EHR 2020: Making an Impact!

The EHR 2020 report is having impact!  Within 1 week of its release, there have been over 2500 downloads of the report, coverage in national media, and it has already gotten the attention of key leaders in Washington.

Prompted by the release of the Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs, AMIA Board Chair-Elect, Thomas Payne, MD, FACP, FACMI, has been asked to testify before the full U.S. Senate Committee on Health, Education, Labor & Pensions (HELP) panel on “Health Information Exchange: A Path Towards Improving the Quality and Value of Health Care for Patients.” The Committee is chaired by Sen. Lamar Alexander, (R-Tennessee), and ranking member Sen. Patty Murray (D-Washington).

The hearing is scheduled for Wednesday, June 10, at 10:00 a.m, 430 Dirksen Senate Office Building. Health information exchange technology is a key part of enhancing health and health care, and empowering patients to be first-order participants in their care. The testimony and hearing will be streamed live beginning at 10:00 a.m., Wednesday, June 10.

Bookmark or paste the URL into your browser
http://www.help.senate.gov/hearings/health-information-exchange-a-path-towards-improving-the-quality-and-value-of-health-care-for-patients

Copies of the Dr. Payne’s testimony and other materials that AMIA submitted are available here.

The request for Dr. Payne to testify came following the May 29 release of the AMIA EHR 2020 Task Force report in the Journal of the American Medical Informatics Association (JAMIA). AMIA believes that it can improve the quality and value of healthcare for patients, thus setting the stage for a more significant benefit in the future.

Also called to testify:

Craig D. Richardville, MBA, FACHE, Senior Vice President and Chief Information Officer, Carolinas Healthcare System, Chair, Premier Healthcare Alliance Member Technology Improvement Committee
Christine Bechtel, MA, Advisor, National Partnership for Women & Families, Chair, Health IT Policy Committee Consumer Workgroup, President, Bechtel Health
Neal L Patterson, MBA, Cofounder, Chairman, Chief Executive Officer, Cerner Corporation

This is a great opportunity for the informatics community to provide their expertise to this important national conversation. I’d like to congratulate the board, the members of the task force, and Tom Payne for his leadership in representing AMIA!

EHR 2020: Charting the Course to a Better Future

Today, the Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs was released in JAMIA and publicly presented at the AMIA iHealth 2015 Clinical Informatics Conference in Boston. The final report articulates 10 recommendations to advance the value of electronic health record systems. This report focuses on one aspect of the health care system – EHRs – and provides concrete recommendations for how to improve how we manage and use EHRs. Both this report, and our iHealth meeting are intended to foster a conversation among key thought leaders at the forefront of the research and the implementation of these systems. Lead by Tom Payne, MD, the 15 member task force has focused on those issues that provide the greatest tangible benefit to patients and the providers that care for them.

Broadly, the 10 recommendations highlight some of the key values of the AMIA community. I encourage you to read the report and consider how the recommendations are interrelated.

Improve documentation requirements and functionality to empower patients so that all members of the care team can contribute their perspectives and information. This means making patients first-order participants in their care through integration of innovative consumer apps, and empowering patients to both have a copy of their entire medical record and to be able to contribute to that medical record in a tangible way. Health care is a team sport, and we need to be sure that every member of the care team — doctors, nurses, pharmacists, other professions, and the patient — have the opportunity to contribute their expertise to the medical record in equal measure. At the iHealth meeting, discussions of OpenNotes and how consumer-focused apps can be integrated into the EHRs resonate with the findings of the EHR2020 task force recommendations 1, 2, 8, and 9.

Refocus regulations so that patients and their caregivers can derive the most benefit. This means some areas will need more oversight and focus from regulations, while other functionality may need to be relaxed if it doesn’t provide that value. There is a tension between the urgency we feel in getting good solutions out there, and the patients it takes to do it right. We don’t want to just get quickly to the “next stage”, but we need to make sure we accelerate the work toward the common goal of improving health and healthcare. The report rightly identifies that if we focus on the value to the patient, we are more likely to find that right balance. Already, the recommendations by CMS to accelerate the progress toward new payment models will open the door to new and innovative ways to improve documentation and patient care. (recommendations 4,5)

Increase transparency of the testing environment, and the oversight of EHRs should problems be identified. This empowers providers to pick the best system(s) for their practices, researchers to be able to present analysis and research that involves EHRs, and users to share potential patient safety issues with how EHRs are used. We cannot improve things that we can’t study, and we can’t study things that are hidden from view. It is critical for us to be able to foster open, transparent conversations about what is working and what is not, so we can share best practices, and learn how to do things better. (recommendations 6,7)

Foster innovation so that we can begin to build toward the next generation of EHRs. It would have been hard for us to predict 10 years ago that we would need to summarize our live experiences in 140 characters, or that we would order most of our holiday gifts online, so although we don’t know what the next generation EHR will look like, we know that it will likely be very different than the systems that we have now. If we want to have the same successes that we’ve seen in the internet, we need a stable base of standard building blocks that allows us to create new technology to benefit patients. This will require standards for connecting different systems together (like APIs), standards that allow patients to have a copy of their entire medical record (and not just a summary) and continued investments in research on how best to capture data, integrate data, and design new interfaces. (recommendations 3, 8, 9, 10)

I want to applaud the work of the EHR 2020 Task Force members for their work on this report. It represents a commitment to the practical and challenging work that our applied informatics community is tackling, and demonstrates that AMIA and informatics can truly lead the way.

A busy week in informatics: Precision Medicine

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Left: President Obama at the announcement of the Precision Medicine Initiative
Right: Doug Fridsma and Francis Collins celebrate with a selfie

It has been a busy couple of weeks for informatics and health IT. On January 30 ONC released their interoperability roadmap, and President Obama announced details about the Precision Medicine Initiative that same day, just a few hours later. The day before, the House Energy & Commerce Committee released a discussion draft bill that would affect clinical research, the FDA, and potentially EHR functionality, and CMS set targets for payment reform over the next 5 years.

Wow. There’s a lot to talk about.

Over the coming few days (weeks?) I’m going to try and break the different initiatives down because they will have significant impact on our work. It will take some time to dig into the interoperability road map, and into the proposed legislation, but the Precision Medicine Initiative is moving full steam ahead. And informatics is leading the way, most immediately, this week, as part of an NIH workshop on building the cohort for research. But first, a little bit about precision medicine.

Precision medicine

There’s been some debate in the AMIA online communities about what “precision medicine” means. While  it is traditionally associated with tailoring therapies based on genomic information, I think it is much more than that. Precision medicine is about having all the information you need to precisely tailor interventions for an individual, so that you can achieve a better outcome. For some, this might mean understanding their activity record in their FitBit so that you can identify the best time for someone to take their insulin; it might mean analyzing their EHR information to see if the person is eligible for a clinical study; it might mean identifying that an individual lives in a food desert that makes dietary modifications difficult; and it might mean using an individual’s genomic information to predict if they will respond to a particular intervention.

What is different and exciting about the Precision Medicine Initiative is that it is all about the person — it’s about engaging people in improving health and healthcare and having them be a part of something bigger than themselves.

On February 11-12, the NIH is hosting a workshop on “Building a Large US Cohort for Precision Medicine Research”. Eric Green from National Human Genome Research Institute (NHGRI) and Gary Gibbons from National Heart, Lung, and Blood Institute (NHLBI) are leading the effort and have organized four planning teams:

  • Building a consortium of cohorts (identification and recruitment)
  • Participant engagement, data privacy, and novel ways of returning information to participants
  • Data collection (including mobile health technology)
  • Informatics and EHRs

AMIA has a number of representatives who are actively participating in this work, particularly around EHRs and informatics. Leading the effort on EHRs and informatics, is Daniel R. Masys, MD, FACMI, Affiliate Professor, Dept. of Biomedical Informatics and Medical Education, University of Washington. Also participation are Joshua Denny, MD, MS, FACMI Associate Professor of Biomedical Informatics, and Medicine, Department of Biomedical Informatics, Vanderbilt University, School of Medicine; and Lucila Ohno-Machado, MD, MHA, PhD, FACMI, editor of JAMIA; and Professor and Division Chief, Division of Biomedical Informatics, University of California, San Diego; and myself.

Participate online

This event will be live-streamed and available on WebEx so there is an opportunity for everyone in the AMIA community to track and learn from the activity. Follow on twitter @NIH #PMINetwork

The agenda for the presentations is packed. Day 1 is Patient/Participant centered and Day 2 is Informatics/Data centered. More AMIA members will also be participating in the workshop.

White papers

– Building a Consortium of Cohorts — Cohort Identification and Participant Recruitment
– Participant Engagement, Data Privacy, and Novel Ways of Returning Information to Participants
– Data Collection and Mobile Technologies
– Opportunities and Challenges Related to the Use of Electronic Health Records Data for Research

Work groups experts are clustered as follows.

– Genomics/PGx/Other omics
– Epidemiology, population & clinical
– Policy, ethics, law
– Computer science (mobile platforms, UI)
– EHRs and informatics
– Measures of the personal environment
– Health services, implementation, & outcomes research
– Patient groups/patients
– Industry/Other private sector
– Consent platforms

For the President’s Precision Medicine Initiative to be successful, we must enlist all of the informatics community. How do we use mobile technology and personal engagement to encourage participation in this national cohort? Are the novel ways that we can collect and analyze this data? How do we link the data from patients to EHRs, to public and population health, and finally to clinical and translational research? Informatics will clearly play a role in supporting this key presidential initiative, and it provides the kind of engagement that years ago we could only have dreamed about.

I would encourage everyone to tune into the live feed, and to continue to track events here as I report on the results of those meetings.

Partnering with AMIA

Informatics Impact: The power of I

An important measure of AMIA’s impact is how AMIA can support the success of its members. As the home for informatics professionals, AMIA serves a broad community that include clinicians of all stripes and disciplines, and people with informatics expertise that range from biological discovery to care delivery and population helps. We have academicians, researchers, government officials, non-profit advocates, and industry professionals. We have individual members, academic institutional members, and corporate members.  This diversity  and expertise is  one of our strengths.

Because the strength of our members and the depth of our expertise, AMIA is often approached to support special projects and initiatives in informatics and health IT. We welcome the opportunity to work with our members  (individuals, academic institutions or corporate members) who want AMIA join a project, working group, task force, or advisory group. It’s a way that we can serve our members and advance the impact of informatics. Our diverse membership and our ability to provide a neutral, evidence-based perspective has helped AMIA be the trusted advisor for informatics issues, and that is recognized by the people who look to AMIA for advice.

We work closely with our elected leaders on the AMIA Board of Directors to guide our approach to working with members and have developed a set of core principles that help guide us. For example,

  • We chose strategic partnerships and projects that are aligned with AMIA’s mission and provide value to our members. We want the informatics community to have an impact on the health care ecosystem, and we want the informatics perspective well represented in important projects.
  • We don’t choose sides. We don’t participate in exclusive relationships that would impair our ability to have a non-partisan approach to supporting efforts of our members.  We promise to respond to the members who seek AMIA’s help and do so in non-exclusive ways.
  • We give preference to our members (individual, academic institutions, and corporate members) over non-members. Our goal is to help our members make a difference.
  • We focus on where we can provide value to our members. We may be able to provide access to subject matter experts, be a conduit for collaborations between academics and innovators and industry, or serve as a convener of authority within informatics. We want partnerships that truly leverage AMIA’s unique position and perspective.

So if you are considering a project where you believe AMIA’s depth and breadth of knowledge can be useful to your project, please reach out to us. We want to help. Let us know how we can help you make a difference, and continue to advocate for informatics across the healthcare ecosystem!

Informatics and 2015: The year ahead

Informatics Impact: The power of I

Happy 2015!
It’s hard to imagine that things could get any busier within the informatics community, but 2015 looks to be another important year for our field.  With the changes that have happened with HIT adoption across the country, the maturation of the field of informatics, and the continued growth of AMIA membership, AMIA is uniquely positioned to have a significant impact in 2015. While there are a myriad of activities that AMIA and our community is involved in, I’d like to highlight a few in this first blog (with more to follow).

AMIA Strategy Update in 2015
For example, the AMIA Board of Directors will be updating our shared strategy for how we can increase the impact that we have on health and health care delivery.  It’s important that our AMIA strategy is reflective of our entire membership — we have a unique organization that has representation from a broad cross section of the informatics and health care system — and creating a strategy that reflects those strengths will be important.

Advanced Interprofessional Informatics Certification
We made great strides in establishing the clinical informatics medical subspecialty in the past few years, but that is only the first step in recognizing the expertise of our diverse community. Work on the Advance Interprofessional Informatics Certificate (AIIC) will accelerate in 2015, and we have assembled a expert team of individuals to serve on this working group.  Supporting informatics professionals who have worked to adopt, optimize and develop innovative solutions to informatics challenges are reflected in our iHealth meetings. Linking cutting-edge researchers with the communities who are implementing these systems benefits both researchers and implementers but stimulating new areas to explore in research, and giving access to implementers to novel solutions.

New legislative policies that may affect informatics
I anticipate that 2015 will be a busy year for policy activities that affect informatics. A review of the successes and shortcomings of the meaningful use programs, efforts to streamline clinical and translational research, proposals to accelerate the learning health system and data analytics, suggestions for how patients can become active participants in research and informatics data exchange  are all possible topics in legislative proposals in the coming months.

I could go on with other activities and predictions for the year ahead, but as the year progresses, I’ll use this blog as a way of keeping the informatics community informed about activities at AMIA, links to important educational opportunities, research findings and discussions, updates on our strategy and key policy initiatives that affect informaticians. But I’m anxious to also use this as a way of learning more about what’s important to you.

We need your input

  • What are some of your priorities? What would you like the board to consider as they look at updating the AMIA strategy?
  • Where do you see the opportunities for informatics? How can we move from providing value to providing impact to the health care system?
  • How can AMIA continue to help you in your professional life as an informatician?

Let us know what you think!