The Future of Health Informatics -Nov 12 -Five Nations
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Transcript of 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
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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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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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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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