Value Cases: AHIC's New Artifact

In January 2009, the AHIC Successor Organization (AHIC) will be relaunched with a new name and a new primary artifact: Value Cases. Value Cases will be used by AHIC 2.0 to "prioritize health IT initiatives and syndicate the cost of interoperability." Catch that? Syndication.

So what exactly is a Value Case? Laura Miller, interim Executive Director for AHIC, discussed Value Cases with the National Committee of Vital and Health Statistics on November 18.

A Value Case "describes an opportunity for information exchange within the context of an interoperability roadmap illustrating specific scenarios for interoperability (similar to a use case) and demonstrates a case for action based technical, business, and societal risk adjusted value. Specifically, a Value Case presents the costs, value, and risks of implementing the specific scenario and describes potential measures of actual impact on improving care. Once recognized, it commits the submitting organization to fund and execute actions necessary to implement the case."

AHIC prioritization will be based on an overall interoperability strategy maintained byAHIC. A call for Value Cases from the healthcare community will begin in January 2009. Decisions on national priorities for this first round will be made in September 2009 with recommendations from expert committees (committees such as "Genomics, Chronic Disease Management or Clinical Research").

HITSP and CCHIT will continue their roles in standards harmonization, standards development and certification, with HITSP transitioning to work on Value Cases in 2010.

News Analysis

This can't possibly work, can it? Pay for interoperability?

It willl work for the big players. The big Healthcare IT businesses will quickly grasp the opportunity to differentiate themselves through first-to-market leadership on carefully crafted Value Cases. Big payers will look for the opportunities to drive down cost related to the chronically ill and to the revenue cycle, among others. Innovation and cost reduction are important to healthcare nationally and will be well funded.

However, key national priorities related to population health management and needs of underserved populations don't necessarily have the financial backing to support syndication. AHIC recognizes that "Public Good Value Cases" may require "scholarship" funding. This is a crucial component to gain support across the broader healthcare community and may be the litmus test of the effectiveness of the new AHIC.

Mobilizing Personal Health Information - Consumer Perspective

How will consumers "mobilize" their personal health information?

On July 29, the American Health Information Community (AHIC, "The Community") examined how consumers may access, use and share their personal health information (PHI). This article highlights the consumer perspective.

Utility Service Model

John Moore from Chilmark Research compared several business models for PHI delivery. These include: 1) Consumer approach to manage health, 2) Employer and healthplan approach to reduce costs and manage risks, 3) Provider approach for consumer (patient) retention, and 4) Utility service model approach to "create an ecosystem".

The utility service model consolidates multiple data sources into a secure repository available to multiple applications and services. This model scores very well, with the notable exception of portability which is "under development". Moore scored the utility service model as the only approach with the potential for high rates of adoption.

Consumer Interest

Carol Diamond of Markle Foundation's Connecting for Health organization surveyed public attitudes towards Personal Health Records (PHR). Markle's survey found only 13.5% of respondents very interested in using a free web-based PHR and another third somewhat interested.

Markle contends that the establishment of privacy and information practices are critical to consumer PHR adoption.



















Markle's Connecting for Health Common Framework and Framework for Networked Personal Health Information define clear "price of admission" requirements for PHR adoption, but are they sufficient to achieve adoption?

Standards and Interoperability
Connectivity with healthcare organizations will be required to make PHR's easy to access and manage. Jeff Blair, Lovelace Clinic, made the case for the Nationwide Health Information Network and standards based interoperability as foundational elements to achieve adoption.

Editorial comment: Where are the incentives?
The one missing ingredient in all of this: financial incentives for patients and providers. Why are payers and employers more interested in PHR adoption? They are dealing with the pocketbook issues of how population health affects their P&L.

Personalized Health Care doesn't get more personal than this

On Tuesday of this week, with little notice from the healthcare IT press, the Personalized Health Care workgroup (co-chairs are Doug Henley and John Glaser) presented its recommendations related to pharmacogenomics to AHIC.

Personalized health care focuses on genomics, specifically the identification of genes and relationship to drug treatment, to allow for tailoring of medical treatment. HHS had established two broad goals for Personalized Healthcare in their September 2007 announcement:

1. Provide federal leadership supporting research addressing individual aspects of disease and disease prevention with the ultimate goal of shaping preventive and diagnostic care to match each person’s unique genetic characteristics.
2. Create a “network of networks” to aggregate anonymous health care data to help researchers establish patterns and identify genetic “definitions” to existing diseases.

The broad charge of the Personalized Health Care Workgroup is to "establish a common pathway based on common data standards to facilitate the incorporation of interoperable, clinically useful genetic/genomic information and analytical tools into electronic health records to support clinical decision-making for the clinician and consumer."

The workgroup reported that pharmacogenomics' use in clinical practice has been slow due to:

• "Lack of an evidence-base and information on clinical utility
• Lack of clinical guidelines for the use and interpretation of pharmacogenomic tests in pharmaceutical selection and treatment decisions
• Impediments to reimbursement for the performance of laboratory tests
• Paucity of clinical practice experience with pharmacogenomic test"

The workgroup's June 3 recommendations include:

1. EHR Standards to Enable Clinical R&D: Expand standards to include pharmacogenomics data, within the context of informed consent and privacy considerations. Establish EHR minimum data sets to support clinical interventions based on pharmacogenomics data with demonstrated clinical validity and utility. Pilot unidirectional flow of this information from EHRs for clinical research.
   
2. Clinical Decision Support: As Clinical Decision Support (CDS) approaches and standards are integrated into healthcare IT, the implications of pharmacogenomics should be taken into account.
3. Medication Prescribing: HHS should work with stakeholders to document challenges, opportunities and information flows related to dispensing pharmaceutical drugs based on pharmacogenomic test-derived interpretations.
   

The workgroup contends that these actions will encourage physician adoption of pharmacogenomics.

Making Sense of National Healthcare IT

Avance Health Analysis

Recent news of HITSP's submissions to The Community (AHIC) June meeting, prompted a reader to ask: How do the various national healthcare initiatives (AHIC, HITSP, HHS, CCHIT and NHIN) fit together?

Is the relationship between these organizations Rube Goldberg-esque? Or is there some more coherent design?



The mission of American Health Information Community ("The Community" or AHIC) is to provide "input and recommendations to the Department of Health and Human Services (HHS) on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected in a smooth, market-led way." AHIC is presently reorganizing itself to ensure its viability beyond the term of the current administration, by establishing "AHIC 2.0" as a sustainable public-private organization. AHIC is the focal point for guidance to HHS on priorities for interoperability and develops the use cases for these priorities.

The Healthcare Information Technology Standards Panel (HITSP) mission is to "harmonize and integrate standards that will meet clinical and business needs for sharing information among organizations and systems." HITSP takes its guidance on priorities and use case definition from AHIC and proposes standards (like those to be presented today at the AHIC June 2008 meeting) to the HHS Secretary.

The HHS Secretary can accept the recommendations which starts the clock on a one year cycle of testing and implementation. At the end of this cycle, the HHS Secretary can choose to "recognize" these standards. Once standards are recognized, by Executive Order, they are incorporated into new Federal Systems and Healthcare Contracts.

Recognition of these standards also serves as input to the Certification Commission for Healthcare Information Technology (CCHIT). CCHIT is a recognized certification body (RCB) for Electronic Health Records (EHR) with the goal of accelerating EHR adoption. CCHIT establishes its roadmap and criteria for Electronic Health Records based in part on the recognized standards from the HHS Secretary.

These recognized interoperability standards are also incorporated by the Nationwide Health Information Network (NHIN), a network of networks promoting Health Information Exchange.

HITSP keeps on rolling

Chair of HITSP, Dr. John Halamka, announced that he will be presenting 4 new harmonized interoperability specifications to Health Human Services Secretary Leavitt and the American Health Information Community (AHIC) at the June 3 AHIC meeting. These specifications focus on Medication Management.





These specifications and definitions include:

Medication Dispensing Status provides a medication prescriber the dispensing status of an ordered prescription (dispensed, partially dispensed, not dispensed).

Medication Orders defines the transactions between prescribers (who write prescriptions) and dispensers (who fill prescriptions)

Medication Formulary and Benefits Information performs two tasks: 1) performs eligibility check for a specific patient's pharmacy benefits and 2) obtains the medication formulary and benefit information.

Patient Generic Health Plan Eligibility Verification provides the status of a health plan covering the individual, along with details regarding patient liability for deductible, co-pay and co-insurance amounts for a defined base set of generic benefits or services. The base set of benefits includes coverage status and patient liability for medical, chiropractic, dental, hospital inpatient, hospital outpatient, emergency, professional physician office visit, pharmacy and vision services that are included in the patient's generic health plan benefit.

Dr. Halamka announced he will also be presenting a technical note on Document Reliable Interchange to support a secure communication of a clinical document over a network.