Chopra defends Obama’s approach to healthcare innovation

By: Neil Versel | Oct 4, 2012        

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Neil_Versel_LargeA lot of people out there believe “meaningful use” regulations has stymied innovation in health IT by effectively standardizing functionality in electronic health records. Backers of President Obama might argue the point. In fact, one did this week.

“There has never been a better time to be an innovator in healthcare,” former federal CTO Aneesh Chopra, said Wednesday at the 2012 American Health Information Management Association (AHIMA) convention in Chicago. Though he curiously followed comedian and “The View” co-host Joy Behar in the closing plenary session, Chopra was not joking.

And in many ways, he was right. We have a ton of innovation going on right now, as long as you look past traditional EHR functions. And, as Chopra pointed out, a lot of it is in the realm of mobile and wireless health.

Chopra rejoined the Advisory Board Co. as a senior advisor after leaving the Obama administration, and subsequently announced his intention to run for lieutenant governor of Virginia in 2013, was particularly enthusiastic about one program he and his successor Todd Park – who was CTO of HHS before taking Chopra’s White House job – championed: the Health Data Initiative.

In three years, this program, which Park calls “data liberación,” already has produced a number of successful apps. How successful? iTriage, which Dr. Peter Hudson created by downloading an otherwise dry list of Federally Qualified Health Centers maintained by HHS, was bought by Aetna. “Dr. Hudson found a way to make it meaningful,” Chopra said.

iTriage may be the exception to the rule – there wouldn’t be innovation without a few failures along the way – in terms of its sale to a major corporation, but Asthmapolis, which Chopra noted pulls from a little federal database known as the Global Positioning System, has partnered with Qualcomm Life. He also pointed out that symptom-checking and triage app Symcat, which won the backing of accelerator Blueprint Health, queries National Library of Medicine databases in search of medical and scientific knowledge.

“This is starting to have a profound effect on the way you and I access the healthcare system,” Chopra said of mobile apps in general and “liberated” government data in particular.

Some things very much remain works in progress, however.

Castlight Health, which Park helped establish in 2008 before entering government service, went mobile in March. As Chopra noted Wednesday, that system draws on a mix of public and private databases to help consumers understand the costs of health services and compare the quality of certain providers. But we are a long way from having anything close to full price transparency in healthcare.

“We are probably in the first or maybe second inning of empowering patients with this information to make better choices,” Chopra said, using a baseball analogy on the final day of the 2012 major-league regular season.

Chopra also hyped the Blue Button initiative, a push to include a single blue button in EHR patient portals offering patients one-click downloads of their health information to print out, import into personal health records or share with other healthcare providers. Blue Button has its roots, and some success, at the Department of Veterans Affairs; the VA said in August that 1 million patients had clicked to download records in the first two years since Obama announced Blue Button in a speech marking the end of U.S. combat operations in Iraq.

Chopra highlighted a mobile version of Blue Button, namely the iBlueButton suite of iPhone and iPad apps for consumers, veterans and physicians that can “push” data between patient and doctor when two iBlueButton users are within Wi-Fi or Bluetooth range of each other. “Apps like the iBlueButton allows people to literally fistbump their medical records [onto their phones],” Chopra said.

I bet it works well at the VA, where everyone is on the same EHR system, but the nearly 6-minute video demo makes it seem like a cumbersome process that won’t fit the average private physician’s workflow, just like so many other PHRs. And Blue Button continues to use unstructured data that comes in the form of Excel files. It will take some formatting to import into an EHR.

Consider Blue Button another a work in progress, but one that the administration is bullish on. This week, the Office of the National Coordinator for Health Information Technology issued an $8,350 challenge for people to create short, engaging videos meant to raise awareness of Blue Button.

Though he left the government months ago, Chopra hinted at the next phase of this program. In the next 90 days, expect to see “Auto Blue Button,” that will let patients authorize automatic record sharing between hospital and primary care physician, a process Chopra said should be as easy as connecting the Netflix streaming service to an Apple TV box. If it works, the patient might just become the hub for health information exchange, but I’ve heard promises like this before and we still don’t have much patient-centric HIE.

In other mobile news, Chopra recalled Obama’s line in the 2011 State of the Union address that closing the digital divide is about such things as “a patient who can have face-to-face video chats with her doctor.” Chopra called it ironic that this proven, popular technology would make healthcare a lot more efficient, but the prevailing fee-for-service reimbursement structure discourages physicians from taking part.

That’s what value-base purchasing needs to address. “The payment model will change, bringing to life these new innovations,” Chopra predicted. And it will save money while improving quality.

For example, preemies are vulnerable and expensive to care for. According to Chopra, every week a baby remains in utero saves $40,000 in neonatal intensive care. With bundled payments for managing pregnancies, obstetricians and hospitals might have the incentive to invest in remote monitoring devices and consumer-engagement tools for at-risk pregnant women, Chopra said.

Chopra, an unabashed Obama booster, may have ruffled some feathers in the AHIMA audience, though, when he said Congress “micromanaged” HHS in terms of bundled payments in the Patient Protection and Affordable Care Act, a.k.a. Obamacare, then said Obama believes in “bottom-up” approaches to payment reform rather than top-down control.

I can only imagine what partisan Republicans will make of that that line.

  • Bettina Experton, MD, MPH

    The power of Blue Button is
    to give consumers easy access to their own health (Blue Button) records from
    any Blue Button enabled portal which provides a minimally structured file (text
    file with common main headers) that developers can parse, categorize and
    display in user friendly formats. Today, the million plus Americans who have
    downloaded their Blue Button records from VA, Medicare, and TRICARE, will soon
    be joined by millions of Americans who are now downloading their Aetna,
    RelayHealth, United and the 200+ Federal Employee Health Benefit plan Blue
    Button records. With Medicare for example, the partially structured claim
    generated Blue Button text file contains all the critical data elements to
    generate an up-to-date longitudinal record (3-year long) which can be directly
    accessed by the patient and shared with a provider on demand, at the point of
    care, directly and immediately when using a mobile device. This is a revolution
    for patient care, especially if this information is presented in real time at
    the point of care using ubiquitous mobile devices.


    That is exactly what the
    iBlueButton apps do today. For a MobiHealthNews preview to the apps, please see
    this new 3 minute video of the iBlueButton 3.6 apps under review by Apple now
    and set to be released in the next few days. The 2-tap push of Blue Button records from the
    patient smartphone to the physician iPad takes…10 seconds only! A big time
    saver compared to other means of data exchange (time consuming health
    information exchange system login and specific record search, or various PHR
    granted access login, or patients and providers using secure email-providing
    it’s available on both sides). The iBlueButton apps, which are not PHR apps but
    rather apps which access multiple PHR/EHR (Medicare, VA, TRICARE, Aetna, RelayHealth
    and many more Blue Button records soon), capitalize both on the ease of use of
    mobile apps (for both consumers and physicians) and both Federal initiatives
    discussed by Aneesh Chopra: the Blue Button Initiative to give consumers direct
    access to their records and the Health Data Initiative to bring contextual data
    to enrich the Blue Button records. To your point, we took the partially
    structured Blue Button text file and totally structured it on board the apps
    with detailed problem and medication lists, translating Medicare claim data
    into detailed encounter tables (hospitalization, ER visits, imaging services,
    etc.) and on the fly decode all claim coded info (ICD9, NDC drug codes, NPI
    data etc.) with on the fly look-up using 8 public databases…all on board the
    apps. Our ER and primary care docs who have trialed the apps love it!

  • Bettina Experton, MD, MPH

    You can find the iBlueButton 3.6 video here:

  • Sadia Romi

    well said

  • Usman Erc

    The Basis Health Monitor touts being able to track your heart rate accurately and in real time without the need for a chest strap.

  • Farnandas

    To your point, we took the partially
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    with detailed problem and medication lists, translating Medicare claim data
    into detailed encounter tables Generic Viagra (hospitalization, ER visits, imaging services,
    etc.) and on the fly decode all claim coded info (ICD9, NDC drug codes, NPI
    data etc.) with on the fly look-up using 8 public databases

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