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Health Information Technology Platform The Meeting at Harvard on a Health Information Technology Platform www.ITdotHealth.org Executive Summaries The Meeting at Harvard on a Health Information Technology Platform September 29-30, 2009 Table of Contents Session Title Speakers Page Key Themes 3 Opening Keynote: Mitch Kapor, Senior Advisor on Health Information Technology, Center 5 Building the Health Internet for American Progress Open or Closed Platforms? One or More Moderator 7 Platforms? Isaac Kohane, Henderson Professor of Pediatrics and Health Sciences and Technology, Harvard Medical School; Director, CHiP; CBMI; Countway Library of Medicine Panelists Hamish Fraser, Assistant Professor, HMS/Brigham and Women’s Hospital; Director, Informatics and Telemedicine, Partners in Health John Halamka, Chief Information Officer, HMS and Beth Israel Deaconess; Chairman, Health IT Standards Panel David McCallie, Vice President, Medical Informatics, Cerner; Director, Cerner Medical Informatics Institute Sean Nolan, Chief Architect, Microsoft Health Solutions Group Business-Government Interactions to Moderator 9 Support a Platform Mark Frisse, Accenture Professor of Biomedical Informatics, Vanderbilt University, Director, Regional Informatics Programs through Vanderbilt Center for Better Health Panelists Charles Friedman, Deputy National Coordinator for Health IT, Office of the National Coordinator for Health IT, Department of Health and Human Services Robert Kolodner, Self-employed; retired as National Coordinator for Health IT, Department of Health and Human Services David Liss, Vice President, Government Relations and Strategic Initiatives, New York Presbyterian Hospital Alfred Spector, Vice President, Research and Special Initiatives, Google Keynote: The Innovator's Prescription: Clayton Christensen, Robert and Jane Cizik Professor of Business 11 How Disruptive Innovation Can Administration, Harvard Business School Transform Health Care Models for Adoption of Platforms Moderator 13 Kenneth Mandl, Associate Professor, HMS/Children’s Hospital Boston; Director, Intelligent Health Lab, Children’s Hospital Informatics Program Panelists Henry Chueh, Chief, Division of Biomedical Informatics, HMS/Massachusetts General Hospital; Director, Lab of Computer Science Ahmed Ghouri, Co-Founder and Chief Medical Officer, AnvitaHealth David Kibbe, Senior Advisor, American Academy of Family Physicians Ross Koppel, Professor, University of Pennsylvania School of Medicine; Research Director, Center for Clinical Epidemiology and Biostatistics Mike Stein, Medical Director, Map of Medicine (UK) Technical Requirements for a Successful Aneesh Chopra, Chief Technology Officer, Executive Office of the 16 Health IT Platform President, Office for Science and Technology Policy Todd Park, Chief Technology Officer, Department of Health and Human Services Closing Keynote: Regina Herzlinger, Nancy R. McPherson Professor of Business 18 Who Killed Health Care? Administration, Harvard Business School Biographies ©2009 by Harvard Medical School 2 The Meeting at Harvard on a Health Information Technology Platform September 29-30, 2009 Key Themes Background A practical example of how this could work: An individual could open a Microsoft HealthVault account. At the The Meeting at Harvard on a Health Information Technology patient’s request, providers who have adopted the Health Platform, held at the Countway Library of Medicine at Internet (like the VA) could send the patient’s medical data Harvard Medical School on September 29 and 30, 2009, to the individual’s HealthVault account via the Health brought together about 100 of health information technol- Internet (the updated NHIN). ogy’s foremost leaders. The focus of this meeting was on practical, actionable steps to create a health IT platform. Meeting attendees were extremely enthusiastic about this vision and proposal. There were commitments from a wide One particular metaphor was used to prompt thought: the array of stakeholders to support the proposal and to work iPhone. The iPhone platform has been widely embraced, together collaboratively to make it happen. An oft repeated and almost 85,000 substitutable applications have been phrase was, “We are in!” developed for it; these applications have been downloaded more than 1 billion times. Perhaps such a metaphor can be Participants voice strong support for the idea of used to spur thinking in health IT. openness. Among the lessons learned from the PC revolution and the Key themes from this meeting are summarized below. formation of the Internet was the importance of openness. Summaries of each keynote and panel discussion follow. Participants supported open standards, open source, open architecture, an open data platform, modularity, and an Key Themes opening of previously closed vendor platforms to allow greater customization. The government plays many roles that affect health IT. To create a Health Internet, the government must be a Participants emphasized the need for data liquidity as facilitator. a prerequisite for all else. Throughout this meeting, the government was mentioned Participants supported the idea of substitutable applica- as a regulator, a provider of funding, and a developer of tions and most (but not all) like the concept of an “app policies and programs. But in the opinion of many meeting store.” But many attendees focused on the importance of participants—including keynote speaker Mitch Kapor—to first being able to get at the data in EHRs and PHRs. It is bring about an interoperable health Internet, the role that the access to and availability of data, and the ability for the government must play is that of facilitator that data to easily flow (“data liquidity”), that will make apps catalyzes action. As the government did in helping bring useful. about the original Internet, the government can help create a Health Internet by bringing together the key players, Access to data will drive development of substitutable defining a lightweight set of protocols, and creating critical applications. Once apps are being developed, the creators/ mass around the use of these protocols. sellers will benefit from offering their applications through an app store, and users/buyers will benefit by being able to The Obama Administration is committed to the use an app store to easily find relevant applications that concept of a Health Internet, and used this meeting to meet their needs. Also, the aggregation of data for overall lay out a specific proposal for moving forward. population health is essential. Creating a robust technology infrastructure is seen by the Administration as critical to health care reform. At this There was a proposal that most attendees supported: meeting, White House CTO Aneesh Chopra and Health defining a narrow, common, and non-controversial set of and Human Services CTO Todd Park laid out a vision and data—possibly around medications and/or immunizations offered a specific proposal. —and then developing standards so that this data can be accessed. This in turn will spur development of ⎯ The vision: create a Health Internet by turning the applications. current NHIN (Nationwide Health Information Network) into the Health Internet. Then, use this Health Internet Disruptive innovations help people do jobs they are to bring consumer health data into consumer-controlled trying to get done. personal health records (PHRs). Professor Christensen emphasized that there is no way to force clinicians to use EHRs or applications. Instead of ⎯ The proposal: undertake an initiative to begin using this trying to force a solution upon people, follow the formula Health Internet to move live data into live PHRs by the used by disruptive innovators: create solutions that help second quarter of 2010. Doing so entails identifying the people do a job easier, faster, and cheaper. Such a gaps in the current NHIN protocols, addressing these solution will then be embraced. (He also noted that when gaps by creating new protocols (and possibly elimin- disruptive innovations occur, entrenched incumbents do ating existing ones), updating CONNECT, and then everything they can to forestall the disruptive innovation, initiating live betas. including trying to get regulation imposed to block it.) ©2009 by Harvard Medical School 3 The Meeting at Harvard on a Health Information Technology Platform September 29-30, 2009 Creating a Health Internet, data liquidity, and a Yet in spite of those challenges, there was tremendous platform with substitutable applications requires optimism among those in attendance regarding what is overcoming many formidable obstacles. possible. Attendees believe that through collaboration, by Realizing the vision for an interoperable health technology focusing on specific use cases and pilots, value can be platform faces many obstacles. These issues include shown and positive momentum will be built. Once an technology, security, privacy, legal, regulatory, policy, and interoperable platform is developed, a tipping point will states’ rights issues. There is a lack of a common vocabu- occur. In a short period of time health IT adoption will lary, lack of EHR adoption, especially among individual increase and a huge number of applications will be primary care physicians, and conflicting interests among developed. The end result will be improvements in health businesses of different sizes and stages. There is a lack of outcomes and lower costs. use cases, perverse incentives throughout the system, a lack of proven business models, and at times lack of a clear and compelling value
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