Effective information sharing will require medical record interoperability between not only the large government health care providers such as the Department of Veterans Affairs (VA) and DoD’s Military Health System (MHS), but also all major third-party commercial systems. The agencies need new tools to allow for greater electronic record interoperability across different electronic record systems. Additionally, patients need access to their health records so that they can personally participate in their own healthcare treatment decisions, which is where joint iEHR project come in, as does the “Blue Button” initiative to enable veterans to download copies of their personal health records.

HITECH and ACA will enable big data tools
Two major legislative initiatives have supported healthcare reform over the last several years: The Health Information Technology for Economic and Clinical Health (HITECH) Act, initiated under the American Recovery and Reinvestment Act of 2009, and the Patient Protections and Affordable Care Act (ACA) of 2010.

HITECH focuses on the supply side of healthcare services by laying the foundation for a de facto nationwide, interoperable, private, and secure electronic health information system. It requires healthcare provides to make meaningful use of their electronic records, financially rewards hospitals, physicians, and healthcare professionals for using EHRs through the Medicare and Medicaid reimbursement system. HITECH also includes necessary standards and certifications for electronic records, without which EHRs will do little to improve actual health of individuals and achieve efficiency in overall care across our health system. These standards enable health data to flow freely, privately and securely.

[Big data and public health, part 2: Reducing unwarranted services.]

The ACA, for its part, gets at the demand side of healthcare. It focuses on making sure that nearly all Americans are covered by affordable health insurance and have access to quality care. Its goal is to reduce the amount of cost-shifting that goes on within the healthcare system to cover the acute emergency care of individuals without health insurance and without the ability to pay for their healthcare costs.

Together, HITECH and ACA are enabling a private healthcare system that provides for standards of healthcare record interoperability and will enable the use of big data tools to supply innovative improvement in the use of health IT to reduce cost and improve the quality of healthcare. While both of these Acts are important to the current national effort at healthcare reform, it is primarily the HITECH – which is not part of the Supreme Court case – that is driving the implementation of next-generation health IT and big data systems through the mandated meaningful use criteria for EHRs.

Use case: VA transforming care via informatics
The VA, as a major provider for health care delivery, is interested in reducing the diagnostic, prescription errors, and performance variance across their healthcare delivery sites. The VA began a major initiative established by Secretary Shinseki in September 2010 to Transform Health Care Delivery through health informatics. The initiative will provide the foundational IT and informatics components for VA’s transition from a medical model to a patient-centered model of care. Big data tools will be critical to improving quality and lowering cost of care.

A key part of this initiative is to build a Health Management Platform (HMP) to Transform Patient Care. HMP will integrate health informatics and IT to the next generation of browser-based EHR. This platform will be the basis for VA’s ability to use big data tools across the entire VA EHR.

[Part 1: How to harness Big Data for improving public health.]

The new HMP will comprise infrastructure and clinical functionality that focuses on increasing patient engagement and satisfaction, enhancing team capability and adaptability for patient centered care, and addressing population-based or health system aspects of care. The system will be open and extensible with a published Collaborative Development Environment (CDE) to expose data from the Veterans Health Information Systems and Technology Architecture (VistA) enterprise EHR and other sources. The CDE will work in a manner that allows true interoperability, decision support, and will support big data longitudinal studies of veterans health data.

Healthcare organizations and government agencies must use their vast big data collections of patient and population data to improve the overall quality of medical resources and reduce costs associated with the variability in performance across the healthcare system.

In the next article, I will address how big data can be used for preventable conditions and support avoidable care including the early detection of disease, drug and product failures and helping individuals manage their overall health.
 

Roger Foster is a Senior Director at DRC’s High Performance Technologies Group and advisory board member of the Technology Management program at George Mason University. He has over 20 years of leadership experience in strategy, technology management and operations support for government agencies and commercial businesses. He has worked big data problems for scientific computing in fields ranging from large astrophysical data sets to health information technology. He has a master’s degree in Management of Technology from the Massachusetts Institute of Technology and a doctorate in Astronomy from the University of California, Berkeley. He can be reached at rfoster@drc.com, and followed on Twitter at @foster_roger.