Thursday, February 25, 2016

Unity Farm Journal - Fourth Week of February 2016

You may have heard the term “lipstick on a pig”,  which generally refers to dressing up a flawed product.    You may have also heard the term “lipstick on your collar”, which generally refers to evidence of an affair.    However, you may not have heard of “pig lipstick on your collar”.  Here’s the story:

After I feed the pigs every night,I give them stomach rubs and tuck them into their beds of straw.   Hazel Marie, who weighs 120 pounds, generally spends the day rooting for grubs, worms, and tender vegetable shoots.     By nightfall, her snout is covered with mud as pictured below.     Pigs are very intelligent and communicative creatures, and their nose disks are their major sensory organ - they push, smell, and explore with their nose disks.   After a stomach rub, she will often nuzzle with me, by rubbing her wet nose disk across my face.   I did not realize that I came to dinner last weekend with “pig lipstick on my collar” - my nose was covered with mud from pig affection.   The cat (or pig) was out of the bag.  Kathy forgave me.

February is a busy time at Unity Farm because we are four season farmers.   We harvest vegetables every day of the year, even when it’s -34F outside.   We do this by using our hoop house, our row covers, our indoor and outdoor germination stations, heat mats, and grow lights.   Now that the worst of winter has passed, I planted 15 raised beds with germinated vegetables.   Here’s our 2016 Winter/Spring succession planting plan for the hoop house

Left side
Bed 1 - Rex Greenhouse lettuce -> Bell peppers
Bed 2 - Vit Mache -> Roma tomatoes
Bed 3 - Buttercrunch Bibb lettuce -> Heirloom Beefsteak tomatoes
Bed 4 - Nancy Boston lettuce ->Plum tomatoes
Bed 5 - Sugar and Snap peas  ->
Bed 6 - Bloomsdale Spinach -> Jacob’s Cattle beans
Bed 7 - Haruke Turnips ->

Right side
Bed 1 - Chiogga Beets ->
Bed 2 - 8 different types of carrots
Bed 3 - Red Cross lettuce -> JalapeƱo peppers
Bed 4 - Meadowlark Kale ->
Bed 5 - Bloomsdale Spinach -> Jacob’s Cattle beans
Bed 6 - Winter Density Romaine -> Little Finger Eggplant
Bed 7 - 8 different types of carrots
Bed 8 - Rouge D’ Hiver Romaine -> H19 Cucumber

We’ll also have a Fall crop in every bed including Argulua, Ottos, Endive, Lettuces, Mache, Parsley, Radicchio (a Chicory), Scallions, Spinach, Upland Cress

Outside of the hoop house, we’ll plant squash and pumpkins in the compost piles.

It’s the middle of February and all our beds are filled with growing plants.  The miracle of hoop houses/high tunnels and the greenhouse effect.

I spent last weekend moving tons of fallen branches from winter storms.   The Terex front loader is amazing.   Here’s how I moved an entire fallen tree in one load to the Shiitake processing area.

The winter storms of February did collapse one of our barn windows - it literally imploded and blew into the barn when a 40 mph gust hit the barn.   This week, we hired a carpenter to retrofit every barn window with wood strips to reinforce them against the wind.   We should be resilient to any storm that nature can bring.

This weekend, I’m flying to HIMSS for a few keynotes and many meetings.   Kathy will be doing barn chores for 3 days as well as tending the new winter plantings - over 1000 new plants.   I try to be everywhere for everyone, but having a doppelganger who has been with you for 35 years makes Unity Farm possible.

Wednesday, February 24, 2016

The Pillars of the BIDMC IT Strategic Plan

Communicating the IT strategic plan is one of the primary responsibilities of a CIO.   Most importantly, the IT strategic plan should be seen as an enterprise wide activity and not just an IT centric exercise.  IT should be an enabler for the strategy of the business and every IT tactic should tie back to a high priority of the business.

In 2016, the BIDMC IT strategic plan has five pillars that align with quality, safety and efficiency imperatives (instead of Meaningful Use, ICD10, and the Affordable Care Act as was the case 2013-2015).   The pillars are:

1.  Inpatient documentation which integrates novel communication methods such as groupware and secure texting
2.  Crowdsourced mobile apps as an enabler for patient generated healthcare data
3.  Security
4.  Care Management Medical Records (our term for population health integrated into the EHR)
5.  A move to the cloud including interoperability of data, documents, and images

Here’s a bit more detail about why these are driving our work in 2016

Documentation - although many organizations have been at HIMSS Level 7 and had paperless inpatient medical wards, BIDMC has purposely waited for the technology to evolve so that we have better usability and ergonomics.   In 2016, we’ll be able to use the internet of things, natural language processing, cloud-based voice recognition,  social networking ideas, and mobile to create an entirely different documentation experience.    We’re partnering with an equipment vendor to provide our nurses with a single device that wirelessly transmits all vital signs and observations into the EHR as structured flowsheet data.   We’re engineered a novel approach to searching all medical record content for much easier navigation of previously written content.   Cloud based voice recognition will enable clinician voice input to the medical record from any device, at any location, for any document.   Groupware and secure texting will enable team communication with better workflow than email and reading charts.   Everything is optimized for mobile.    Sometimes it pays to be a laggard when the clinician experience depends upon waiting for the convergence of technology, regulation, and demand.

Mobile apps - today, 80% of all BIDMC publicly available content/portals is accessed by mobile devices.   The desktop is dead.    If we want to engage patients and families we must gather subjective (how do you feel), objective (what is your blood pressure), and care plan progress on mobile devices.   We’ve already launched BIDMC@Home to gather the objective data.   In 2016 we’ll be adding new functionality to share even more data between doctor and patient.

Security - I’ve written about the Cold War that is security and the fact that security is a process not a project, that will never be complete.    We must make security the foundation of every application we launch and every infrastructure we procure.

Care Management Medical Records - What is population health?   If you ask 10 clinicians, you’ll get 12 answers.    Our view is that care management requires identification of a cohort based on about 50 data elements (problems, meds, allergies, labs, demographics)  then inserting that cohort into a queue with a plan/to do list for the entire care team (doctors, nurses, social workers, pharmacists, physical therapists etc) to process.     We’ve created a generalizable framework for care management and in 2016 we’ll roll it out broadly.

Cloud hosted services - As I wrote two weeks ago, agility requires the use of cloud hosted services.    We’re partnering with many vendors - Amazon, Google, Dell, Meditech, and AthenaHealth to move core functionality to the cloud in a way that builds greater data liquidity/information sharing while also protecting privacy.

It’s hard to create an elevator speech for IT but if I told you that we’re putting usability and the clinician/patient needs first, instead of overly prescriptive regulations,  and using social networking, mobile  analytics, and cloud to create automation that meets the goals of the business, I hope you would stand and cheer.

The five pillars of BIDMC IT in 2016 are our best hope to bring joy back to the practice of medicine.

Thursday, February 18, 2016

Unity Farm Journal - Third Week of February 2016

A few years ago, I wrote about keeping warm in New England when  alpine climbing in -40F weather.

Over the weekend at Unity Farm, it was -35F with wind chill and -15F without.  While using my ice ax to break up manure in the barn (really), I wore the same gear I use for the White Mountains.

On Saturday night we had to prepare every animal area for what turned out to be the lowest recorded temperatures ever in the Boston area, caused by the polar vortex.

Llama/alpacas - we cleaned their barn stalls right before nightfall and added extra hay on top of their rubber mat floors so that each animal would have a dry, insulated, wind protected shelter.   I fed them chopped alfalfa with molasses to given them extra calories and added flavoring to the water in their heated buckets to encourage them to stay hydrated.  

Dogs - we put a 1500 watt space heater in the barn in an effort to keep the temperature for the dogs near zero.   We created insulated beds for them by wrapping hay in tarps.   We gave them extra food before bed.

Chickens/Guinea fowl - we closed the coop at 3:00pm to retain the warmth of the day and ensured the three panel heaters on the roof over their roosts were functioning well.   We made them a pot of warm oatmeal and added extra pine shavings to the floor, so everyone would be warm and dry

Geese/ducks - we added extra straw their waterbird house and made them warm oatmeal.  The ducks love their warm heated nesting area, but the geese seem to prefer to stay in the outside pen no matter how cold it gets.

Pigs - our real concern was the pigs because they do not like cold.   They have panel heaters above their straw beds, but with low wattage heaters, blankets, and straw they are still cold when the temperatures go below zero.   We added a 1500 watt space heater to their pig barn, gave them extra food (grain/bananas), and wrapped them in their quilts.

On Sunday morning, I waited until dawn to check on everyone, so they would not be disturbed from their shelters.   Everyone made it through the night without a problem.

As I went into the farm refrigerator (35F) to get vegetables for the pigs, I took the opportunity to warm up, because the inside of the refrigerator was 50 degrees warmer than the barnyard!

During the winter we keep water flowing in our duck pond on the farm for the deer, birds, and other local wildlife.    To keep the pumps and piping flowing in the negative temps, I did my best to break up ice, use snow as an insulator, and cleaned all the filters.    We are the only liquid water for miles around.

In the picture below, you’ll see some of our geese.  Hercules (the large french tufted goose in the photo below) began to collect straw from around the barnyard this week.     I  got the sense that Hercules wanted to nest.   Our geese were raised from 3 day old (unsexed) hatchlings so their gender is still unknown to us.   I built an 18x36 inch box, pictured below.

A few hours later, I returned to find the goose egg  pictured below (yes, it is enormous).   We now know that Hercules is female.    So far, no eggs from Xena, Gabrielle, or Iolaus.  Our guess is that Iolaus is male and all the others are female.    When the weather is warmer, we’re happy to let the geese hatch any fertile eggs.  At the moment, eggs left outside just explode in the cold.

We had planned to transplant our lettuce sprouts last weekend, but with negative temperatures, even hardy lettuce would struggle.   Next weekend, we’ll plant all our transplants and early spring crops in the hoop house.      As with everything else at Unity Farm, we’re learning every day.   It’s unclear if late February is the right time to plant lettuce in the hoop house.  In a few weeks, we’ll know if we were right!

Wednesday, February 17, 2016

Enabling Nationwide Interoperability

Today’s post is co-written by Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, and me.

It’s been over 10 years since ONC head David Brailer and HHS Secretary Tommy Thompson published the “The Decade of Health Information Technology”, one of the goals of which was to create a “a new network to link health records nationwide.”  Since the beginning, government planners have advanced the notion of a national-level network, at first suggesting a single “national health information network” architecture, which was later modified to be a “nationwide health information network” built on a foundation of federally-subsidized regional health information organizations (RHIOs) working together across the country.  More recently, the ONC Interoperability Roadmap, recognizing that the building blocks of universal interoperability could not be so neatly erected, leans on the idea of “coordinated governance” of networks.

While these frameworks have paid homage to the concept of nationwide network as a “network of networks”, we have yet to crisply define the stitching needed to form this nationwide network quilt.  This issue hasn’t been so pressing up until now because there were relatively few networks – the “last mile” problem was the bigger concern.  Network formation is evolving rapidly, however, which has made more pressing the question of what it means to connect networks in a uniform way.

We believe that there are five key interoperability transactions that need to be operationalized across networks in order to achieve the goal of nationwide interoperability.  Those are:

1.  Patient matching/identification

2.   Provider directory supported by a FHIR query/response transaction

3.   Constrained CCDA payload with little to no optionality

4.  Data-level FHIR API for MU common data elements and a document-level FHIR API for a CCDA supported by a standard schema and controlled vocabularies

5.  OAuth/OpenID Trust fabric supported by appropriate HIPAA/state/local policies for consent

There are obviously many other interoperability functions that have value in the market, but we believe that those are best left to individual networks to provide within their networks as their customers and stakeholders see fit and are willing to pay for and enable.  This is exactly how other network-based industries have developed.  Wireless connections work seamlessly across networks even though within their networks they don’t all use the same standards or offer the same functions (e.g., Verizon users can do more with each other than they can with AT&T users, for example, which is also true for iphone users).

We obviously made some decisions about what to relegate to within network.  For example, what about a record locator service?  We do appreciate the value that record location can provide, but given the variation in network architectures that exists today and the policy complexity involved, we see this as a capability that is best left for the future.  We also caution against letting the perfect be the enemy of the good.  It’s important that we begin with achievable, practical steps and grow from there.

How would this be accomplished?  Network development is now at the point where the private sector – a small group of existing networks such as CommonWell, Epic CareEverywhere, Surescripts, DirectTrust, the eHealth Exchange – should assemble to roll up their sleeves and agree on practical, federated solutions to these five issues.  And if the experiences of other network industries is any guide, once a critical mass of networks launches such functions according to open industry standards, the rest of the market will soon follow.

In our various speaking events at HIMSS this year, you’ll hear a call to action from  Micky and me to move this agenda forward.

Thursday, February 11, 2016

Unity Farm Journal - Second Week of February 2016

Stormaggedon arrived this week.    Heavy, wet snow covered the entire farm like a paste, breaking trees, puncturing holes in the hoop house, and taking out power for more than 100,000 households in Massachusetts, including Unity Farm.

Power failed at 10am on Friday and was restored at 10pm on Sunday.

Three years ago, we installed a 20 kilowatt backup generator, fueled by 6 tanks of propane with the idea that we could run the farm for 2 weeks without grid power.   Kathy and I do not mind the cold, dark, and inconvenience, but the 150 animals at Unity Farm would definitely not do well without water, light and their daily routines.  

The generator powers all the outbuildings - barn, coop, duck/goose house, sheds, and cider house.   When we did the initial wiring, we did not have pigs, so the pig barn was without power for 3 days.   We wrapped the pigs in blankets (really), gave them extra straw, and fed them their favorite snacks, all in an effort to keep them warm.    Their “sweeter heaters” normally keep the pig barn above freezing but without power they had a chilly Friday night at 20F (we have temperature telemetry in each of the animal spaces).   We checked on them frequently and they came through the weekend without a problem.    We’ve already contacted an electrician and we’ll take our own bedroom off the generator if needed to keep the pig barn warm.

The hoop house also is not on the generator.   That was not a problem previously because it is heated by sunlight.  However, now that we’re germinating all our spring seedlings, there is a heat mat that needs power.   I hand carried 300 seedlings up to the house to keep them warm over the weekend.

Other than cold pigs and seedlings, the three day power outage was not a significant problem.    We had water, food, and light everywhere we needed it.   We used the Terex front loader to clear the heavy thick snow.  

I learned a bit about the grid during the restoration process.   Unity Farm is on a lateral from the main line which serves only three customers - two farms to the west of Highway 27 and one farm to the east.   The connection from main to lateral uses a 7000 volt fuse housed in a “fuse door” on a “fuse cutout”.     When the fuse blows, the “fuse door” hangs down from the cutout, indicating an interruption.     Here’s a photo that illustrates the issue

Thanks to Brian from Eversource for teaching me about high voltage grid engineering.  I can now diagnose any local electrical outage problem.

During the outage, the pigs did try to make a break for it, however.   On Saturday, Kathy ran into the house and told me that Hazel (120 pound pig) was running into the forest.   Pigs are incredibly smart and she figured out how to lift a gate off its hinges so she could forage in the woodland.    I grabbed an apple (her favorite food) and she followed me back to the pig barn.   After a quick trip to Home Depot, I outfitted the pig gates with nylon lock nuts.

During the storm, we had 40 mph winds and at 4:30am on Sunday, one of the barn windows blew in - the old sliders on the window frame sheared off.   The dogs raised an alarm and when I got to the barn, I found the window in pieces about 20 feet away from the wall.   I used ten 2.5 inch wood screws to attach a piece of plywood over the window frame, resealing the barn against the storm.  Over the next few weeks, we’ll remove the barn windows and replace all the old sliders.

As part of my Umass course in organic farming management, this week I reflected on the record keeping I do every week on the farm.   Some people use sophisticated digital applications.    Some use spreadsheets.    I use notebooks - see the photo below.  I realize this is very out of character for a technology guy, but I think of the farm as a living laboratory.  What better way to document the daily events than lab notebooks!

This weekend we’ll have temperatures as low as -10F without wind chill.    I was going to plant our peas, beets, and other cold weather crops, but I have a feeling that even in the hoop house, the soil will be frozen solid.    We may spend Valentine’s day in front of a fire, doing our best to keep all the animals, plants and ourselves warm throughout the day.

Wednesday, February 10, 2016

Embracing the Cloud

As I have written about previously, CIOs across the country are telling me that expectations for IT delivery are at an all time high.    More must be delivered faster, cheaper, and with greater usability.

After a recent EHR rollout, a number of clinicians told me they were disappointed with the project.  I asked them what criteria they used to measure success - their answer was that they hoped to get home an hour earlier,  make more money, and be less stressed.   Sounds good to me!

The cloud does not solve every healthcare IT problem, but does enhance agility, reduce capital expenditures, and enables IT to focus more on optimization than procurement.  Currently I oversee about 250 physical servers in data centers operated by BIDMC and other hospitals.   The lease on the building housing our primary data center expires in a few years.    My belief is that by the time we move, we will not need to build or operate our own data center. We’ll embrace the public cloud.

Many companies talk about moving to the public cloud, but as one attorney recently told me, they have not read the fine print.    Transitioning from your own data center requires careful planning.   Here are a few elements of the journey thus far.

I'll stratify the issues into technical concerns, security concerns, and legal concerns.

At the technical level, what are you buying?  I¹ve classified types of cloud offerings as:

*Infrastructure as a service - your stuff hosted somewhere else
*Platform as a service - your apps running remotely on someone else¹s software development kit
*Software as a service - you are buying transactions run by someone else
*Outcomes as a service - you are a paying for a result to be achieved.  It just happens that technology is part of it

Each of these approaches requires service level agreements (what happens when their technology fails), disaster recovery  plans (what if their cloud is below sea level in New York City and Hurricane Sandy floods it), local replication in case of an internet outage (such as a denial of service attack), and ability to retrieve your data should the hosting arrangement not work out (who owns the data).

Security concerns can be enumerated by an independent audit of the cloud partner.  Do they have a multi-layered defense to protect against hackers?  Do they have physical security in their data centers?  How are their staff trained and what protections against employee misbehavior is in place?  Encrypting data is sometimes seen as a panacea, but if we study the major security breaches of the past year, we'll find that most accesses occurred at the application level, not the data level - encryption of data at rest on servers in data centers would not have helped.

Legal concerns include business associate agreements, indemnification for costs associated with a breach, and clear definitions of roles/responsibilities  so that when something bad happens, it is clear what is to be done by whom and who pays.

Of all of these, the legal concerns are the most difficult to resolve. Many customers will ask cloud vendors for an indemnification clause without a cap - the vendor must cover all costs associated with a breach including third party law suits.   No cloud vendor will sign an agreement without a cap.    What is the current benchmark? The Cloud Council offered this white paper which suggests a cap of 12 months of fees is typical.

What do I suggest?

Get your cloud vendor to sign a business associate agreement that gives them a legal mandate to protect privacy.

Try to negotiate a cap of at least three years of fees.

Try to get your cloud hosting vendor to agree to cover federal fines should the vendor be at fault - the HIPAA Omnibus rule really requires business associates to be accountable in the case of their mistakes.

Try to get your cloud hosting vendor to cover notification costs, credit monitoring costs, and call center costs in the case of a breach.   These can be expensive.

Even with 3 years of fees, federal fines covered, and reporting costs covered, there still may be expenses that go beyond the cap.    Consider cyber-liability insurance for these excess costs.  No cloud vendor will cover everything.

Your legal and compliance departments will be important partners as you have the discussion with Board members and senior management about acceptable risks.

I was recently asked the following question - do you believe that your internal staff can manage operating system patching, network/server/storage configuration, and technical security as well as a cloud hosting company with thousands of employees dedicated to that task? Are you really taking on more risk by moving to the cloud?   Interesting to speculate.

Here¹s a list of milestones for our next two years of cloud migration effort:

1. Move community hospital inpatient services to a single cloud hosted instance of Meditech's mobile web platform (we call the project CommunityONE).

2. Move ambulatory services at several sites to Athena’s cloud including the clinical record, practice management and billing.

3. Use public cloud services such as Amazon for an increasing array of hosting - disaster recovery, development, test, and production.

4. Use cloud hosted apps such as Gmail and Google docs as long as they can be operated securely under a business associate agreement.

5. Use cloud hosting companies such as Dell for infrastructure as a service.

The cloud is the right thing to do and as with any change management activity, there will be a process.   Over the next few weeks, I'll be presenting cloud ideas in many Board and senior management meetings, discussing risks, mitigations, and legal agreements.

Step by step, year by year, we'll get to the point that IT no longer provisions services, but instead procures them from cloud vendors.

Thursday, February 4, 2016

Unity Farm Journal - First Week of February 2016

The germination station I built last week has worked fabulously.  500 sprouts of romaine, bibb, boston, greenhouse, and red lettuce are growing rapidly in the heated, moisture retaining, and light controlled spaces.   Here’s what lettuce looks like 3 days after planting!

 I’ll cold harden these plants starting the week of February 14 and I’ll plant them in the hoop house beds the week of February 21.   We have a succession planting schedule for three rounds of planting in 2016 - early lettuce/greens, warm weather vegetables, and late lettuce/greens.

I’ve prepped all the beds in the greenhouse using a 36 inch field rake with 2 inch tines to break up the soil and a flat edge to smooth it for seeding.

 Some have asked how I have learned the various skills needed to run a farm.  My approach to any new field is a mixture of reading, practical experience, and constant iterative improvement.    In 1972 when I was 10 years old, my parents went to law school and I had free time after school.    I went to the Henderson Public Library in Torrance, California  (about a block from our apartment) and started reading at Dewey Decimal 600 and read through to Dewey Decimal 700 (600-699 is Applied Sciences and Technology).   My favorite range was 621.0-621.9 which covers electrical engineering, mechanical engineering, and tools.  Using several of those books, I built devices using parts I scavenged from surplus stores in Torrance.   I learned to manage analog modules, digital integrated circuits, and early microprocessor concepts.

Farming is similar.  My farm office contains  books on everything from managing an alpaca in labor to fermenting sauerkraut.   After reading all these books, Kathy and I built infrastructure and began managing the farm operations.

 I made many mistakes and gained the experience that books could not teach.    For example, last weekend I had to trim the pig's toenails.    I used my experience with llamas (and the same tools), but had to master pig relaxation techniques (it involves belly rubs and sleeping in the sun) in order hold and do precision cutting of a pig trotter.    I did cut a little too deeply on one of Tofu’s nails and drew a few drops of blood, but he did not seem to mind.   Lessons learned for next time.

This week we adopted another rooster (our 5th) from  a local family who thought they had a hen but when it started to crow, they knew their neighborhood would object and did not want to surrender the rooster the someone who would eat it.  At our vegan farm, we’re going to run a skilled nursing facility for chickens - they will all live 15 years.    The new rooster has established himself in the pecking order (he’s docile and submits to the alpha rooster) and has his own spot in the coop where he returns every night.

Thus far the snow has been light in 2016.   The Terex snowblower moves 10 tons/hour.  I feel that buying it last year had the same effect as washing your car.   If you wash your car it will rain.  If you buy snow removal gear, it will not snow.  At least the pigs are happy - they do not like snow!

This weekend will be inoculating more mushroom logs, rebuilding some of our pond circulation infrastructure to be more robust in winter, and harvesting carrots/lettuces.  Here’s what the hoop house lettuce beds look like today - fresh greens daily in the middle of winter.

Wednesday, February 3, 2016

On the Road to Interoperability, Industry Collaboration Drivers Wanted

The following is a guest blog post from Tom Skelton, CEO, Surescripts.     I've asked the leaders of number of health information exchange organizations to write guests posts to inform us about their plans for the next year.  These posts will appear over the next few weeks.

"As exemplified already by these first few weeks of 2016, health IT leaders certainly have a lot on their plates this year. Regulations and standards are changing, value trumps volume, the market is evolving, and the patient is moving to the center. Care providers and technology providers are both trying to keep pace with impending changes to the meaningful use program, as announced in early January, as well as the continued impact of MACRA—the Medicare Access and CHIP Reauthorization Act of 2015--which focuses on cost, quality and clinical improvement as the basis for Medicare reimbursements.

But keep in mind, these regulatory updates must not deter the use nor the development of technology solutions that both meet changing federal objectives and enable quality-driven care management despite them.

Luckily, we can tap into past successes to ensure these patient-centric, value-based priorities become a reality. Consider the evolution of e-prescribing, one of the most successful examples of technology implementation and widespread interoperability to date. In 2004, just four percent of physicians were sending prescriptions electronically. Then came MIPPA and HITECH, in 2008 and 2009 respectively, which incentivized electronic information exchange and introduced penalties for not using technology like e-prescribing. From 2010 to 2012, e-prescribing took off, with the number of transactions doubling in two years and continuing to increase dramatically since then. In 2015, we’re on track to process more than 1.5 billion electronic prescriptions on our nationwide health information network.

Now more than ever, collaboration is arguably one of the most important drivers of market progress. The industry’s use of technical standards such as Fast Healthcare Interoperability Resources (FHIR), rooted in the use of open APIs and Internet-based information exchange frameworks, has helped improve data exchange and interoperability. But standards and innovation only work when strategy, business models, and mission are aligned. Therefore, it’s critical that we not place all of our bets on a single approach.

Looking back at how far we’ve come, technology providers must apply lessons learned and remain diligent about expanding and improving capabilities going forward. As we continue to find ways to create value, decrease costs, and improve care quality, there are a number of critical areas in which we feel the industry must focus in 2016 and beyond:

Increasing Medication Adherence and Combating Formulary Inefficiencies: Nearly one third of all prescriptions are left unfilled at the pharmacy – many times due to long waits from prior authorization requirements or unforeseen, costly co-pays. But co-pays aren’t the only cost factor. The World Health Organization estimates that 50 percent of patients do not fully adhere to their medication treatment, causing as many as 125,000 premature deaths and billions of dollars in preventable costs.

But when caregivers have digital access to patient-specific cost and coverage information at the point of care, they are able to improve medication adherence and combat issues stemming from inefficient, ineffective formulary and benefits processes. Together with many of our partners, we have convened multiple cross-industry collaborations to improve patient care and experience while driving quality and value into the system from a formulary and benefits perspective. This includes working with our EHR partners, to deliver health-plan generated, patient specific insights directly into provider workflows so that patients have the medication they need, when they need it.

Combating Prescription Fraud and Abuse: In the United States, there are 16,000 deaths from prescription painkillers each year, or nearly 44 each day. By digitizing the prescribing process for controlled substances, prescribers and pharmacists can use technology to combat drug diversion and improve patient safety. And with Vermont becoming the 50th state to legally allow electronic prescribing of controlled substances (EPCS) for all scheduled drugs, prescribers across the nation can now use e-prescribing technology to stomp out fraud and decrease abuse of these highly addictive medications.

Improving Access to Patient Records: Enabling access to patient information in real-time is one of the most important ways that technology can improve care quality and add value. Without this information, providers are essentially jumping into care delivery blindfolded, with patients being the ones who suffer. When providers have electronic access to a patient’s records at the point of care, including critical information like medication history, outcomes are improved and safety is increased. Today, nearly half of all hospitals in the country depend on real-time access to patient medication history data, ultimately saving large 1,000 bed hospitals more than $1 million each year through decreased adverse drug events, prevented patient readmissions, and reduced staff time.

The benefits of digital records access become even greater when solutions are integrated into existing workflows and technologies, and when we can foster collaboration and connectivity where there previously wasn’t any. With EHRs, PBMs, and providers working together to implement solutions like our National Record Locator Service, clinicians can have a fast, easy way to locate patient records, regardless of geography or EHR system, saving time and reducing unnecessary and costly tests or procedures.

Enabling Accountable Care: With knowledge comes power, and the more relevant and actionable the information is, the more accurate and targeted providers can be with their treatment. This knowledge becomes even more urgent when considering changing reimbursement landscape and quality-focused benchmarks of the not-so-distant future, with 30 percent of traditional Medicare payments set to be tied to alternative payment models by the end of 2016 and increasing to 50 percent by the end of 2018.

By combining data from an array of healthcare participants, including pharmacies and PBMs, accountable care entities can reach their quality benchmarks and ensure their providers are operating with the timeliest, most meaningful information possible. This information, when delivered electronically, is ultimately improving population health and helping accountable entities better track and care for their patients.

The key takeaway? Interoperability is a reality for many in health IT today, and quality, efficient patient care is the end goal. We must apply the lessons learned in e-prescribing to broader health information exchange for value-driven care with technology as its foundation. We’ve been committed to connecting healthcare for over a decade, and remain focused on continuing to reduce prices to move critical health information affordably and securely, for the benefit of all who are connected.

By continuing to partner with doctors, pharmacists, software vendors, PBMs and others connected through our nationwide network, we are able to add value that could only otherwise be realized through connections with dozens or hundreds of separate organizations. Collaboration-enabling technologies made possible by a nationwide health information network have a direct impact on patients, by saving lives and improving quality on a massive scale each and every day – all while reducing costs and keeping information exchange private and secure. "