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July 01 2010

The potential of Healthcare.gov


The Department of Health and Human Services continues its rapid
roll-out of new data initiatives that bring ordinary Americans
digitally into the heart of the health care system. Today, HHS
announced the latest in these open government projects, which
collectively provide excellent examples of the goals behind opening up
data--not data for data's sake, but data as a tool people can use to
get more involved in policy, have an impact on civic life, and
hopefully make their own lives better along the way.

Healthcare.gov grows out of a
requirement passed as part of the recently-passed health bill, the
Patient Protection and Affordable Care Act. The site features a
searchable compendium of health care insurance options, public and
private, ranging from any applicable private plans to children's
coverage (CHIP), Medicare, Medicaid, and high-risk pools. So far as
HHS knows, this is the first web site combining public and private
options from across the country.

Those of us who have compared insurance plans know that each company
combines options in different ways, defines terms differently, and
makes it as hard as possible overall to compare their plan to any
other. We get the impression that the problems of data filtering and
curation would be easier to solved for the Search for
Extra-Terrestrial Intelligence or sequencing the human genome than for
choosing the best insurance plan.

Healthcare.gov takes some big steps toward clarity in the area of
health insurance. I had a chance to talk to Todd Park, the CTO of HHS,
about the new site, and based this blog partly on his description and
partly on a couple sample runs.

Currently, you visit the site and answer a short series of questions.
Based on your answers, it then searches its inventory of potential
coverage choices to produce a customized menu of options that may be
right for you. The site supports over three billion potential
personal scenarios (potential combinations of answers to the site's
questions) in all.

I tried walking through the site with two typical scenarios. In the
first I came in as a typical graduating college student with no job. I
answered six questions and found seven options, ranging from Medicaid
to the high-risk pool and signing on with my parents' plan.

In the second scenario, I answered six questions as the self-employed
head of a family with a middle-class professional income. I turned up
a few dozen plans from eleven vendors along with state-specific
information. When I clicked on a private vendor, I saw a list of their
plans with three links to key sets of information on each plan:

  • View Plan Benefits

  • Check For Your Doctor

  • View Drug Coverage

Each link took me to the health care provider's site, so
Healthcare.gov served here as a referral service without helping me
compare plans. That's going to improve. Starting in October,
HealthCare.gov will also include price estimates for private insurance
plans, along with more detailed information on deductibles,
coinsurance, and copayments. This will cut through a lot of the
complexity caused by the variation I mentioned before in company
plans, and enable consumers to make head-to-head cost comparisons
between plans.

The private insurance plan data on HealthCare.gov comes from a
market-wide data request HHS issued to all insurance carriers. Over
one thousand insurance carriers, offering many thousands
of plans, are represented on the site.

Other features of Healthcare.gov include:

I actually think the search function, if it produces useful, practical
results, will do more to explain the health care law than any text.
Because most people (myself included) didn't read the bill, they had
no way to tell what it meant for them and their families. Hence the
widespread distaste for a bill that makes life materially better for
many of the people who carp about it.

Healthcare.gov will (for the first time on any website) let people
evaluate different options, both private and public, and find out some
of what they actually get from Patient Protection and Affordable Care
Act. (I am not, by the way, embracing this bill as the best feasible
approach to health care. I'm just saying that it has tangible effects
on people's access to health care, making available new options that
were closed off to them before.)

Another bit of unfinished business is the format of Healthcare.gov's
data, which is available through a search but not yet downloadable
through an API. That feature is on the HHS to-do list. Some other data
from HHS--including the href="http://www.hhs.gov/open/datasets/data_sources.html">huge,
recently released set--will be available in December through a
"health indicators clearinghouse."

The American Recovery and Reinvestment Act, and now the landmark
health care bill, have brought burdens as well as opportunities to
health care providers and the public. HHS has shown a sensitivity to
the needs of those affected by the bills, and a responsibility to make
it easier for them to get its benefits. That responsibility drove its
creation of the href"=http://www.connectopensource.org/">CONNECT project, which I
discussed in a recent href="http://radar.oreilly.com/2010/06/from-apache-to-health-and-huma.html">interview,
and the derivative NHIN Direct
project, the topic of another href="http://radar.oreilly.com/2010/06/giving-patient-data-meaningful.html">interview.
while those reach out to health care providers, the new data sites
serve everyone.

May 19 2010

What I like about the health care technology track at the Open Source convention

OSCON Conference 2010The href="http://www.oscon.com/oscon2010/public/schedule/topic/Health">list
of sessions at the Open Source convention's health care track was
published this week. We found it wonderfully gratifying to get so many
excellent submissions in the brief three weeks that the Request for
Proposals was up. Although the credentials of the presenters cover a
lot of impressive accomplishments, my own evaluation focused on how
the topics fit into four overarching areas we're following at
O'Reilly:

  • Patient-centered records, education, and activity

  • Mobile devices to collect and distribute health care information

  • Administrative efficiencies, which could range from automating a
    manual step in a process to revising an entire workflow to eliminate
    wasteful activities

  • The collection, processing, and display of statistics to improve
    health care

Our OSCon track has something to say in all these areas, and lots
more. Here's what I like about each of the proposals we chose.

  • Nobody sees just one doctor or stays in just one hospital. So one of
    the pressing needs in health care is to remove the barriers to
    exchanging patient records, while ensuring they go only to authorized
    recipients. A project called the Nationwide Health Information Network
    (NHIN), currently run by the U.S. Department of Health and Human
    Services, acts as a broker for the authorizations and data exchanges
    between health care providers.

    NHIN has taken on a new excitement over the past couple years for two
    reasons involving the two great motivators in policy work: people and
    money. The people-based motivator came when HHS opened up key parts of
    the NHIN software and actively built a nationwide community to make it
    more usable. The money-based motivator came from the federal stimulus
    bill, which allocated billions to promote electronic records and data
    exchange.

    HHS's Office of the National Coordinator handles implementation of the
    stimulus bill. Their schedule for payments (and penalties too, in the
    case of providers accepting Medicare and Medicaid) is aggressively
    short, making progress urgent. NHIN work includes two major
    initiatives taking on the challenge of data exchange.

    The first initiative is NHIN CONNECT, a platform for interconnecting
    the patient health data systems of hospitals, health care providers,
    and federal health agencies. David Riley and Brian Behlendorf,
    contractors to HHS on this project, href="http://www.oscon.com/oscon2010/public/schedule/detail/13257">will
    recount the steps in creating a robust community around
    CONNECT. Will Ross will give us the view from the ground, as a href="http://www.oscon.com/oscon2010/public/schedule/detail/14944">regional
    Health Information Exchange sets up and carries out data transfers
    among clinics in a rural area. Nagesh Bashyam will give more href="http://www.oscon.com/oscon2010/public/schedule/detail/15267">insight
    into the CONNECT development process.

    The second initiative is a new project called href="http://nhindirect.org/">NHIN Direct, which is focused on a
    more "push"-oriented approach to secure messaging in the healthcare
    industry. Its core principles include "rough consensus and running
    code", and is on a breakneck pace to get from user stories to
    production implementation by the end of the year. Arien Malec, a
    health IT industry entrepreneur who leads the NHIN Direct effort as a
    contractor to HHS, will describe href="http://www.oscon.com/oscon2010/public/schedule/detail/15304">the
    history and mission of the project.

  • The Veterans Administration went over a ten- or fifteen-year period
    from being one of the least satisfactory health care providers in the
    US to one of the most highly praised. Its classic electronic medical
    system, VistA, is a key component of that success, and VistA has been
    open source for several years. None of the leading-edge initiatives
    mentioned earlier in this blog can be accomplished without an
    electronic medical system, and proprietary ones have the disadvantages
    not only of high cost but of being silo'd. Open source systems
    facilitate both innovative enhancements and data exchange.

    Ben Mehling href="http://www.oscon.com/oscon2010/public/schedule/detail/15255">will
    introduce VistA, its open source distributions, and how community
    contributors are adapting it to civilian use. Joseph Dal Molin
    will show href="http://www.oscon.com/oscon2010/public/schedule/detail/15274">how
    it improves patient care and the health care delivery
    process. David Uhlman will continue the discussion with href="http://www.oscon.com/oscon2010/public/schedule/detail/15252">lessons
    from working with VistA code.

  • OpenEMR is one of the most
    ambitious projects started by an open source community in health care.
    Like VistA, OpenEMR is being prepared for certification along the
    "meaningful use" criteria defined by HHS, so doctors can get federal
    funds for using it. Tony McCormick and Samuel Bowen href="http://www.oscon.com/oscon2010/public/schedule/detail/14893">will
    talk about advances in OpenEMR.

  • In an age where people are talking back to the experts and striving to
    gain more control as consumers, citizens, and patients, we can no
    longer treat health care as a one-way delivery system administered by
    omniscient, benevolent providers. Sam Faus will describe a href="http://www.oscon.com/oscon2010/public/schedule/detail/15275">open
    source system for maintaining and delivering data to
    patients. Teddy Bachour will cover href="http://www.oscon.com/oscon2010/public/schedule/detail/14952">APIs
    and open source toolkits from Microsoft for clinical documentation and
    sharing of patient records
    , and Roni Zeiger will cover href="http://www.oscon.com/oscon2010/public/schedule/detail/15272">how
    Google Health's API facilitates interactions with mobile devices,
    thus supporting one of the key trends in health care mentioned earlier
    in this blog.

  • Scientific research can deliver almost futuristic advances in health
    care, although the gap between promising lab results and effective
    treatments is always frustrating and difficult to bridge. In addition,
    statistics are critical for clinical decision support, now popularized
    under the term "evidence-based medicine."

    Melanie Swan shows how to href="http://www.oscon.com/oscon2010/public/schedule/detail/13943">bring
    ordinary people into the research process in genetics. Chris
    Mattmann, David Kale, and Heather Kincaid will describe a href="http://www.oscon.com/oscon2010/public/schedule/detail/15279">partnership
    between NASA and Children's Hospital Los Angeles to master and
    harness the recalcitrant mass of clinical data and data formats.
    Thomas Jones will talk about an href="http://www.oscon.com/oscon2010/public/schedule/detail/14931">open
    source system to link patient information with research to improve
    care.

  • Medicine is moving from coarse-grained, invasive treatments such as
    surgery and drugs to subtler, data-driven interventions using a
    variety of devices. Karen Sandler will describe a href="http://www.oscon.com/oscon2010/public/schedule/detail/13978">personal
    experience that led her to a campaign for open source medical
    devices.

  • Privacy is one of the touchiest subjects in health care. Few of us
    risk real harm--such as losing our jobs or having our names splayed
    across tabloid headlines--from privacy breaches, but there have been
    instances of snooping and embarrassing breaches that make us skittish.

    Thomas Jones will describe
    efforts to secure patient records in the Netherlands
    and how they
    can apply to US needs. The talk shows the potential that comes from
    giving patients access to their records, as well as the the advanced
    state of some foreign initiatives in health care are.

  • While we argue over access and costs in the US, most of the world has
    trouble seeing a doctor at all. Dykki Settle and Carl Leitner will
    describe href="http://www.oscon.com/oscon2010/public/schedule/detail/15268">tools
    that can help underserved areas recruit and manage critical health
    care staff. The talk will be a sobering reminder of the state of
    health care across continents, and a ray of hope that technology
    offers even in situations of great deprivation. The talk is also an
    illustration of the use of technology to improve an administrative
    process.

  • Fred Trotter, a long-time leader in open source health care, and open
    source advocate Deborah Bryant will provide overviews of href="http://www.oscon.com/oscon2010/public/schedule/detail/14856">open
    source health care IT. David Uhlman summarizes href="http://www.oscon.com/oscon2010/public/schedule/detail/15242">open
    source technologies for interpreting health care data.

The health care track takes a proud place as part of a href="http://www.oscon.com/oscon2010/public/schedule/grid">huge,
diverse conference program at this year's Open Source
convention. I'm sure discussions at the sessions and BOFs will
reveal connecting threads between health care IT and the other classic
open source topics at the conference.

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