Patti Brennan: We need new policies for a new era of patient-centered care

WendySwanberg, Project HealthDesign Communications Project Assistant

Last week, national program director Patti Brennan held a briefing in Washington, DC, to speak with policy makers about the many insights that have emerged from the work of Project HealthDesign. While it's nearly impossible to summarize the findings of a project that's been evolving for nearly a decade, Patti does a beautiful job in this brief video.

We're at an important juncture in the future of healthcare and health technology, and a critical point for policymakers to attend to the knowledge gained by in-depth research like that conducted by Project HealthDesign's project teams.  Patti stresses four key considerations:

• The EHR is not enough

• We need safe and trustable ways to manage clinically-generated data and patient-generated data

• We need practice-permissive policies that support the use of patient-generated data and enable inter-visit care actions

• We need to expand the concepts of confidentiality and privacy to better fit the data landscape

These ideas have been germinated over the Project's duration, and we've chronicled much of their history on our website. In the months ahead,we invite you to explore the rich content on our website, and to keep the conversation going!

 

 

Joint ONC Committee Hearing Focuses on HealthIT and Patient Engagement

Sara Koliner, Policy Analysis Project Assistant, Project HealthDesign National Program Office

On Tuesday, January 29th, the HIT Policy Committee and HIT Standards Committee hosted a joint hearing on health information exchange (HIE). The hearing, divided into four panels, assessed the current state of HIE through the testimony of a number of distinguished speakers and fostered discussion about what next steps the Office of the National Coordinator for Health IT (ONC) should take to address business, technical, and regulatory barriers.

Of considerable interest was the final panel, Consumer-Mediated Exchange, moderated by physician Paul Tang, who served as chair of Project HealthDesign’s National Advisory Committee. The panel featured testimony by Jeff Donnell, MaryAnne Sterling, Neal Patterson, and Alan Blaustein.

Jeff Donnell began with a salute to how far patient engagement has come in the past six years:

Meaningful Use Stage One placed patient engagement squarely on the map, and Stage 2 requirements -- including view/download/transmit and the modest five percent patient participation threshold -- have moved patient engagement from a check box item to a health IT strategy imperative.

The panelists touched on some issues that have been discussed among Project HealthDesign grantee teams. First, for patient generated data to be useful, it requires clinical buy-in: Consumers don’t just need easy access to their information, providers need to consume it. Jeff Donnell offered a memorable quote:

From a technical point of view, it’s not difficult. There’s policy and standards work, but much of it is education. We encounter providers that are so fearful of patient-generated data — but then we talk to them about, “how do you handle patient-generated data now? I mean you’re having a patient fill out a paper form in a waiting room, and then you’re having someone rekey it in, are you saying that that data collected in probably the worst possible environment is better than a patient bringing it in from multiple sources and making it accessible? . . . A lot of it is fear of the unknown. I believe that that is where the ONC can help.

The speakers addressed concerns over the interaction between the Health Insurance Portability and Accountability Act (HIPAA) and data transmitted outside of the EHR system. In varying contexts, participants called for the creation of mechanisms to allow for the flow of information among consumers, caregivers and healthcare providers.

One salient point that came up frequently was the notion that consumers are the keys to solving the barriers to interoperability. Aside from technical concerns, current business often models impede the movement of data because data liquidity might appear to harm profitability. However, if individuals are given control of their own information, a new business model might arise – One in which consumers are part of the health care system rather than just being served by the system.

As Alan Blaustein pointed out, it is important that the consumer be engaged. When asked what opportunities and challenges existed to enable consumer-mediated exchange in the next two years, he responded:

The greatest challenge of the consumer-mediated exchange in the next two years is a clear communications strategy that explains the value to the healthcare consumer.   The consumer-mediated exchange must be communicated as a first step to the overall engagement of the healthcare consumer in their healthcare experiences.  Otherwise these efforts will be simply seen as an additional burden on the healthcare consumer, particularly if the healthcare consumer now thinks that she is primarily responsible for moving a particular file from Point A to Point B with nothing more at stake.

Furthermore, the culture of our healthcare system will need to begin changing and the healthcare consumer must be invited into the conversation.  Countless times we get calls at CarePlanners from clients whom the system has largely ignored, where their facts and opinions were not considered.  That requires far more change and self-evaluation than can possibly be rectified in the coming two years.

This isn’t to say that consumer-mediated exchange is a replacement for HIE. Rather, it should serve to complement and accelerate the entire HIE expansion, creating a combined synergy that’s essential to improving healthcare nationwide. Read testimony transcripts and listen to the entire hearing here: http://www.healthit.gov/policy-researchers-implementers/hitpc-hitsc-health-information-exchange-public-hearing

 

Federal Government Finalizes Stage 2 Meaningful Use Requirements

Robert Belfort, Proje­ct HealthDesign Regulatory and Assurance Advisory Group, Manatt, Phelps & Phillips, LLP

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) recently released a final regulation setting forth the requirements for Stage 2 of Meaningful Use under the Medicare and Medicaid Electronic Health Record Incentive Program (the “Final Rule”).  In the Final Rule, CMS adopted a number of provisions that require eligible professionals and hospitals to increase their efforts to share data electronically with patients.  As a result, the Final Rule is likely to encourage greater patient engagement in health care, something the Robert Wood Johnson Foundation advocated in comments it submitted on the proposed rule.  Here is a relevant excerpt from RWJF’s comments::

We are encouraged by efforts in the proposed rule regarding patient and consumer engagement, especially regarding secure messaging; direct, downloadable access to patient data; patient reminders; inclusion of family health history; and provision of patient education. Nevertheless, we would like to see the required percentages higher than proposed in some cases. In addition, as our Project HealthDesign makes clear, patients now expect to engage with their personal health data in apps and on mobile devices of their choosing. We expect this trend to increase significantly. Further, patients will almost certainly expect that the flow of information be in two directions. In other words, patients will reasonably expect they will have both access to personal health data but also the ability to provide personal data to their health professionals.

RWJF’s full comments are available here.

The chart below lists the “patient engagement” requirements in the Final Rule:

Stage 2 Objectives		Stage 2 Measures
Eligible Professionals (EPs)	Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs)
Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP.		1.  More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information, subject to the EP’s discretion to withhold certain information.   2. More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information
	Provide patients the ability to view online, download and transmit information about a hospital admission.	1. More than 50% of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an EH or CAH have their information available online within 36 hours of discharge   2.  More than 5% of all patients (or their authorized representatives) who are discharged from the inpatient or emergency department (POS 21 or 23) of an EH or CAH view, download or transmit to a third party their information during the reporting period.
Provide clinical summaries for patients for each office visit		Clinical summaries provided to patients or patient-authorized representatives within 1 business day for more than 50% of office visits
Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient	Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient	Patient-specific education resources identified by the certified EHR technology are provided to patients for more than 10% of all unique patients with office visits seen by the EP during the EHR reporting period.   More than 10% of all unique patients admitted to the EH’s or CAH’s inpatient or emergency department (POS 21 or 23) are provided patient-specific education resources identified by the certified EHR technology.
Use secure electronic messaging to communicate with patients on relevant health information		A secure message was sent using the electronic messaging function of certified EHR technology by more than 5% of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.

Also of note to Project HealthDesign:  the Final Rule includes a new “menu set” requirement that eligible professionals and hospitals record a patient’s family history.

Stage 2 begins in 2014.  In the Stage 1 meaningful use regulations, CMS established an original timeline that would have required Medicare providers who first demonstrated meaningful use in 2011 to meet the Stage 2 criteria in 2013. The Stage 2 Final Rule gives providers more time to meet the Stage 2 requirements. A provider that attested to Stage 1 of meaningful use in 2011 would attest to Stage 2 in 2014, instead of in 2013.  Therefore, providers are not required to meet Stage 2 meaningful use before 2014.

Since the Medicare and Medicaid EHR Incentive Programs began in January 2011, more than 120,000 eligible healthcare professionals and more than 3,300 hospitals have qualified to participate –23,000 more than the federal government had hoped to enroll by now, according to the U.S. Department of Health and Human Services, which oversees the programs.

The Final Rule – along with a fact sheet describing it -  are available at  http://www.hhs.gov/news/press/2012pres/08/20120823b.html

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No Sleepy Summer for Project HealthDesign’s Policy Efforts

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

Ordinarily August is a slow month for federal policy, particularly in an election year. Congress goes on recess, and it is a popular month for family vacations. But August has been a month of milestones for Project HealthDesign:

ODLs Being Considered for Inclusion in Stage 3 of Meaningful Use

On August 1, the federal Health IT Policy Committee met to begin deliberations on potential meaningful use and EHR certification criteria for Stage 3 of the EHR incentive program. The Policy Committee’s meaningful use workgroup presented preliminary recommendations for Stage 3 criteria; under consideration is a requirement that patients be provided with the ability to report patient-generated data to providers and hospitals. Observations of daily living (ODLs) are specifically mentioned on the list of acceptable types of patient-generated data.

Although the Policy Committee is just beginning to deliberate the proposed Stage 3 criteria, the presence of ODLs on the initial list of options for provider incorporation of patient-generated data into the EHR is a significant development. The testimony of Nikolai Kirienko, co-director of Project HealthDesign’s Chronology.MD team, and Patti Brennan, Project HealthDesign national program director, at the Policy Committee’s recent hearing on patient-generated data helped make the case for having ODLs as an option for incorporating patient-generated data to meet Stage 3 meaningful use.

Policy Committee deliberations about Stage 3 criteria will continue into the fall, and a formal Request for Public Comment on proposed criteria is planned for release in November 2012. It will be critical for proponents of including patient-generated data such as ODLs into clinical workflows to continue to weigh in on Stage 3 discussions.

Project HealthDesign Spotlighted at Briefing on Capitol Hill

On August 13, Project HealthDesign was the topic of a briefing sponsored by the Alliance for Health Reform, the Bipartisan Policy Center, and the Robert Wood Johnson Foundation. The briefing was carried live by C-SPAN 2 and featured Stephen Downs (Robert Wood Johnson Foundation), Stephen Rothemich (Project HealthDesign’s BreathEasy team; Virginia Commonwealth University), and Deven McGraw (Project HealthDesign’s Regulatory and Assurance Advisory Group; Center for Democracy & Technology) — as well as Joy Pritts (Chief Privacy Officer, Office of the National Coordinator for Health IT).

The briefing, which took place in the Dirksen Senate Office Building, was well attended. Those present were particularly interested in hearing more about how clinicians in the BreathEasy project incorporated ODLs into clinical workflows, and how the health care system can financially support innovative models of care like those in Project HealthDesign.

The briefing also provided an opportunity to draw attention to “Lessons from Project HealthDesign: Strategies for Safeguarding Patient-Generated Health Information Created or Shared through Mobile Devices” (pdf), a new paper from Project HealthDesign’s Regulatory and Assurance Advisory Group (Manatt, Phelps & Phillips, LLP, and the Center for Democracy & Technology), which was published in late July by the Journal of Healthcare Information Management (JHIM). The paper draws on the experiences of the five current Project HealthDesign grantee teams and the approaches they used to implement device and security precautions.

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Patient-Generated Data Governance: Fitting into the Clinical Setting

Dorothy Miller, J.D., M.P.H., Health Policy Project Assistant, Project HealthDesign National Program Office

This post is second in a series contemplating governance of patient-generated data in a clinical setting.

How can we encourage providers to integrate patient-generated data into their clinical decision-making? Providers need to feel confident that the patient-generated data they are accessing is trustable and authentic. Providers often have limited time to meet with patients and could see patient-generated data as an additional task to be completed, instead of a way in which patients can effectively communicate a richer picture of their day-to-day health.

Providers can think about patient-generated data fitting in with a traditional model of clinical decision-making in two ways. First, the data can be considered another means of understanding a patient’s description of their health. The model below (see Figure 1) shows the patient-generated data entering the clinical workflow as a type of information presented to the provider by the patient as they describe their condition.

Figure 1

A provider might traditionally ask a patient to describe their health status and expect an answer that describes the patient’s experience. With patient-generated data, the patient uses an alternate method to explain her health status and related experiences. A second way that patient-generated data can be integrated into clinical decision-making is for the provider to access patient-generated data as an external source of knowledge. The model (Figure 1) also shows the patient-generated data in that capacity, informing the provider as an external resource. Along with test results, medical history, and other types of information a provider consults, the provider may also access patient-generated data to provide additional information. 

Figure 1 demonstrates how patient-generated data can be integrated into the clinical setting. By understanding patient-generated data’s integration into clinical decision-making, we can create governance tools that integrate the principles emphasized in the previous blog post: data accuracy, integrity, and appropriate use. So what types of governance tools would encourage providers to take these steps in integrating patient-generated data at both levels? Providers should be encouraged to integrate patient-generated data into clinical workflows. Today, many patients interact with providers without the opportunity to discuss their patient-generated data. One solution to this challenge is clinical workflows that give patients opportunities to share their data. If the provider is worried about being overwhelmed with data that is voluminous or difficult to interpret, a clinic could provide standardized summaries accessible to providers, without compromising patients’ abilities to collect and generate data as they desire. 

Regarding laws and policies that govern patient-generated data, we need to thoughtfully and carefully balance provider concerns with the advantages patient-generated data can give patients and providers. Laws and regulations should be designed that give providers confidence in patient-generated data, both in terms of data accuracy and data integrity. When providers feel confident that the patient-generated data they receive is trustable, accurate, and reflects the patient’s day-to-day experiences, they may feel more confident in acting on that data. Clear guidelines allow patients to be comfortable with sharing their own data and may decrease providers’ concerns about liability stemming from using patient-generated data. 

If you’re wondering how provider liability fits into this picture, stay tuned. Our legal and policy advisory group at Manatt, Phelps & Phillips, LLC, and the Center for Democracy & Technology is working on a paper on this exact topic, and we will share more information about it soon.

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Citation for Figure 1: Robert B. Elson et. al. The Practice of Informatics: Viewpoint: An Industrial Process View of Information Delivery to Support Clinical Decision Making: Implications for Systems Design and Process Measures J Am Med Inform Assoc 1997; 4:4 266-278 doi:10.1136/ jamia.1997.0040266.

 

Patient-Generated Data Governance Tools: Our Perspective

Dorothy Miller, J.D., M.P.H., Health Policy Project Assistant, Project HealthDesign National Program Office

This post is first in a series contemplating governance of patient-generated data in a clinical setting.

How does patient-generated data fit into the clinical setting? How do we encourage patients to engage in their own health care by enabling them to bring their own data into the clinical setting? And how can we reassure providers that their patients’ data can be treated as trustable and authentic sources of information for clinical decision-making? Understanding how to integrate patient-generated data into clinical decision-making focuses on three key principles:

• Integrity: Patient-generated data is trustable and authentic for both patients and providers.
• Accuracy: Providers are confident that the patient-generated data reflects the patient’s inputs.
• Appropriate use: Patients are confident that the data they generate is being used as intended.

Project HealthDesign’s five current teams have equipped more than 135 patients with chronic diseases to track, review and share their “observations of daily living,” or ODLs. These ODLs are patient-generated, patient-defined and patient-sourced, and can range from information about an individual’s pain or energy levels to truly unique observations about his or her moods. Each team has taken a different approach to the systems and technologies used to capture ODL data and share the resulting data and/or summaries with the patient’s clinicians. These new approaches also present new challenges as we think about how patient-generated data fits into the clinical experience. As a result of our work with ODLs, we’ve started to think critically about ODLs and other innovative types of patient-generated data.

We want patients to have the ability to bring the patient-generated data they value into a clinical setting. At the same time, we believe that governance tools for patient-generated data must be carefully and thoughtfully crafted.  Keeping in mind the three principles of integrity, accuracy, and appropriate use, we believe that policies and governance tools that recognize the unique nature of patient-generated data can be crafted. Stay tuned for the next post in this series, which deals with how patient-generated fits into the clinical workflow.

Key Points from the Meaningful Use Workgroup Patient-generated Data Hearing

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

On June 8, the Meaningful Use Workgroup of the federal Health IT Policy Committee held a hearing on patient-generated data. The purpose of the hearing was to inform the Workgroup’s consideration of possible objectives for Stage 3 of CMS’ incentive program for the meaningful use of EHRs.. Since Stage 1 of the program, the Policy Committee has signaled its interest in including patient-generated data as part of Stage 3.

Project HealthDesign was well represented at the hearing. The Workgroup heard testimony from Nikolai Kirenko, Chronology.MD co-project director and Patricia Flatley Brennan, Project HealthDesign national program director. I testified on behalf of Project HealthDesign’s regulatory and assurance advisory group.

Some of the key points of the hearing were:

• The term “patient-generated data” encompasses many different types of data, from device and sensor data (e.g., blood glucose levels or data from a pacemaker), to patient-reported data used to assess health care quality, to observations of daily living (ODLs) used by patients for better self-management and to inform their clinical care. Developing effective Meaningful Use measures and objectives that involve patient-generated data will likely require a range of approaches.

• Some high-performing health systems are already deploying models of care that include patient-generated data (including the Veterans Administration, Dartmouth, Geisinger, Partners, and the institutions participating in Project HealthDesign). However, getting other institutions and smaller ambulatory practices to adopt care models that incorporate patient-generated data may require starting with more modest, manageable steps. The objectives set for Stage 3 of Meaningful Use also should provide the foundation for adoption of more robust, patient-centered care models after the HITECH incentives have ended.

• Patient-generated data need not come directly into the provider’s EHR in order for it to be effectively utilized as part of patient care. Decisions about what to include in the EHR should preserve the role of the record in documenting and supporting clinical decision-making processes.

• Organizations that have successfully incorporated patient-generated data into clinical care have done so in accordance with specific plans. These plans document agreements between patients and clinicians about  what information will be collected and how it will be used. Consequently, Meaningful Use objectives for patient-generated data will need to be structured in a way that provides flexibility for providers and patients to come up with a plan that works for their circumstances. Dr. Brennan recommended that the Meaningful Use Workgroup focus on “providing assistance, incentives, and structures” that will enable clinicians to have a way to document their use of patient-generated data in clinical decision-making.

Read the written testimonies submitted for the hearing. 

The Meaningful Use Workgroup will be working over the summer to develop more specific recommendations on how to incorporate patient-generated data into Stage 3 of Meaningful Use, and members of the public are invited to participate in Workgroup calls. Learn more. 

Project HealthDesign and Patient-generated Data [Video]

Libby Dowdall, Communications Coordinator, Project HealthDesign National Program Office

Throughout Project HealthDesign’s history, our grantee teams have worked closely with patients in order to explore the potential of personal health records (PHRs) and personal health data. As our first nine teams worked on their projects, they listened closely to patients and began hearing patients describe their health in idiosyncratic ways. Their work led to the recognition of observations of daily living (ODLs) — information about an individual’s life that is both patient-defined and patient-generated.

Project HealthDesign's five most recent grantee teams have carried this vision forward by designing five different technical systems that allow patients to track their ODL data. In these projects, patient participants have tracked a variety of ODLs, from daily activity and stress levels to socializing and moods.

But ODLs are just one type of patient-generated data. Other types include traditional patient-reported information about signs and symptoms (e.g., blood pressure, blood glucose), sensor data, patient preference data, and patient-reported quality assessment data.

We’ve been excited to see interest in patient-generated data grow throughout the course of the program. This month, Patricia Flatley Brennan, Project HealthDesign national program director, testified before the HIT Policy Committee’s Meaningful Use and Quality Measures Workgroups and the HIT Standards Committee’s Consumer Engagement Power Team at their Patient-generated Data Hearing. (Listen to an audio recording of the hearing.)

“Patient-defined, patient-generated data can be incredibly important in helping to understand the care process of individuals,” said Dr. Brennan. Watch the video below to learn more about Project HealthDesign’s outlook on patient-generated data.

Project HealthDesign Director Testifies at Meaningful Use Workgroup Hearing

Libby Dowdall, Communications Coordinator, Project HealthDesign National Program Office

Today, Patricia Flatley Brennan, R.N., Ph.D., Project HealthDesign national program director, and Nikolai Kirienko, co-project director for Project HealthDesign’s Chronology.MD team, will testify at a hearing on the incorporation of patient-generated information to manage health. This hearing is organized by the Meaningful Use Workgroup of the HIT Policy Committee.

Brennan has been invited to testify on the business and technology of patient-generated data and its use in clinical care. Her written testimony (pdf) draws upon the experiences of all fourteen Project HealthDesign teams throughout the program’s two rounds of funding, as well as the teams’ interactions with hundreds of patients. However, she will focus mainly on stories and findings from Project HealthDesign’s five current teams.

Brennan’s testimony will focus on three main points:

1. We need to expand the idea of patient-generated data to include patient-defined data.
2. Sharing patient-defined data with clinicians improves the business of health care.
3. Existing technologies are adequate but not optimal for the clinical integration of patient-defined and patient-generated data.

Kirienko will draw upon the experiences of Project HealthDesign’s Chronology.MD team; he will also speak as an advocate for patient engagement in health and health care. His testimony will focus on the need for patient access to open APIs in the EHR and the need for standards for dynamic patient engagement on mobile devices.

Paul Tang, M.D., Project HealthDesign National Advisory Committee chair, co-chairs the Meaningful Use Workgroup, and Deven McGraw, J.D., M.P.H., a member of Project HealthDesign’s regulatory and assurance advisory group, is also a member of the Workgroup.

Listen to the webcast.
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Implications for Patient Engagement if the Health Reform Law Falls

Robert Belfort, Project HealthDesign Regulatory and Assurance Advisory Group, Manatt, Phelps & Phillips, LLP

It is hard to escape the news coverage about the constitutional challenge to the Affordable Care Act (ACA), and the attention being paid to the case is understandable. The ACA is arguably the most far-reaching piece of domestic legislation that Congress has passed since it enacted Medicare in the 1960s. Although the focus of the legal challenge to the ACA is on the individual mandate, which requires that almost all Americans without health insurance buy individual health insurance policies or pay fines, there could be implications for patient engagement initiatives if the Supreme Court strikes down the law.

The Supreme Court heard oral arguments relating to the constitutionality of the ACA on March 26, 27 and 28. The Court’s decision is not expected until late June. The first issue confronting the Court is whether the individual mandate should be struck down because it represents an unconstitutional exercise of Congress’ power. If the Court does decide the mandate is unconstitutional, it will then consider what should happen to the ACA’s hundreds of other provisions. The answer depends on whether some or all of these provisions are deemed “severable,” meaning that they operate independently enough of the mandate to stand on their own even if the mandate falls.

The severability issue is a critical one. A number of the ACA’s payment and delivery reform provisions encourage patient engagement and care coordination, and, at least indirectly, could go a long way toward promoting the integration of patient-generated health information into care management and other health care delivery models.  These include provisions:

• establishing a Medicare hospital value-based purchasing program that pays hospitals based on performance against quality measures;
• requiring the development of similar value-based purchasing programs for other types of providers;
• gradually reducing Medicare payments that would otherwise be made to hospitals to account for preventable hospital readmissions; and
• establishing rules governing the formation and operation of Accountable Care Organizations (ACOs).

Each of these provisions attempts to reform the current health care payment system by rewarding health care providers for coordinating care and delivering better patient health outcomes – as opposed to rewarding them for the volume of services they provide. The ACO program, for example, creates financial incentives for providers to work together to treat patients across multiple care settings, including physician offices, hospitals, and in the home. An ACO consists of a group of providers that have agreed to collaborate to coordinate care for patients enrolled in Medicare Parts A and B. ACOs are intended to be patient-centered organizations, driven by the goal of delivering integrated, efficient and cost-effective care. ACOs that achieve quality targets and succeed in providing care at a cost less than what would otherwise be expected will share in savings with the Medicare program. To succeed, ACOs will likely have to find ways to better engage patients in their own health and health care. Incorporation of patient-generated health information, like observations of daily living (ODLs), could be one way of achieving this goal.

It is currently unclear whether the ACO program and other ACA payment reforms will continue to exist if the Supreme Court strikes down the entire ACA. Some have suggested that without the ACA’s payment reform provisions, health care providers will have less incentive to engage in innovative care coordination strategies, including those involving patient-generated health information. We will continue to follow the legal challenge to the ACA with great interest, and with an eye toward how it may affect the goals that Project HealthDesign supports. Please don’t hesitate to post any questions or comments about these issues below.

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