reported that some CIOs’ roles were limited because they did not have the authority to review and approve the entire agency IT portfolio,” the GAO commented in its report.

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The Coast Guard ended up canceling the health IT system project, called the Integrated Health Information System (IHiS), in 2015 after decommissioning two legacy electronic health record (EHR) systems.

The head of the Health, Safety and Work-Life (HSWL) Directorate at the Coast Guard identified several financial, technical, schedule, and personnel risks with the IHiS project that led to its termination. Some of the risks with the IHiS project identified by HSWL director included:

Lack of testing: IHiS lacked an independent security assessment to verify that the system’s security infrastructure was adequate. In addition, full interface testing with systems such as the Defense Eligibility Enrollment Reporting System had yet to be completed to ensure security and data integrity.

Limited system functionality: The system that was to provide user verification and IHiS role management services had yet to be completed. In addition, Coast Guard workstations could not yet access IHiS from the network, and the patient portal lacked two-factor authentication. Further, the service that was to register new IHiS users in the system had yet to be completed.

Delays in the implementation timeline: The Defense Health Agency team projected the timeline for the first clinic implementation of IHiS would be approximately one year later than originally estimated. DHA said that the timeline was delayed, in part, because critical IHiS interfaces and workflows were not complete or operational.

As a result of the decision to cancel the IHiS project and shutting down the legacy EHR systems, Coast Guard clinics had to revert to using paper medical records for their 50,000 military members, the GAO said.

The challenges presented by the paper-based system included incomplete records, bad penmanship, problems tracking medications, amount of time needed to manage records, and limited ability to search within records.

The Coast Guard subsequently joined the DoD MHS GENESIS contract to deploy a Cerner-based EHR system. To incorporate the Coast Guard into the EHR implementation and to establish a standardized EHR baseline with the Coast Guard and the Department of Veterans Affairs, the DoD asked for a $1.2 billion increase in funding for MHS GENESIS based on the Cerner platform.

The standardized EHR baseline will include common off-the-shelf software, clinical application services, and interfaces, as well as shared infrastructure.

The MHS GENESIS system will replace legacy DoD EHR systems, such as the Armed Forces Health Longitudinal Technology Application, the Composite Health Care System, and components of the Theater Medical Information Program-Joint.

The new EHR system will provide two-way communication and integrated medical and dental records. It will monitor members’ health through better population health data, tracking, and alerts; improve the ability to track patient safety, outcomes, and readiness; expand access to and sharing of health data across military operations and veteran and civilian healthcare organizations; and increase accessibility of integrated, evidence-based healthcare delivery and decision making.

Article link: https://hitinfrastructure.com/news/gao-coast-guard-wasted-60m-on-unusable-health-IT-system

Donald Trump, Elizabeth Warren, and other presidential hopefuls will be protected against AI doppelgängers thanks to a technique that looks at how they move.

By Brandi Vincent, Staff Correspondent June 20, 2019

Experts say fortifying strong international collaboration is critical to advancing the emerging technology.

Though some fruits of quantum information science (think atomic clocks and CAT scan technology) are increasingly prevalent in Americans’ daily lives, there is still a great deal of progress to be made across the quantum computing space, scientific experts from government, industry and academia said in Washington Wednesday.

At the end of last year, President Trump signed the National Quantum Initiative into law, which granted more than a billion in quantum research funding and followed a large effort led by the executive and legislative branches and many others from the quantum research and development community. The initiative calls on the nation to substantially increase its reasonably expansive QIS efforts.

“So we are in the process of going through that expansion, and part of that is through the president’s budget, part of that is by having individual agencies of the United States government take on expanded roles,” Jake Taylor, assistant director for quantum information science in the White House’s Office of Science and Technology Policy, said.

Taylor said the policy’s base is vast, but his team is expressly working to ensure that economic growth opportunities and opportunities for improving the world are baked into quantum policies and systems. He said they are also working with international collaborators to advance and govern the emerging technology.

“When you’re taking the scientific space and you’re trying to really push it forward, you’re seeking the best answers around the world, and so the way you do that is by building and making strong collaborations to keep that culture of discovery moving,” Taylor said.

The assistant director said his team participated in a “wonderful dialogue” with the European Union last month and will be engaging in a workshop this summer to look further into expanding its collaboration with the EU. He said the nations fundamentally support the same “science first” approach and understanding that policies should benefit individual citizens across diverse societies.

“What I can say is that by choosing to maintain a leadership role and to work with international collaborators and to cooperate across the world, we have the opportunity to realize that and it’s up to us to maintain that strength,” Taylor said. “This is what this bill is about and what we’re up to—come back to me in seven years and I’ll have more details.”

And as for the next decade, other officials said the U.S. can expect to witness a whirlwind of progress and quantum advancements.

“We are in the late ‘40s and early 1950s of information technology, when machines were big and ugly and had lots of wires hanging off of them,” said Bob Wisnieff, chief technology officer of quantum computing at IBM Research. “At this point, we should expect rapid generations of machines, growing capabilities, and machines that, like the IBM360 in the 1960s, are better suited to machine rooms than to your wrist.”

But Wisnieff said as America moves toward the quantum advantage, experts will need to establish new fields of thought and put the right people in place to explore how the machines will evolve and influence society over time.

“We are now getting into the regime where we need to deal with a lot of the engineering challenges, because as you scale up not only will we need to continue to make scientific advances here, but we will need to develop an entire new field of engineering—how one builds these systems and constructs them and tests them and operates them on a daily basis to provide value,” he said.

While there’s a long way to go, insiders said the potential impacts of the technology will be monumental.

For example, Associate Director of the Quantum Economic Development Consortium Celia Merzbacher said she sees exciting possibilities at the convergence of quantum computing, artificial intelligence, 5G and other technologies connected to the internet of things.

“Some of the most exciting things that come to my mind are in the ability to optimize certain problems that will allow for driverless cars and management of these big systems of things that need to be interacting with each other,” she said. “So whether it’s on the energy grid space or transportation or the financial sector, there are applications I think that are going to blow all our minds.”

Article link: https://www.nextgov.com/emerging-tech/2019/06/look-inside-governments-latest-quantum-computing-efforts/157888/

Look across the Potomac River toward Rosslyn, where the corporate logos of government contractors crown a parade of office towers that follows the river past the Pentagon. The skyline, like America’s defense industrial landscape, is changing. Soon, 25,000 Amazon employees will be climbing the Metro escalators to work in Crystal City each morning along with the tens of thousands of workers from military, intelligence, and the defense industry organizations.

The arrival of Amazon’s HQ2 in the cradle of U.S. government contracting comes at a portentous time for the Defense Department. Technology is altering what makes us strong, prosperous, and secure. The defense industrial base is becoming the strategic innovation base. Today’s leading digital companies have disrupted every industry they have touched, from publishing to automotive. Could Amazon and the rest of the “FAANG companies”—Facebook, Apple, Netflix, and Google—or one of a handful of pure-play artificial-intelligence companies, such as the authors’ SparkCognition, become fixtures of this new industrial base?

While that remains to be seen, the Pentagon supplier that can master robotics and AI will become the most essential of the firms that build America’s arsenal. Moreover, the Defense Department’s practices will increasingly resemble those of this new wave of strategically important companies because that is what the current revolution in warfare requires.

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Related: Lasers, AI, Hypersonics Top DARPA’s Small-Biz Wishlist

Related: China Is Closing the Innovation Gap: Report

The world is on the doorstep of an artificial intelligence- and robotics-driven revolution in conflict that, after decades of looming just over the horizon, now is a near-term certainty. Just as industrial-age tanks and machine guns devastated World War I battlefields and the U.S. Air Force’s GPS-guided weapons headlined the 1991 Gulf War, social media algorithms and AI-equipped robotic swarms will decide conflicts. Data is not just the new oil, as the saying goes. Data is also the new ammunition.

The Pentagon is preparing accordingly, doing everything from standing up an Army Futures Command to engaging technology luminaries with the Defense Innovation Board to establishing a Joint Artificial Intelligence Center to reforming mid-tier acquisitions policy. But it needs to do more — and do it faster — if the U.S. military is to prevail in future machine-speed conflicts. Fortunately, the Pentagon and its suppliers can learn from the digital disruptors in areas such as robotics, acquiring groundbreaking capabilities, software ecosystems, data management, and symbiotic innovation strategies.

Taken together, today’s leading digital companies have many of the traits for a reimagined, expanded defense industrial base, one that reflects the social, political, and strategic power of companies such as Amazon, Google, and Facebook. Moreover, the most strategically important machine learning and robotics technologies will likely originate in non-defense firms based on their overall investment, market-driven innovation cycles, and talent acquisition. U.S. defense policy is shifting but the speed of technological advancement remains far faster. In recent House testimony, DOD Chief Information Officer Dana Deasy said acquisition changes will come from asking “how do we move to a more startup mentality when moving to technologies like AI?”

Well, here is how.

Be aggressively robotized. While autonomous robotic swarms will become a staple of future battlefields, the nations that can harness automation for logistics, supply, and maintenance will have a decisive operational – and economic – edge.

As of 2017, Amazon reportedly had more than 100,000 robots on the job. This is especially relevant to the Defense Department and the future strategic innovation base because the shift to process automation is driven by the speed-and-cost expectations of “divinely discontent” customers, as CEO Jeff Bezos called them in the company’s 2017 annual report. Such automation — though unlikely to go as viral as a bounding robot biped — is of extreme consequence in the business world, to politics, and to American society.

Be highly acquisitive. In 2012, Facebook purchased Instagram for $1 billion; two years later it bought WhatsApp for $19 billion and virtual-reality company Oculus for $2 billion. With deep corporate coffers, Facebook could have built and marketed its own competing platforms. But this approach allowed Facebook to establish itself immediately with a suite of technologies it could integrate into its central products, while still allowing these separate entities to develop in parallel into innovative platforms in their own right.

Be software-driven. As machines learn to code faster and more accurately than humans, smaller and smaller organizations will be able to develop their own software applications to best suit their mission requirements. For all the beauty of an iPhone or iMac, Apple’s products are only as good as the software that runs on them —which gets better every day as developers bring new ideas to market through the App Store.

Think data, data, data. The importance of being able to effectively wield data at every level of Defense Department operations – from recruiting at home to finding targets abroad – cannot be overstated. Precision is expected in American military operations, which generally reduces the reliance on rampant destructive, kinetic military force. Groups that glean insight from what will be essentially a limitless pool of data will tip the balance even further toward precision and decreased destruction; to be sure, getting the right data at the right moment will be an enduring challenge during conflicts but the ability to develop such an insight with alternative data sets is an altogether novel paradigm. Whether it is creating the world’s most popular search engine or developing open-source machine learning algorithms, data is at the center of everything Google pursues. Currently, Google’s search engine processes tens of thousands of searches each second. Meanwhile, a broader and more decentralized array of devices, from smart TVs to mobile phones to fitness trackers, gather more and more data each day.

Pivot purposefully: A successful organization must be able to hold the virtual and physical in tension, while finding ways to develop both in a symbiotic manner underpinned by data analytics. In yet another sign of the sea-change in studio-developed entertainment, Netflix won 23 Emmy Awards this fall — as many as Amazon. While Netflix will still send you DVDs by mail, the company moved beyond that revenue stream years ago as advances in servers and telecom bandwidth allowed them to supplant the physical with the virtual. Its entry into the capital-intensive and hands-on business of film and show production is backed by years of data about customer tastes and preferences.

These are just a few of the lessons from leading technology companies in what it will take for America to have a globally dominant strategic industrial base. Fortunately, with the varied examples of innovation U.S. digital disruptors have already pioneered and demonstrated, the Pentagon need not look much farther for inspiration than its own backyard.

Article link: https://www.defenseone.com/ideas/2019/06/new-industrial-base-taking-shape-call-it-military-ai-complex/157503/

June 17, 2019 05:23 PM ET

Shannon Sartin and her team are working to cut through convoluted tech and give patients easier access to their data.

For decades, healthcare providers have doubled down on technology to improve the way they treat patients, but Shannon Sartin worries the industry’s expansive IT ecosystem is getting in the way of better care.

As executive director of the Digital Service at the Health and Human Services Department, Sartin is on the front lines of the government’s efforts to revamp healthcare for the 21st century. In recent years, much of the battle has played out at the Centers for Medicare and Medicaid Services, which oversees the care of more than 100 million people across the country.

Like other U.S. Digital Service outposts, she and her team work to bring tech industry best practices—like agile development, cloud services and user testing—to federal IT shops that are sometimes far behind the times. But while many digital services branches focus on modernizing processes unique to their respective agencies, Sartin sees the potential for her work to reach far beyond the borders of HHS, and even the government itself.

“We want to be in a place where our technology and the choices that we’re making are actually the ones that are impacting the way you and I receive healthcare,” Sartin said in a conversation with Nextgov. “That’s how much economic force CMS has. It could slow down or speed up the entire healthcare industry.”

HHS Digital Service’s efforts have been so successful that the Partnership for Public Service nominated Sartin and her team for one of its annual Service to America awards.

In Sartin’s eyes, technology can work both for and against patient care. If used correctly, IT can give people more control over their own health and allow doctors to focus more energy on treating patients. But incorporating too many different systems can overburden providers with administrative tasks, leading to impersonal, inefficient and expensive care.

Unfortunately, Sartin said, the modern healthcare industry seems to more closely resemble the second model than the first. But by overhauling its outdated infrastructure and making healthcare data more readily accessible, she said, CMS could free up more resources for treating patients ultimately drive change across the broader industry.

Last year, Sartin and her team launched an application programming interface called Blue Button 2.0, which contained detailed health information on some 53 million Medicare recipients. The API, which originated from an earlier CMS program, allows patients to connect their medical records to the numerous health-centric applications and services that have popped up in recent years. They can also opt to donate their data to inform medical research efforts around the globe.

So far, more than 1,800 developers have signed up for the platform and dozens of apps are already using the API to give patients a better handle on their healthcare.

Before Blue Button, Medicare claims data was only available to recipients in a PDF format, something “none of us really want” in the age of smartphones and wearable tech, Sartin said. Future, tech-savvier generations of beneficiaries will want to pay bills, access data and manage healthcare through their devices, and according to Sartin, APIs like Blue Button are laying the groundwork for that reality, she said.

“I think it’s really about … empowering innovators and entrepreneurs with the data,” she said. “How do we make sure it’s available in a way that not only aligns with what industry is already doing but actually sets the standard” for where it goes in the future.

On the provider side of the equation, Sartin and her team also launched a tool that sped up payments to doctors and offers rapid feedback on their treatment of patients. The platform came as part of a governmentwide effort to promote “value-based” care—the concept of paying doctors based on performance instead of the specific services they provide—and incentivizes doctors to take “a broader, holistic” approach to treating patients, according to Sartin.

When developing the tool, she and her team conducted extensive testing with doctors who would ultimately be using the system, a practice common in industry but not at CMS, Sartin said. Their feedback played a large role in shaping the platform, she said, and since its launch, the Quality Payment Program has been embraced throughout the medical community.

The system “ended up being one that doctors not only didn’t hate but were giving praise to, which is a rarity at CMS,” she said. “Our team really believes that partnership is how we achieve success.”

Looking ahead, Sartin said she expects her team to continue improving the platform and modernizing the backend payment system, which is still running on outdated COBOL software. While there won’t be “crazy, flashy launches” every few months, she said, incremental improvements to CMS’ payment processes will have significant impacts on both providers and patients.

Sartin said her team also plans to explore ways to make it easier to share patients’ data among HIPAA-covered entities like doctors and insurers.

Article link: https://www.nextgov.com/it-modernization/2019/06/more-health-it-isnt-always-better-says-hhs-digital-service-director/157790/

In a recent report, GAO named the health IT system in use at HHS among the 10 federal legacy systems most in need of modernization to prevent security problems.

By Kate Monica
June 12, 2019 – The Government Accountability Office (GAO) urged HHS to modernize its 50 year-old health IT system in a report naming the ten federal legacy systems most in need of significant upgrades.

The health IT system, implemented in 1969, was ranked third on the list of ten outdated IT systems in need of revamping. The EHR system supports healthcare delivery for the Indian Health Service (IHS) and is considered a highly susceptible to security threats.

IHS uses the clinical and patient administrative information system to gather, store, and display clinical, administrative, and financial information about patients visiting its clinics and hospitals. Due to the sensitive nature of this information, HHS officials stated that a modernization effort is “imperative.”

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Specifically, HHS officials interviewed by GAO said the system’s technical architecture and infrastructure are outdated, obstructing the federal agency’s efforts to fulfill regulatory requirements.

The EHR system software includes 50 additional modules implemented over time to keep pace with the changing demands of the evolving healthcare system.

“The software is installed on hundreds of separate computers, which has led to variations in the configurations at each site,” wrote GAO in the report. “According to HIS, this type of add-on development becomes detrimental over time and eventually requires a complete redesign to improve database design efficiency, process efficiency, workflow integration, and graphical user interfaces.”

System variations negatively affect interoperability and health data exchange between IHS employees. Replacing or modernizing the EHR system would help to boost interoperability with other healthcare organizations and facilities and improve care coordination for patients within the IHS network.

IHS officials expressed an interest in modernizing the EHR system earlier this year, but officials have not yet developed concrete modernization plans.

In September 2018, HHS awarded a contract to conduct research related to modernizing its health IT infrastructure, applications, and capabilities.

“According to the department, the research will be conducted in several stages over the next year, and a substantial part of the research will be an evaluation of the current state of health IT across IHS’s health facilities,” wrote GAO.

“Once the research is conducted, in consultation with IHS and its stakeholders, the contractor will use the findings and recommendations to propose a prioritized roadmap for modernization.”

HHS officials stated the agency expects to complete its modernization initiative in the next five years, and anticipates launching an EHR implementation plan as early as 2020.
While the federal agency has taken some steps to initiate a modernization effort, HHS has not calculated a potential cost for the project.

“With regards to potential cost savings, HHS noted that the modernization will take significant capital investment to complete and it is unknown whether the modernization will lead to cost savings,” noted GAO.

Launching an EHR modernization project at IHS would help to promote care coordination and data sharing between IHS, VA, and the Department of Defense (DoD.)
VA and DoD are currently in the process of replacing their legacy health IT systems with a Cerner EHR platform.

“HHS officials stated that this modernization could improve interoperability with its health care partners, the Department of Veterans Affairs and the Department of Defense, and significantly enhance direct patient care,” GAO officials wrote.

In 2017, IHS issued a request for information (RFI) to inform an EHR modernization effort. The RFI was part of the federal agency’s exploratory market research effort to assess health IT industry innovations and capabilities.

IHS provides healthcare services to American Indians and Alaska Natives per provisions established by the relationship between the federal government and Indian tribes in 1787.

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