Last week at Harvard Kennedy School, we hosted a roundtable of several dozen healthcare leaders to discuss how better use of data can lead to improved care, smarter spending, and healthier people.
By conversation’s end, leaders from a dozen public and private sector organizations pledged a number of tangible steps to make data more open and to use it to keep people healthy. As we have said previously, data can be thought of as infrastructure and as “fuel” for new technology-enabled products and services. In health care specifically, one important use of data will be by population health management organizations to coordinate care and proactively keep people from getting sick.
U.S. Health and Human Services (HHS) Secretary Sylvia Burwell’s recent “Better, Smarter, Healthier” call to action boldly sets a goal to move 50 percent of Medicare payments from fee-for-service toward value-based alternatives by 2018, and with it, usher in an era of better care coordination and quality improvement.
With this and broader commercial shifts toward population health in mind, roundtable participants ranked the opening up of electronic health records data among the top priorities for collaboration. While the federal government has invested tens of billions of dollars to accelerate the deployment of electronic health records, interoperability between most systems isn’t yet working well at scale.
But there are signs of progress, and a path forward, as outlined by a HHS-commissioned report on health data infrastructure and a new HHS strategic plan for interoperability. Building on these visions, and under the leadership of HL7, a leading health IT standards body, a number of health IT vendors, hospitals, and medical organizations have come together to develop a common specification (Fast Healthcare Interoperability Resource, or FHIR) to enable expanded sharing of electronic health records. This will make it easier for software (such as the electronic health record system at a different hospital, or your smartphone health app) to access your data privately and securely.
A promising effort to put these standards into practice was an announcement last December by key stakeholders of an open, industry-led “code sprint” to support a first-generation FHIR-based application programing interface (API). “Project Argonaut,” as this effort is called, is thoughtfully summarized by participant David Kates in this recent article.
At last week’s roundtable, Project Argonaut manager Micky Tripathi described the open program that welcomes health systems, health IT vendors, app developers, and the general public to access the underlying code, implementation guides, and testing infrastructure. Many are taking up this offer.
Innovative health systems throughout the country are committing to participate, including Beth Israel Deaconess Medical Center (Boston, MA), whose CIO, Dr. John Halamka, had helped convene the sponsors, Boston Children’s Hospital, which pioneered and prototyped SMART-on-FHIR (one of the enabling technologies incorporated into Project Argonaut) in 2012, Geisinger Health System (Danville, PA), whose SMART-on-FHIR app is already available through its commercialization partner, xG Health Solutions, Hackensack University Medical Center (Hackensack, NJ), and Jefferson Health System (Philadelphia, PA).
Equally important are new applications to empower patients and providers by enabling “plug-and-play” connectivity for applications adhering to the proposed standards. Roundtable participant Health 2.0 has pledged to evangelize and recruit app developers through its many participatory channels, including conferences, developer workshops, and its challenge platform. CEOs from RxREVU, a prescription intelligence service, PicnicHealth, a Y-Combinator alum focused on helping patients organize their records, Healthloop, a patient-provider communications platform, Act.md, an operating system for promoting effective and efficient team-based care, and NavHealth, a service to help anticipate and inform a patient’s journey, all pledged to implement and share feedback on the Argonaut specifications.
And in a sign of growing interest, prominent health IT and tech firms are also committing:
- A coordinated demo organized by Argonaut sponsor The Advisory Board Company and inclusive of fellow sponsors Epic, Cerner, athenahealth, and others demonstrating the viability of Argonaut specs at HIMSS;
- eClinicalWorks, a vendor of electronic health records, also pledged to support its customers in the implementation of the Argonaut specs;
- Independence Blue Cross (IBC) and NaviNet will conduct a pilot to exchange patient information between Independence Blue Cross’s data warehouse and hospital electronic medical record systems using NaviNet Open’s clinical information exchange software and FHIR technology. Independence Blue Cross wants to develop efficient clinical data exchange methodologies for coordinating care, delivering care gaps, conducting outcomes research and building predictive algorithms for personalized care;
- Apigee, an intelligent API management platform company, is implementing an “Early Adopter Program” to accelerate the adoption of the Argonaut specs and commits to open source the FHIR connectors it will build for existing systems;
- Start-up Amida Technology pledged to support Argonaut by integrating the FHIR standard into its publicly available software, the Blue Button Data Reconciliation Engine, which makes it easier to download and use your personal health information; and
- Intel has pledged support for Argonaut as a demonstration of its continued commitment to innovating an ecosystem of open APIs, standards-based data exchange, and intuitive experiences for its developers and implementers.
We were equally impressed by CMS’ entrepreneur-in-residence, Mark Scrimshire, who personally pledged to work on “Blue Button on FHIR” as noted in his blog following our meeting. That commitment to action summed up the spirit of our roundtable.
Aneesh Chopra and Nick Sinai
Walter Shorenstein Media and Democracy Fellows
Shorenstein Center for Media, Politics and Public Policy
Harvard Kennedy School
Disclosure: Aneesh Chopra serves as an Advisor to The Advisory Board Company (and in this capacity, serves as an alternate member of the SMART Advisory Committee), Apigee, and is co-founder and President of NavHealth.