John D. Halamka

See the following -

Halamka on China's Expanding Healthcare System

On Monday and Tuesday I met with government, industry, and academic stakeholders  in Qingdao and Shenzhen China to discuss healthcare technology,  patient empowerment, and process improvement in the rapidly expanding Chinese healthcare system. Over the past few years, I’ve watched the Chinese government gradually change policy - from promoting a fully public healthcare system, to limited pilots of private facilities, to embracing public/private partnerships... Read More »

Halamka on Enabling Nationwide Interoperability

...recently, the ONC Interoperability Roadmap, recognizing that the building blocks of universal interoperability could not be so neatly erected, leans on the idea of “coordinated governance” of networks. While these frameworks have paid homage to the concept of nationwide network as a “network of networks”, we have yet to crisply define the stitching needed to form this nationwide network quilt. This issue hasn’t been so pressing up until now because there were relatively few networks – the “last mile” problem was the bigger concern. Network formation is evolving rapidly, however, which has made more pressing the question of what it means to connect networks in a uniform way.

Halamka on MU3 Regs: The Good, The Bad, and the Ugly

On Friday March 20, CMS released the Electronic Health Record Incentive Program-Stage 3 and ONC released the 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Perhaps the most important statement in the entire 700+ pages is the following from the CMS rule:  "Stage 3 of meaningful use is expected to be the final stage and would incorporate portions of the prior stages into its requirements."

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Halamka on the Most Important Interoperability Story of 2016

You may have missed or not understood the implications of this press release.  Here's a guest post from Micky Tripathi, the CEO of the Massachusetts eHealth Collaborative that explains everything you need to know: "This summary provides some additional information on the recently announced interoperability agreement between CommonWell and The Sequoia Project (Carequality).  For full disclosure, I am on the Board of Directors of The Sequoia Project, a contractor to CommonWell, and participated in the discussions leading to the agreement.  The description below does not necessarily reflect the views of either of these organizations or any of the named vendors...

Halamka on the November HIT Standards Committee

The November HIT Standards Committee included a comprehensive review of the CMS Meaningful Use Stage 3/Modification Rule and the ONC 2015 Certification Rule.
We begin the meeting with a presentation from Robert Anthony of the Meaningful Use Stage 3 and Modification Rule. A robust discussion followed. Issued raised as those similar to the ones I identified in previous blog posts. The main concern was the alignment of the CMS Meaningful Use rule with future pay for performance criteria that will be part of MACRA/Merit-based Payment Incentive programs.

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Halamka on The ONC 2015 Certification Rule

Just as I summarized the CMS Meaningful Use Final Rule last week, this week I’ll summarize the 560 pages of the ONC 2015 Certification Final Rule. Key points to understanding the rule include...The 2015 Certification Rule is decoupled from Meaningful Use. Thus, you’ll find functionality to support EHR Incentive Programs plus  several certification criteria for long-term/post-acute care, chronic care management, behavioral health,  and other programs such as merit-based incentive payments  (MIPS).

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Halamka on the ONC Blockchain Challenge

Early this year, I posted a collaborative discussion about the potential applications of Blockchain for healthcare. Ariel Ekblaw from the MIT Media Lab collaborated with Beth Israel Medical Center (BIDMC) to actually implement Blockchain medication reconciliation with deidentified patient data. ONC selected it as a winner of the Blockchain Challenge. The idea is simple. Blockchain was invented to handle financial transactions such as deposits and withdrawls. Medication management is very similar to a bank account. Think of your body as a vault.

Halamka on What's Next for Electronic Health Records

With the Department of Justice announcement of the $155 million dollar eClinicalWorks settlement (including personal liability for the CEO, CMO and COO), many stakeholders are wondering what’s next for EHRs. Clearly the industry is in a state of transition. eCW will be distracted by its 5 year corporate integrity agreement. AthenaHealth will have to focus on the activist investors at Elliott Management   who now own 10% of the company and have a track record of changing management/preparing companies for sale. As mergers and acquisitions result in more enterprise solutions, Epic (and to some extent Cerner) will displace other vendors in large healthcare systems. However, the ongoing operational cost of these enterprise solutions will cause many to re-examine alternatives such as Meditech...

Halamka on Why he Disagrees with the "Snake Oil" Analogy

Earlier this week, the American Medical Association CEO called digital healthcare products modern-day "snake oil." As a provider and a technologist, I think we need a deeper dive to understand the issues, avoiding the kind of hyperbole that’s so common in politics today. Paul B. Batalden, MD, Senior Fellow, Institute for Healthcare Improvement (IHI), once said “Every system is perfectly designed to get the results it gets”. Let’s take a brief look at the history of national healthcare IT efforts from 2004-2016 to understand how we’ve achieved exactly the results we designed.

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Halamka Outlines Social Media Guidelines for Beth Israel Clinicians

We recently published this guideline at Beth Israel Deaconess Medical Center (BIDMC) based on the input from a multi-disciplinary working group. I thought it might be useful to share with the community, since many healthcare organizations are at the early stage developing social media policies...We receive reviews on all our social media sites. Some are informal, like a tweet. Some are formal reviews, like on Facebook, Yelp, Google+, etc. BIDMC monitors all sites 24/7 using a social media dashboard. To maintain our integrity, BIDMC follows the same social media guidelines as the universal online community. This means...

Halamka Outlines the Pillars of Beth Israel's IT Strategic Plan

Communicating the IT strategic plan is one of the primary responsibilities of a CIO. Most importantly, the IT strategic plan should be seen as an enterprise wide activity and not just an IT centric exercise.  IT should be an enabler for the strategy of the business and every IT tactic should tie back to a high priority of the business. In 2016, the BIDMC IT strategic plan has five pillars that align with quality, safety and efficiency imperatives (instead of Meaningful Use, ICD10, and the Affordable Care Act as was the case 2013-2015). The pillars are:

Halamka Pays a Visit to Oscar Health

Today I’m in New York City visiting Oscar Health, on my continuing quest to determine how best to integrate digital platforms, patient-family engagement, and care coordination in preparation for MACRA/MIPS and the transformation from fee for service to alternative payment models. At the moment, there is no single magic bullet, but there are early innovations that hold promise. At BIDMC we’ve thought the best approach to care management is to identify a cohort with a disease, then enroll that cohort in a program which involves tracking progress against guidelines/protocols, deploying telemedicine/visiting nurses, and measuring data from home-based devices...

Halamka Reports on the Progress on Interoperability Made by the HIT Standards Committee

The March 2015 HIT Standards Committee was one of the most impactful meetings we have ever had. No, it was not the release of Meaningful Use Stage 3 or the certification rule. It was the creation of a framework that will guide all of our work for the next several years - everything we need for a re-charted standards harmonization convening body as well as a detailed interoperability roadmap, complementing the 10 year general plan developed by ONC. Thanks to Arien Malec for yeoman’s work in both areas...

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Halamka Says We Can and Must Improve Healthcare Management

As a physician and CIO, I’m quick to spot inefficiencies in healthcare workflow.  More importantly, as the care navigator for my family, I have extensive firsthand experience with patient facing processes. My wife’s cancer treatment, my father’s end of life care, and my own recent primary hypertension diagnosis taught me how we can do better. Last week, when my wife received a rejection in coverage letter from Harvard Pilgrim/Caremark, it highlighted the imperative we have to improve care management workflow in the US. Since completing her estrogen positive, progesterone positive, HER2 negative breast cancer treatment in 2012 (chemotherapy, surgery, radiation), she’s been maintained on depot lupron and tamoxifen to suppress estrogen...

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Halamka Sets Healthcare Innovation Priorities for 2017

As we begin 2017, what should be the focus of our work over the next year?... Regardless of the policies, repeals, and delays of the Trump administration, we’ll still need to optimize usability and support the four goals of value-based purchasing - quality measurement, total medical expense management, practice process improvement and technology adoption. BIDMC has already created a prototype of groupware documentation and we should complete our next generation inpatient documentation solution by mid 2017. Part of that work incorporates open source secure texting as part of the medical record. We’re also piloting Google’s G-suite so that our stakeholders can store/share, collaborate, and communicate on any device from anywhere using only a browser...