Unlocking data is a key part of our efforts to transform our health care system into one that works better for all Americans.
AS PREPARED FOR DELIVERY
Thank you, Dana [Alexander]. I want to thank the HIMSS Board for inviting me to speak today, and especially Chair Dana Alexander and President Steve Lieber. This group is made up of some the most influential leaders in health care and we are lucky to have you as partners.
I’m honored to join you all, along with quite a few of our HHS team members. I have the pleasure of being surrounded every day by some of the best and most hard-working people in public service, and Karen DeSalvo and Andy Slavitt exemplify that level of excellence. I hope you will enjoy hearing from them on these important topics as well over the next couple of days.
While we are here, members of our HHS team are in Flint, Michigan, helping with the recovery efforts. Two weeks ago, I traveled there to see that work and to get a better understanding of the challenges families there are facing.
The town is still reeling from this breach of trust, but it’s on its way to recovery. The nation is watching now. But before the headlines, before the national spotlight, Dr. Mona Hanna-Attisha, a pediatrician at Hurley Medical Center, was fighting for the children of Flint.
Dr. Hanna-Attisha told CNN that, in August, she learned from a friend that the city wasn’t doing corrosion control to prevent lead in aging pipes from leaching into the water supply. She knew the danger lead posed and began what she called a “crusade” to find out if it was affecting children.
She began mining Hurley’s electronic health records to compare blood test results from more than 700 children in the area. By comparing records to children outside of her area, and mapping home addresses for geographic variations, she quickly discovered that the percentage of children in Flint with lead poisoning had doubled, and even tripled in some neighborhoods.
She said, “If we were still on paper, it would have taken forever to get these results.”
Engaged and Empowered Individuals
Dr. Hanna-Attisha’s story shows us the power of putting health care data to work. It allows us to see the connections in our communities and helps us put patients in the center of their care.
And unlocking that data is a key part of our efforts to transform our health care system into one that works better for all Americans. You may know this effort as Delivery System Reform. At HHS, we talk about it in terms of putting individuals in the center of their care.
We are working to create a system that delivers better care, spends our dollars more wisely, and supports healthier people. Because, at the heart of our efforts are the doctors and their teams who want to deliver the best possible care… and the patients who get put through the same tests over and over again… and the people, like the children of Flint, who need a doctor who can see the big picture and make changes at the community level.
We have a three-part strategy to make this transformation a reality:
The first thing we are focused on is changing the way we pay doctors and other providers so that we pay for quality of care, not quantity of service.
Next, we are improving care delivery by promoting coordination and integration, and helping doctors and patients prioritize wellness and prevention.
And finally, we are working to unlock health care data and information, so that providers are better informed and patients are empowered to be active participants in their care.
Health Care Information
And that last strategy is why we are here today.
Because, as you know, technology isn’t just one leg of the table. It’s a crucial support for all of these strategies.
Health care data is the language that patients use to tell the story of their health.
It’s the lines of the network that allow doctors and hospitals to connect to each other, as they work together for one patient, or for an entire patient population.
And for hospitals, cities, states, and those of us at HHS, technology is the lens through which we can see our communities’ health. It lets us envision goals and drive improvements.
We have made tremendous progress to bring health care into the 21st Century. In six short years, we have tripled the adoption of electronic health records. Today, three quarters of physicians are using them. And nearly every hospital uses EHRs, meaning that there is now a digital care footprint for almost everyone in this country.
But we still have work to do to get the real value of this information for providers and consumers. As we look at where our current way of doing things often falls short, it’s in three areas:
First, consumer access remains a challenge. It’s great to have an electronic record, but if that record can’t be easily accessed by doctors and patients because of clunky technology, then we aren’t consistently seeing the benefit.
Second, information is still too often knowingly or unreasonably blocked, whether because of business practices or misunderstandings of HIPAA. With these barriers, information is stopped from flowing seamlessly to support patients when and where it matters.
And finally, without agreement on a common data “alphabet,” our technology is stuck speaking different languages.
A Roadmap Forward
As we have seen, these improvements will allow us to move forward on creating a better, smarter, healthier health care system. And that’s why supporting these efforts is a top priority at HHS. We are committed to leading where we can and should.
We have laid out a clear path ahead, not just for federal partners, but for the nation as a whole, in the Nationwide Interoperability Roadmap. It identifies four critical pathways to a health system that empowers individuals to use their electronic health information to the fullest extent; enables the delivery of better care; and promotes innovation.
- We must demand interoperability: Connectivity, comparability, and data that is free to be put to good use—these are the foundation to the kind of system that is needed for lasting delivery system reform with better health for all.
- We have to speak the same language: Federally recognized, national standards for how the technology communicates and consistency in how that communication flows will put us all on the same page.
- Data moving should be private and secure: People should be able to easily and securely access their electronic health information and send it to any desired location. They need to be able to understand how their information can be shared and used. And they must be assured that this information will be effectively and safely used to benefit their health and that of their community.
- We need to work together to unblock data: Doctors should share individuals’ health information with other providers, whenever permitted by law. A patient should have the comfort of knowing that his doctor and his specialist can share information with one another to provide better care. And the policies and practices that impede this movement—like exorbitant fees, restrictive legal arrangements—halt our progress.
We’ve already taken a number of steps.
First, and most important to setting a strong foundation, we’ve advanced policy that requires publishing APIs [Application Programming Interface] to support the development of apps that are agnostic to the electronic health record underneath. So that means that anyone can pull together their electronic health information in one place regardless of the source.
To make sharing straightforward and clear, we’ve provided guidance on best practices by publishing the Interoperability Standards Advisory. We’ve done this work closely with leaders in the private sector.
And we’re using existing opportunities like the health IT certification program to ensure products do what they say they will and people know what they are purchasing. We are also working with Congress to find solutions and supporting innovation and transparency in the Health Insurance Marketplace.
We will keep pushing the frontier of this work, but we can’t, and should not do it alone. Sometimes the most important part of our job is to step back and let others take the lead.
That’s why I’m excited to announce today that companies that provide over 90 percent of electronic health records used by U.S. hospitals have stepped up and made public commitments to make data work better for consumers and providers. The nation’s five largest health care systems and more than a dozen leading professional associations and stakeholder groups have also made the pledge. Some of the biggest, most influential names in health care, including health care systems serving patients in 46 states, are standing up to become leaders in this progress.
Health IT developers like Cerner, Epic, and Meditech. Health care systems like HCA, Community Health Systems, and Ascension Health.
They also include leading consumer, provider and technology societies like the National Partnership for Women and Families, the American Academy of Family Physicians, the American Medical Association, and our gracious hosts today, HIMSS.
Together, they are helping us put patients first, through three specific commitments:
- They have agreed to make it easier for consumers to access their data, from test results to care progress to communicating with their providers. They are going to use standardized APIs so that user-friendly resources, like mobile apps, can quickly come to market and will be compatible with varied sources of electronic health information.
- They have agreed to not block information and allow data to move, unimpeded by barriers like fees and perceived legal restrictions.
- They have agreed to speak the same language: We’ve created a catalog of existing and emerging standards and implementation specifications to help our technology communicate. Our private sector partners have committed to using it.
Many of our great partners are here with us today, like the new Center for Medical Interoperability. This group, started by providers, plans to take its seat at the table to help beta test technologies and make sure they work for doctors on the ground.
That commitment to cooperation and innovation will help us build our health care system into one that works best for that patient who checks in to a hospital for high quality care.
Today’s commitments are a critical first step toward success on this front. I want to thank everyone who has stepped up and become a leader in this field.
From our end at HHS, we are committed to supporting our partners as best as we can.
We can all agree that the bedrock of an interoperable health information technology system is privacy and security. Cyber threats like those we’ve seen recently endanger our national security, financial security, and the privacy of millions of Americans.
This is especially true in health care, and that’s why Congress enacted legislation creating a task force focused on protecting the health sector from cyberattacks. The task force will bring together leading thinkers in government and the private sector to develop strategies for addressing our shared cybersecurity challenge. You can find out more about nominations on our website at hhs.gov.
And, as always, we are committed to listening to all of you. Your voices are crucial to this conversation and we want to know what you need from us, and how we can support your efforts.
In Flint, Dr. Hanna-Attisha was able to use technology to see dire patterns in her community. So I’d like to end with a story of another woman who used technology to see another big picture that was hidden, the story of her own health.
After going into anaphylactic shock in 2001, Kim Blanton suffered from a number of ailments. From near strokes, to blood pressure and blood sugar problems, to shortness of breath, Kim was in and out of ERs and hospitals more than 70 times from the spring of 2001 to the summer of 2007.
She had no sense of what a red flag looked like and didn’t keep records of medications or her reactions to them…so neither she nor her doctors knew that her heart failure medication was interacting poorly with her kidney medicine, making her condition worse.
But in 2007, something changed. She was able to take part in a program that teaches cardiac patients how to take care of themselves, and she began using an EHR to regularly post her blood pressure numbers and weight and gets analyses from her doctors. Her doctors also use it to alert her to preventive screenings and tests and communicate with her about her condition. She now has a better understanding of what’s going on and can take control of her health.
Thanks to this engagement, Kim’s health is better, and she no longer finds herself in and out of the ER. In fact, her most recent visit was in December 2014. She’s even a volunteer patient family adviser now, helping others better understand and use their care.
She recently said, “As we think about making our health care system better, it’s not enough to make changes for patients. We have to work with patients, putting them at the center of their care.”
Over the last six years, we have made tremendous progress to help make our health care system the best it can be from quality, to affordability, to access.
Since provisions of the ACA took effect, millions more Americans have been able to afford insurance—in fact, for the first time in our nation’s history, more than 90 percent of Americans have health coverage. And we’ve begun to transform the way we deliver and get care.
From the children of Flint to the Kim Blantons of the world, this transformation is about building a system that puts patient health first. That helps them live better lives. Thanks to you all and the work you are doing every day, we are getting closer to our mission of a better, smarter, healthier way to deliver care. And Americans across this country are reaping the benefits.
Thank you all for your work, and I look forward to all that we will accomplish together—this week and beyond.