the future of health informatics -nov 12 -five nations

7/30/2019 The Future of Health Informatics -Nov 12 -Five Nations

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The Future of Health Informatics

Peter L. LevinSenior Advisor to the Secretary & Chief Technology Officer

U.S. Department of Veterans Affairs@pllevin

November 2012


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is open, deep, and blue


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Its been exactly two years

And today I can announce that for the first time ever Veterans will be able to

go to the VA website, click a simple Blue button, and download or print your

personal health records so you have that when you need them and can share

that with your doctors outside of the VA. Thats happening this fall [2010].

- President Barack Obama


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A framework of health record modernization at VA

4

GUI

CSB/ESB

DATA

Clinical Applications and Services

JANUS, the jointly developed

user interface, now in four

locations (one with DoD)

The core of the iEHR program;

OSEHRA as the custodial

repository and front-line

certification agent

The core of the VLER program,with Blue Button emerging as a

very good way to structure,

view, download, and transmit

data; now part of ONCs

meaningful use requirements


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5

Lets focus on the data


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Today clinicians have many patients

and patients have many clinicians


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Almost all medical information is exchanged with paper

7Photo taken by Peter Levin at a VBA regional office


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Which is dangerous and drives up costs

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1.5 million

adverse reactions

or Rx errors200,000 deaths

per year from

medical errors

I went through eight years of training to become a surgeon, and yet I still see mistakes every

week. So we worked with Boeing to learn [how to make] a two-minute checklist for operating

rooms. And when we implemented it in eight hospitals, ranging from rural Tanzania to Seattle

and London, the average reduction in deaths was 46%.

- Atul Gawande


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Blue Button is a good way to (at least) get

data to the patient, now

In March OPM required all federal carriers

to Blue Button-enable their PHRs

1.25 million users

VA

DoD CMS


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In the near future, it will be the way that

we view, download, and transmit data

PHRs that are tagged, labeled and coded

will be even more clinically useful

#ABBI for your

primary care physician specialty care provider

in-home caregiver

pharmacist


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Blue Button downloads self-entered and

clinically valid medical record data

Blue Button file is easily

readable and shareable

Downloads in text and PDF:

read, store, print on anycomputer no special software

Patients can share with anyone

they trust to improve or

maintain their health

11My HealtheVet page and sample Blue Button output


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Why an ASCII file?

Its machine readable

Its human readable

Supports electronic dataexchange (not ideal, but good)

We could create it very quickly

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Sample Blue Button immunization record output

released in October 2012


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The future of personal health data

individual data

elements

today tomorrow

day after

tomorrow

proteomic

description

(~2 million)

lumped

parameters

(~220)

genetic

blueprint(~22,000)

102

104

106

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Scope of data

Size of one proteomic snapshot for a single patient: 0.04 terabytes

Amount of (non-image) data contained in the entire

AHLTA electronic health record at DoD for 9.7 million

patients today:

113 terabytes

Storage space required for a single proteomic snapshot

data for those 9.7 million AHLTA patients:390 thousand terabytes

If every patient who had an office visit last year had a

single proteomic snapshot taken, it would equal:10 million terabytes

Amount of data passed over the internet globally in 2010: 250 million terabytes

If everyone in the United States had a proteomic

snapshot taken every day for one year, it would equal:4600 million terabytes

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15

Veterans

are about

half of all

users


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There are plenty of commercial EHRs,

but they dont communicate well

Interoperability has been historically neglected

Were making progress on standardization

but progress is really slow

Blue Button starts with an ordinary ascii file

this has proven to be surprisingly well adopted

VAs platform was already in the public domain now weve closed the loop with OSEHRA

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VAs recent health IT innovations

NewPersonal Health Record (PHR)

NewImplementation Roadmap

NewElectronic Health Record (EHR)

Blue Button

OSEHRA

VistA, AHLTA, and the

Joint Common Platform

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Why open source?


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Problem StatementFederal software acquisition is notoriously slow and error prone

Encyclopedic requirements

Choose once/choose wisely procurement

Near-zero visibility into development

Epic program slips and cost overruns

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Solution StatementTheres a much better way to do this

Incremental requirements

Interoperable apps (like a smart phone)

Regular customer-facing deliverables

Negotiate features, not time

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Use model for open source

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In July 2012 we installed the first vendor-

contributed OSEHRA component

22Dr James Kahn, VA Medical Center Palo Alto


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October 2012 JANUS pilot performance metrics

More than 600 clinical users James Lovell Federal Health Care Center (Chicago)

Tripler medical center (Honolulu)

Over 20,000 patient records retrieved

Economic benefits

First OSEHRA installation cost approximately $100,000

Recently completed a second one for approximately $50,000

Takes about an hour to learn

Cost savings scale to $10-$50k per clinical user, per year

86% of users agreed that JANUS saves

time and resources, leads to better care


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Whats on, and whats next


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What is our vision for Blue Button?

To extend the simple, efficient data format in a

way that enables industry-wide data exchange.

Blue Button is becoming a broadly deployed,

easily adopted (inter?)national PHR.

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Keep data current

We need Blue Button apps

that make it easier to patients

to see whats going on

Enrich the

patient experience

We need Blue Button apps

that always have latest update

of patient records

To be fully successful, we have to


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Our purpose is to give patients better access to

and use of their Personal Health Information based

on Blue Button.

Improved readability and organization

Increased data portability

Easier mobile development Patient-Mediated Information Exchange

Blue Button for America


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For example, better presentation makes

the data even more meaningful

28Created by Thomas Goetz, used by permission


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Selected Blue Button partnersover 400 commitments on the ONC website


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VA Blue Button Additions (targeted for December 2012) VA Demographics VA Problem List VA Admissions and Discharges (including Discharge Summaries)

VA Notes (progress notes) VA Laboratory Results: (adds Microbiology) VA Vitals and Readings VA Pathology Reports: (Surgical Pathology, Cytology, Electron Microscopy) VA Radiology Reports

VA Electrocardiogram (EKG) Reports Self Entered Food and Activity Journals VA Continuity of Care Document (VA CCD)

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Coming soon: the complete medical record


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Follow Blue Button:

http://www.healthit.gov/bluebutton

http://www.healthit.gov/pledge/

http://wiki.siframework.org/Automate+Blue+Button+Initiative

http://presidential-innovation-fellows.github.com/bluebutton

Twitter: @ProjectBlueBtn

Follow development:

http://www.osehra.org

How to get engaged.
http://www.healthit.gov/bluebuttonhttp://www.healthit.gov/pledge/http://wiki.siframework.org/Automate+Blue+Button+Initiativehttp://wiki.siframework.org/Automate+Blue+Button+Initiativehttp://presidential-innovation-fellows.github.com/bluebuttonhttp://presidential-innovation-fellows.github.com/bluebuttonhttp://www.osehra.org/http://www.osehra.org/http://presidential-innovation-fellows.github.com/bluebuttonhttp://presidential-innovation-fellows.github.com/bluebuttonhttp://presidential-innovation-fellows.github.com/bluebuttonhttp://presidential-innovation-fellows.github.com/bluebuttonhttp://presidential-innovation-fellows.github.com/bluebuttonhttp://wiki.siframework.org/Automate+Blue+Button+Initiativehttp://wiki.siframework.org/Automate+Blue+Button+Initiativehttp://www.healthit.gov/pledge/http://www.healthit.gov/pledge/http://www.healthit.gov/bluebutton


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The future of health informatics is

open, deep, and blue

Open: we're moving from a world of proprietary, closed,and monolithic systems to a better one based on openarchitectures, standards and modular components

Deep: distinguishes the kind of data we have from "big";the progression to 2 million proteins and what thatmeans in terms of infrastructure, outcome, and scale

Blue Button: is it becoming the national platform for

personal health records, and is on the vanguard of theworldwide open data initiative


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the future of health informatics -nov 12 -five nations

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