Suspension of EHR Incentives – Election Year Politics or Potential Reality?

Deven McGraw, Project HealthDesign Regulatory and Assurance Advisory Group, Center for Democracy & Technology

Usually in the weeks before a presidential election, Congress is officially in recess; many elected officials are in their home districts or states campaigning for re-election (and also weighing in on the presidential race); and typically there are few congressional developments worth noting.

But this year has been a bit of an exception – at least for those of us who follow health reform and health information technology issues.  This week, a group of Republican members of Congress and Republican senators sent letters to HHS Secretary Kathleen Sebelius raising serious concerns about the Meaningful Use electronic medical record incentive program.

The letter from key House Republicans – Rep. Dave Camp (R-MI), Chairman of the House Ways & Means Committee, and Rep. Wally Herger (R-CA), Chairman of that Committee’s Subcommittee on Health; and Rep. Fred Upton (R-MI), Chairman of the House Energy & Commerce Committee, and Rep. Joe Pitts, Chairman of that Committee’s Subcommittee on Health (R-PA) – raises “serious concerns” that the Stage 2 final rules for Meaningful Use are too weak. Specifically, the letter points out that the requirements for exchange of clinical health information among health care professionals, such as to support transitions in care, are very low. 

The letter from key Senate Republicans – Sens. John Thune (R-SD) and Tom Coburn (R-OK) of the Senate Finance Committee, and Sens. Richard Burr (R-NC) and Pat Roberts (R-KS) of the Senate Health, Education, Labor and Pensions Committee – stresses concerns about EHR use causing increased utilization of, and billing for, health care services. The letter from House Republicans also notes this concern.  Both letters also raise concerns about the lack of interoperability among EHRs. 

The letter from Senate Republicans requests an extended briefing with administration officials to hear their responses to the concerns in the letter.  In contrast, the letter from House Republicans urges Secretary Sebelius to “immediately suspend the distribution of [EMR] incentive payments until your agency promulgates universal interoperable standards;” to “significantly increase” the Stage 2 Meaningful Use objectives; and to “take steps to eliminate the subsidization of business practices that block the exchange of information between providers.”

Are these letters just typical election year politics?  The issues raised in both letters echo concerns raised by other stakeholders.  The signatories to the House Republican letter are the Chairmen of the most important health committees and subcommittees in the House; signatories to the Senate Republican letter are members of the two relevant health committees in that chamber.  All who have an interest in the successful implementation of the HITECH EHR incentive program would be well served to monitor these developments closely.

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WIRED Health Conference: Living By Numbers

Katherine Kim, iN Touch Principal Investigator

What a privilege it was to attend the Wired Health Conference: Living By Numbers in New York City last week. Thanks, RWJF, for the invitation! Every talk offered something new, something surprising, or something provocative.

Something New

Nicholas Felton, a renowned graphic designer, talked about how he started producing the Feltron Personal Annual Report in 2006 because he wanted to tell the story of his life.  He evolved his process of data collection in three stages.  At first, he used “archeology,” leveraging data from records that already existed. These data included photographs, music downloads, subway rides. He found that 1% of his photos in 2006 included his cat. Next, he used “data hoarding,” collecting data expressly for the purpose of tracking.  During this two-year phase he collected every receipt and calendared obsessively. He became aware of how many “lethal doses of caffeine” he consumed in a year.  Now, he is “sampling” to help understand what he calls the intractable questions like what do I eat, how do I feel, who do I talk to, and what is my social network.  These data are difficult to collect constantly and often non-standard.  By analyzing free text comments through Mechanical Turk he discovered that he was 73% happy, or in his personal dictionary, “swell.”

Something Surprising

Nicholas Christakis of Harvard’s Human Nature Laboratory discussed social networks and how they can be more influential than mass media on people’s behavior.  His research on social networks related to obesity showed that it the condition was contagious: individuals whose immediate network included a friend, sibling, or spouse who became obese were more likely to become obese (57%, 40% and 37% respectively).  Even those who were one or two individuals removed were more likely to be obese. This was not the case for geographic neighbors.  This effect can also apply to positive health states.

Something Provocative

Jennifer Kurkoski and Brian Welle of Google’s human resources organization showed how asking big questions could lead to breakthroughs.  The question they asked was “What if working at Google added two years to your life?”  This led to their redesigning access to food on their campus from smaller plates in the cafes to placing M&Ms in opaque containers while putting healthier options in see-through bins.  Their early surveys are showing that employees like these changes and they are making healthier choices.

As we consider our next steps for iN Touch, I wonder: what if going to a high school with iN Touch added five years to a youth’s life? How could we evolve our approach to self-tracking of ODLs to identify the key signals?  And, what would a school need to leverage the social network that lives within it to make health contagious?

 

Learn more about the iN Touch project

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Thoughts on Project HealthDesign at Health 2.0

Gail Casper, Deputy Director of Project HealthDesign

Although I was unable to attend several talks and demonstrations at the recent Health2.0 convention in San Francisco, I believe I had the “best seat in the house” while staffing the Project HealthDesign booth in the Exhibit Hall. Not only was I accompanied by the creators of the booth Joseph Pullen and Bob McKinnon of Galewill, I also had the opportunity to share time with several of the Project HealthDesign grantees and to talk with many of the Health2.0 participants who stopped by the booth. I was a bit surprised at the virtually constant flow of interested people stopping by, both during breaks and during sessions. 

Because our booth displayed a number of physical devices, many people first stopped by because they thought we were selling something.  But they stayed to learn more about our five projects, to view the devices they used and see the data displays created for both patients and clinicians. Matt Lee’s panel presentation on Monday generated considerable interest in the dwellSense project and the medication sensor; while others were intrigued more for the apps’ personal utility. People who had a newborn infant at home were particularly interested in the Estrellita app.

Others who stopped by were interested in learning more about Project HealthDesign in general and in exploring potential synergies with their own work.  The booth gave us a terrific opportunity to talk about Observations of Daily Living (ODLs) and to emphasize the importance of patient-centered data. 

Many people inquired about a next round of funding for Project HealthDesign.  Although disappointing to those who were asking, we appreciated the opportunity to let people know that Project HealthDesign will officially end in June, 2013.  While Project HealthDesign is coming to an end, we are confident that “our work” will continue, as more providers, developers and patients examine our project’s findings and build on our foundation. 

I would be remiss not to mention the grantees who so successfully represented their projects at the Health2.0 booth:

Matt Lee for dwellSense

Gillian Hayes and Sen Hirano for Estrellita

Lucia Rojas-Smith for BreathEasy

Kathy Kim and Christina Sabee for iN Touch

Marcos Athanasoulis and Nikolai Kirienko for Chronology.MD

Many thanks to all of them for the commitment of time, energy and intellect to this program.

Terrific attendance at Project HealthDesign webinar

Wendy Swanberg, Communications Coordinator, Project HealthDesign National Program Office

More than 200 people signed up for last week’s webinar, "From the iPhone to the EMR: Can patients' personal health data help improve their clinical care?” to learn about the latest work by Project HealthDesign’s grantee teams.  Co-hosted by Stephen Downs of the Robert Wood Johnson Foundation (RWJF) and Patricia Flatley Brennan of the National Program Office, the webinar set a wider lens on the growing interest in weaving patient-generated data into the matrix of clinical health care.   

Steve Downs explained that as part of RWJF’s Pioneer Portfolio, Project HealthDesign was created to stimulate innovation in the area of personal health records.  “We laid out a vision where your medical record would serve as a platform” he explained, “and then lots of third-party apps could be tailored to your specific needs.”  The project’s five research teams took that vision and created applications tailored for patients with chronic conditions, from asthma to obesity to Alzheimer’s disease.

Project director Patti Brennan described what might be the most significant finding to arise from the project, the discovery that information from patients’ daily lives -- data about things like diet, mood and stress level – can play an important role in managing health care.  These “Observations of Daily Living,” or ODLs, became central to the grantees’ research projects and represent a significant, new category of patient-generated data.  Brennan also introduced a short video where members of each project team illustrated their projects’ findings and challenges.

Project investigator Katherine Kim described how her team’s iN Touch application helped young people struggling with obesity to become more engaged in managing their health and lifestyle.   Dr. Stephen Rothemich outlined findings of his team’s BreathEasy project, showing how ODLs can provide clinically useful information and in some cases can lead to changes in diagnosis or therapy. 

Finally, National Advisory Council member Dr. Michael Christopher Gibbons spoke eloquently of the critical role personal health records can play in a rapidly evolving society, where new approaches are needed to tend to the needs of a growing population of seniors, minorities, immigrants and the underserved.  

If you registered for the webinar but weren’t able to view it, follow this link and log in with the email address used at registration.