Presentation by Pierce Graham-Jones (HHS), Henry Wei MD (Presidential Innovation Fellow/VA), and Lorraine Doo (CMS) at the WEDI Pre-Conference 10/22/12 on Blue Button and the Payor Workgroup of the Automate Blue Button Initiative.
WEDI Pre-Conference Blue Button Presentation from Automate Blue Button Initia...henryweiva
Focus on patients & consumers accessing their own digital health data. Aim = Identify a content standard for payor-generated Blue Button data
Practical
Human-readable
Machine-readable
Capable of conveying both clinical and non-clinical data
Data includes Blue Button offered today
Data includes EOB (Explanation of Benefits) data today. Goal = data & interoperability platform
Feasible for payers & PBMs
Attractive to developers
Foundation to innovative apps & to create personally-controlled solutions
Not the solution itself – but should allow solutions to target clinical quality, affordability, access and the experience of care itself
Kammerer How The Interface Design Influences Users Spontaneous Trustworthines...Kalle
This study examined to what extent users spontaneously evaluate the trustworthiness of Web search results presented by a search engine. For this purpose, a methodological paradigm was used in which the trustworthiness order of search results was experimentally manipulated by presenting search results on a search engine results page (SERP) either in a descending or ascending trustworthiness order. Moreover, a standard list format was compared to a grid format in order to examine the impact of the search results interface on Web users’ evaluation processes. In an experiment addressing a controversial medical topic, 80 participants were assigned to one of four conditions with trustworthiness order (descending vs. ascending) and search results interface (list vs. grid) varied as between-subjects factors. In order to investigate participants’ evaluation processes their eye movements and mouse clicks were captured during Web search. Results revealed that a list interface caused more homogenous and more linear viewing sequences on SERPs than a grid interface. Furthermore, when using a list interface most attention was given to the search results on top of the list. In contrast, with a grid interface nearly all search results on a SERP were attended to equivalently long. Consequently, in the ascending trustworthiness order participants using a list interface attended significantly longer to the least trustworthy search results and selected the most trustworthy search results significantly less often than participants using a grid interface. Thus, the presentation of Web search results by means of a grid interface seems to support users in their selection of trustworthy information sources.
10 New Business Models for this Decade (beta)
1. Localized Low-Cost Business Model
2. One-Off Experience Business Model
3. Beyond Advertising Business Model
4. Markets Are Conversations Business Model
5. Low-Budget Innovation Business Model
6. Community-Funded Business Model
7. Sustainability-Focused Business Model
8. Twisted Freemium Business Model
9. Unlimited Niches Business Model
10. In-Crowd Customers Business Model
TREND RESEARCH BY Trend Firm trendwatching.com
MARKET ANALYSIS BY Strategy Boutique Thaesis
BUSINESS MODEL DESIGN BY Strategy Consultant/Graphic Facilitator Ouke Arts
WEDI Pre-Conference Blue Button Presentation from Automate Blue Button Initia...henryweiva
Focus on patients & consumers accessing their own digital health data. Aim = Identify a content standard for payor-generated Blue Button data
Practical
Human-readable
Machine-readable
Capable of conveying both clinical and non-clinical data
Data includes Blue Button offered today
Data includes EOB (Explanation of Benefits) data today. Goal = data & interoperability platform
Feasible for payers & PBMs
Attractive to developers
Foundation to innovative apps & to create personally-controlled solutions
Not the solution itself – but should allow solutions to target clinical quality, affordability, access and the experience of care itself
Kammerer How The Interface Design Influences Users Spontaneous Trustworthines...Kalle
This study examined to what extent users spontaneously evaluate the trustworthiness of Web search results presented by a search engine. For this purpose, a methodological paradigm was used in which the trustworthiness order of search results was experimentally manipulated by presenting search results on a search engine results page (SERP) either in a descending or ascending trustworthiness order. Moreover, a standard list format was compared to a grid format in order to examine the impact of the search results interface on Web users’ evaluation processes. In an experiment addressing a controversial medical topic, 80 participants were assigned to one of four conditions with trustworthiness order (descending vs. ascending) and search results interface (list vs. grid) varied as between-subjects factors. In order to investigate participants’ evaluation processes their eye movements and mouse clicks were captured during Web search. Results revealed that a list interface caused more homogenous and more linear viewing sequences on SERPs than a grid interface. Furthermore, when using a list interface most attention was given to the search results on top of the list. In contrast, with a grid interface nearly all search results on a SERP were attended to equivalently long. Consequently, in the ascending trustworthiness order participants using a list interface attended significantly longer to the least trustworthy search results and selected the most trustworthy search results significantly less often than participants using a grid interface. Thus, the presentation of Web search results by means of a grid interface seems to support users in their selection of trustworthy information sources.
10 New Business Models for this Decade (beta)
1. Localized Low-Cost Business Model
2. One-Off Experience Business Model
3. Beyond Advertising Business Model
4. Markets Are Conversations Business Model
5. Low-Budget Innovation Business Model
6. Community-Funded Business Model
7. Sustainability-Focused Business Model
8. Twisted Freemium Business Model
9. Unlimited Niches Business Model
10. In-Crowd Customers Business Model
TREND RESEARCH BY Trend Firm trendwatching.com
MARKET ANALYSIS BY Strategy Boutique Thaesis
BUSINESS MODEL DESIGN BY Strategy Consultant/Graphic Facilitator Ouke Arts
Big data is more than just a buzzword in healthcare. It's the promise of being able to extract, cull, and interpret medical data to directly benefit population and individual health. learn more about the benefits of big data, roadblocks to leveraging it's potential, how Meaningful Use enablesbig data, what types of cross-country collaboration projects are advancing the use of big data on an international scale, big data's impact on patient privacy and much more! Special thanks to Mandi Bishop for her time on the podcast.
Simple Measures, Big Results: Measuring Program Impact DataTechSoup
Simple Measures, Big Results: How to Collect, Analyze, and Share Program Impact Data
Webinar:
Simple Measures, Big Results: How to Collect, Analyze, and Share Program Impact Data
Simple Measures, Big Results: How to Collect, Analyze, and Share Program Impact Data
Tuesday, May 28
11 a.m. Pacific Time
Mention "evaluation" to a nonprofit leader and it may conjure up visions of complex measures, expensive consultants, privacy concerns, and high overhead. Yet there are lightweight, empirically sound outcome measures that can be collected, analyzed, and shared by virtually any organization. In this webinar, we will walk through selecting, collecting, and analyzing such measures and then creating dynamic dashboards in Power BI to share the results.
An update on the progress in developing the CMS BlueButton on FHIR API to enable beneficiaries to share their data with applications, services and research programs they trust. . The api is based on the HL7 FHIR Specification. This references the Open source software provided by the Non-Profit Transparent Health foundation. Check out GitHub.com/transparenthealth.
Shipping Knowledge Graph Management Capabilities to Data Providers and ConsumersOmar Al-Safi
The amount of Linked Data both open, made available on the Web, and private, exchanged across companies and organizations, have been increasing in recent years. This data can be distributed in form of Knowledge Graphs (KGs), but maintaining these KGs is mainly the responsibility of data owners
or providers. Moreover, building applications on top of KGs in order to provide, for instance, analytics, data access control, and privacy is left to the end user or data consumers. However, many resources in terms of development costs and equipment are required by both data providers and consumers, thus impeding the development of real-world applications over KGs. We propose to encapsulate KGs as well as data processing functionalities in a client-side system called Knowledge Graph Container, intended
to be used by data providers or data consumers. Knowledge Graph Containers can be tailored to the target environments, ranging from Big Data to light-weight platforms. We empirically evaluate the performance and scalability of Knowledge Graph Containers with respect to state-of-the-art Linked Data management approaches. Observed results suggest that Knowledge Graph Containers increase the vailability of Linked Data, as well as efficiency and scalability of various Knowledge Graph management tasks.
Emerging Standards and the Disruption of HIE 1.0Jitin Asnaani
Emerging standards in health information exchange, driven by the ONC and others, are going to change what health IT customers (hospitals, physicians, labs, etc) are going to pay for. This is an overview of those new standards, and my perspective on the implications for health technology companies, particularly EHR and HIE vendors.
The third webcast in this series focuses on ways to meet your health system’s specific needs and achieve a 360-degree view of your patients, processes, physicians, and costs without purchasing multiple, disparate solutions, and creating information silos.
Our speakers discuss their collective experience in working with organizations to create tailored platforms that provide convenient access to data collected by, and stored in, disparate clinical information systems and enabling that data to be securely used by users throughout the broader healthcare community. Actionable data – available to all users when they need it – serves as a foundation for analysis and decision-making aimed at improving how care is delivered.
You can find it online at http://www.informationbuilders.com/webevents/online/24637#sthash.RnwoH27x.dpuf
The Data Operating System: Changing the Digital Trajectory of HealthcareHealth Catalyst
In 1989, John Reed, the CEO of Citibank and the early pioneer for ATMs, said, “I can see a future in which the data and information that is exchanged in our transactions are worth more than the transactions themselves.” We are at an interesting digital nexus in healthcare. Few of us would argue against the notion that data and digital health will play a bigger and bigger role in the future. But, are we on the right track to deliver on that future? It required $30B in federal incentive money to subsidize the uptake of Electronic Health Records (EHRs). You could argue that the federal incentives stimulated the first major step towards the digitization of health, but few physicians would celebrate its value in comparison to its expense. As the healthcare market consolidates through mergers and acquisitions (M&A), patching disparate EHRs and other information systems together becomes even more important, and challenging. An organization is not integrated until its data is integrated, but costly forklift replacements of these transaction information systems and consolidating them with a single EHR solution is not a viable financial solution.
The Data Operating System: Changing the Digital Trajectory of HealthcareDale Sanders
This is the next evolution in health information exchanges and data warehouses, specifically designed to support analytics, transaction processing, and third party application development, in one platform, the Data Operating System.
HIMSS GSA e-Authentication whitepaper June 2007Richard Moore
HIMSS and the GSA, developed a pilot project to demonstrate the adoption of the GSA's secure and interoperable technical architecture for sharing medical information across multiple healthcare providers. The pilot utilized the GSA's E-Authentication Service Component program to provide digital certificates, technical architecture development support, and certificate validation services.
Seven RHIOs/Health Information Exchanges initially volunteered to participate in the project. One participant the Nevada Single Portal Medical Record HIE had to withdraw from the project due to a lack of resources.
Central Ohio HIE - Initiated by eHealth Ohio, and in conjunction with the Ohio Supercomputer Center, this project has focused on evaluating the viability of using the proposed national level user authentication process as a means of authenticating individual researchers, system developers and system administrators who will be both utilizing, creating and maintaining future health care research systems. An emerging area of software development focus, this pilot will also identify key issues faced by resource constrained development efforts.
Achieve Internet VP of Operations Marc Hermsmeyer and Dexcom Inc., Senior Marketing Manager Tom Hall speak about technology solutions for the Healthcare Industry using Open Source software, such as Drupal.
The Government is forcing technology innovation within the Healthcare industry yet there are very few solutions out there that are tailored for the specific requirements and needs of the Healthcare market. In past experiences with Dexcom and other Healthcare clients Achieve has leveraged the power of Drupal to create powerful solutions that drive patient outcomes, improve workflows, and remain compliant with rigorous regulatory requirements.
This presentation shines a light on the technology needs of the Healthcare market and how Drupal can meet those needs.
This document explores the concepts behind how DDOD (Demand-Driven Open Data) can be used in conjunction with FOIA (Freedom of Information Act) requests. It describes how DDOD and FOIA can leverage each other's strengths to help overcome their inherent challenges.
DDOD is an initiative by the U.S. Department of Health and Human Services (HHS) started in November 2014 as part of its IDEA Lab program. The goal is to leverage the vast data assets throughout HHS’s agencies (CMS, FDA, NIH, CDC, NCHS, AHRQ and others) to create additional economic and public health value.
DDOD provides a systematic, ongoing and transparent mechanism for anybody to tell HHS and its agencies what data would be valuable to them. It's the Lean Startup approach to open data. With this initiative HHS can move from measuring Open Data in terms of number of datasets released to value in terms of use cases enabled.
DDOD website: http://ddod.us
In May 2014, the Health Care Cost Institute (HCCI) announced a new national health care cost and quality transparency initiative. The initiative is supported by Aetna, Humana, and UnitedHealthcare; other payers will be announced shortly. The presentation will provide background information on HCCI and describe the initial release of the three tier public transparency website that HCCI is developing. Tier 1, the public website, will be launched by 12/31/15 and was the focus of the discussion.
PHP Frameworks: I want to break free (IPC Berlin 2024)Ralf Eggert
In this presentation, we examine the challenges and limitations of relying too heavily on PHP frameworks in web development. We discuss the history of PHP and its frameworks to understand how this dependence has evolved. The focus will be on providing concrete tips and strategies to reduce reliance on these frameworks, based on real-world examples and practical considerations. The goal is to equip developers with the skills and knowledge to create more flexible and future-proof web applications. We'll explore the importance of maintaining autonomy in a rapidly changing tech landscape and how to make informed decisions in PHP development.
This talk is aimed at encouraging a more independent approach to using PHP frameworks, moving towards a more flexible and future-proof approach to PHP development.
Alt. GDG Cloud Southlake #33: Boule & Rebala: Effective AppSec in SDLC using ...James Anderson
Effective Application Security in Software Delivery lifecycle using Deployment Firewall and DBOM
The modern software delivery process (or the CI/CD process) includes many tools, distributed teams, open-source code, and cloud platforms. Constant focus on speed to release software to market, along with the traditional slow and manual security checks has caused gaps in continuous security as an important piece in the software supply chain. Today organizations feel more susceptible to external and internal cyber threats due to the vast attack surface in their applications supply chain and the lack of end-to-end governance and risk management.
The software team must secure its software delivery process to avoid vulnerability and security breaches. This needs to be achieved with existing tool chains and without extensive rework of the delivery processes. This talk will present strategies and techniques for providing visibility into the true risk of the existing vulnerabilities, preventing the introduction of security issues in the software, resolving vulnerabilities in production environments quickly, and capturing the deployment bill of materials (DBOM).
Speakers:
Bob Boule
Robert Boule is a technology enthusiast with PASSION for technology and making things work along with a knack for helping others understand how things work. He comes with around 20 years of solution engineering experience in application security, software continuous delivery, and SaaS platforms. He is known for his dynamic presentations in CI/CD and application security integrated in software delivery lifecycle.
Gopinath Rebala
Gopinath Rebala is the CTO of OpsMx, where he has overall responsibility for the machine learning and data processing architectures for Secure Software Delivery. Gopi also has a strong connection with our customers, leading design and architecture for strategic implementations. Gopi is a frequent speaker and well-known leader in continuous delivery and integrating security into software delivery.
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Big data is more than just a buzzword in healthcare. It's the promise of being able to extract, cull, and interpret medical data to directly benefit population and individual health. learn more about the benefits of big data, roadblocks to leveraging it's potential, how Meaningful Use enablesbig data, what types of cross-country collaboration projects are advancing the use of big data on an international scale, big data's impact on patient privacy and much more! Special thanks to Mandi Bishop for her time on the podcast.
Simple Measures, Big Results: Measuring Program Impact DataTechSoup
Simple Measures, Big Results: How to Collect, Analyze, and Share Program Impact Data
Webinar:
Simple Measures, Big Results: How to Collect, Analyze, and Share Program Impact Data
Simple Measures, Big Results: How to Collect, Analyze, and Share Program Impact Data
Tuesday, May 28
11 a.m. Pacific Time
Mention "evaluation" to a nonprofit leader and it may conjure up visions of complex measures, expensive consultants, privacy concerns, and high overhead. Yet there are lightweight, empirically sound outcome measures that can be collected, analyzed, and shared by virtually any organization. In this webinar, we will walk through selecting, collecting, and analyzing such measures and then creating dynamic dashboards in Power BI to share the results.
An update on the progress in developing the CMS BlueButton on FHIR API to enable beneficiaries to share their data with applications, services and research programs they trust. . The api is based on the HL7 FHIR Specification. This references the Open source software provided by the Non-Profit Transparent Health foundation. Check out GitHub.com/transparenthealth.
Shipping Knowledge Graph Management Capabilities to Data Providers and ConsumersOmar Al-Safi
The amount of Linked Data both open, made available on the Web, and private, exchanged across companies and organizations, have been increasing in recent years. This data can be distributed in form of Knowledge Graphs (KGs), but maintaining these KGs is mainly the responsibility of data owners
or providers. Moreover, building applications on top of KGs in order to provide, for instance, analytics, data access control, and privacy is left to the end user or data consumers. However, many resources in terms of development costs and equipment are required by both data providers and consumers, thus impeding the development of real-world applications over KGs. We propose to encapsulate KGs as well as data processing functionalities in a client-side system called Knowledge Graph Container, intended
to be used by data providers or data consumers. Knowledge Graph Containers can be tailored to the target environments, ranging from Big Data to light-weight platforms. We empirically evaluate the performance and scalability of Knowledge Graph Containers with respect to state-of-the-art Linked Data management approaches. Observed results suggest that Knowledge Graph Containers increase the vailability of Linked Data, as well as efficiency and scalability of various Knowledge Graph management tasks.
Emerging Standards and the Disruption of HIE 1.0Jitin Asnaani
Emerging standards in health information exchange, driven by the ONC and others, are going to change what health IT customers (hospitals, physicians, labs, etc) are going to pay for. This is an overview of those new standards, and my perspective on the implications for health technology companies, particularly EHR and HIE vendors.
The third webcast in this series focuses on ways to meet your health system’s specific needs and achieve a 360-degree view of your patients, processes, physicians, and costs without purchasing multiple, disparate solutions, and creating information silos.
Our speakers discuss their collective experience in working with organizations to create tailored platforms that provide convenient access to data collected by, and stored in, disparate clinical information systems and enabling that data to be securely used by users throughout the broader healthcare community. Actionable data – available to all users when they need it – serves as a foundation for analysis and decision-making aimed at improving how care is delivered.
You can find it online at http://www.informationbuilders.com/webevents/online/24637#sthash.RnwoH27x.dpuf
The Data Operating System: Changing the Digital Trajectory of HealthcareHealth Catalyst
In 1989, John Reed, the CEO of Citibank and the early pioneer for ATMs, said, “I can see a future in which the data and information that is exchanged in our transactions are worth more than the transactions themselves.” We are at an interesting digital nexus in healthcare. Few of us would argue against the notion that data and digital health will play a bigger and bigger role in the future. But, are we on the right track to deliver on that future? It required $30B in federal incentive money to subsidize the uptake of Electronic Health Records (EHRs). You could argue that the federal incentives stimulated the first major step towards the digitization of health, but few physicians would celebrate its value in comparison to its expense. As the healthcare market consolidates through mergers and acquisitions (M&A), patching disparate EHRs and other information systems together becomes even more important, and challenging. An organization is not integrated until its data is integrated, but costly forklift replacements of these transaction information systems and consolidating them with a single EHR solution is not a viable financial solution.
The Data Operating System: Changing the Digital Trajectory of HealthcareDale Sanders
This is the next evolution in health information exchanges and data warehouses, specifically designed to support analytics, transaction processing, and third party application development, in one platform, the Data Operating System.
HIMSS GSA e-Authentication whitepaper June 2007Richard Moore
HIMSS and the GSA, developed a pilot project to demonstrate the adoption of the GSA's secure and interoperable technical architecture for sharing medical information across multiple healthcare providers. The pilot utilized the GSA's E-Authentication Service Component program to provide digital certificates, technical architecture development support, and certificate validation services.
Seven RHIOs/Health Information Exchanges initially volunteered to participate in the project. One participant the Nevada Single Portal Medical Record HIE had to withdraw from the project due to a lack of resources.
Central Ohio HIE - Initiated by eHealth Ohio, and in conjunction with the Ohio Supercomputer Center, this project has focused on evaluating the viability of using the proposed national level user authentication process as a means of authenticating individual researchers, system developers and system administrators who will be both utilizing, creating and maintaining future health care research systems. An emerging area of software development focus, this pilot will also identify key issues faced by resource constrained development efforts.
Achieve Internet VP of Operations Marc Hermsmeyer and Dexcom Inc., Senior Marketing Manager Tom Hall speak about technology solutions for the Healthcare Industry using Open Source software, such as Drupal.
The Government is forcing technology innovation within the Healthcare industry yet there are very few solutions out there that are tailored for the specific requirements and needs of the Healthcare market. In past experiences with Dexcom and other Healthcare clients Achieve has leveraged the power of Drupal to create powerful solutions that drive patient outcomes, improve workflows, and remain compliant with rigorous regulatory requirements.
This presentation shines a light on the technology needs of the Healthcare market and how Drupal can meet those needs.
This document explores the concepts behind how DDOD (Demand-Driven Open Data) can be used in conjunction with FOIA (Freedom of Information Act) requests. It describes how DDOD and FOIA can leverage each other's strengths to help overcome their inherent challenges.
DDOD is an initiative by the U.S. Department of Health and Human Services (HHS) started in November 2014 as part of its IDEA Lab program. The goal is to leverage the vast data assets throughout HHS’s agencies (CMS, FDA, NIH, CDC, NCHS, AHRQ and others) to create additional economic and public health value.
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DDOD website: http://ddod.us
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In this presentation, we examine the challenges and limitations of relying too heavily on PHP frameworks in web development. We discuss the history of PHP and its frameworks to understand how this dependence has evolved. The focus will be on providing concrete tips and strategies to reduce reliance on these frameworks, based on real-world examples and practical considerations. The goal is to equip developers with the skills and knowledge to create more flexible and future-proof web applications. We'll explore the importance of maintaining autonomy in a rapidly changing tech landscape and how to make informed decisions in PHP development.
This talk is aimed at encouraging a more independent approach to using PHP frameworks, moving towards a more flexible and future-proof approach to PHP development.
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The modern software delivery process (or the CI/CD process) includes many tools, distributed teams, open-source code, and cloud platforms. Constant focus on speed to release software to market, along with the traditional slow and manual security checks has caused gaps in continuous security as an important piece in the software supply chain. Today organizations feel more susceptible to external and internal cyber threats due to the vast attack surface in their applications supply chain and the lack of end-to-end governance and risk management.
The software team must secure its software delivery process to avoid vulnerability and security breaches. This needs to be achieved with existing tool chains and without extensive rework of the delivery processes. This talk will present strategies and techniques for providing visibility into the true risk of the existing vulnerabilities, preventing the introduction of security issues in the software, resolving vulnerabilities in production environments quickly, and capturing the deployment bill of materials (DBOM).
Speakers:
Bob Boule
Robert Boule is a technology enthusiast with PASSION for technology and making things work along with a knack for helping others understand how things work. He comes with around 20 years of solution engineering experience in application security, software continuous delivery, and SaaS platforms. He is known for his dynamic presentations in CI/CD and application security integrated in software delivery lifecycle.
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Defect reporting
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https://arxiv.org/abs/2306.08302
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WEDI Pre-Conference Blue Button Presentation
1. Automate Blue Button Initiative
Payor Content Workgroup
WEDI Pre-Conference
Reston, Virginia
October 22, 2012
2. Agenda
• Overview of Blue Button
(20 minutes)
• Working Session on “Automated Blue Button”
for Payors
(50 minutes)
• Open Discussion
(20 minutes)
3. Blue Button
Background
• Two years ago, the VA added a simple, easy to
recognize “Blue Button” to their patient portal.
• Since then, the use of Blue Button has grown into a
movement – a commitment by many of the VA
country’s largest data holders, including the CMS
Federal government – to get personal health Department
information out of proprietary silos and into the of Defense
hands of the consumers who want a holistic Aetna
picture of their health and health care. United
+ Many more
• Over 1 million veterans, members of the
military, and Medicare beneficiaries have already
downloaded their data through Blue Button.
#ABBI 3
4. Blue Button
How It Works Today
Today, Blue Button means letting consumers download an ASCII file
of their personal health information after they log onto the
dataholder’s portal. For example:
#ABBI 4
6. Draft Charter for S&I
Scope Community Review on
the Wiki
• Identify, define, and harmonize implementation standards, tools
and services that facilitate the automated PUSH and automated
PULL of patient information via the Blue Button
• Identify, define and harmonize content structures and
specifications for the Blue Button so that information
downloaded is machine readable and human readable
• Identify, define, and harmonize protocols around identification
and credentialing, and protocols around access and
authorization, that facilitate the automated PUSH and automated
PULL of patient information via the Blue Button
#ABBI 6
7. Standards being identified
by ABBI Workgroups
Container
Content
• Capable Transport
• Recommended
• Required “Automate”
“Blue Button”
For payors = Standardized EOB, or
Standard Claims Information
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
8. Synopsis (Draft)
Focus on patients & consumers accessing their own digital health data
• Aim = Identify a content standard for payor-generated Blue Button data
– Practical
– Human-readable
– Machine-readable
– Capable of conveying both clinical and non-clinical data
– Data includes Blue Button offered today
– Data includes EOB (Explanation of Benefits) data today
• Goal = data & interoperability platform
– Feasible for payers & PBMs
– Attractive to developers
– Foundation to innovative apps & to create personally-controlled solutions
– Not the solution itself – but should allow solutions to target clinical
quality, affordability, access and the experience of care itself
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
9. Proposed Embedded Machine-Readability
Examples Illustrations
Self-Displaying CDA
http://wiki.hl7.org/index.php?title=Self_Displaying_CDA
JSON Blue Button
https://github.com/blue-button/smart/blob/master/smart-blue-
button.html e.g. Styles and JSON
data embedded in
IHE XDM .zip file single HTML file
http://wiki.ihe.net/index.php?title=Cross-
enterprise_Document_Media_Interchange
PDF with embedded data e.g. machine-readable
http://www.adobepress.com/articles/article.asp?p=1271244
and human-readable
– separate but part of
Email: MIME whole
http://tools.ietf.org/html/rfc1521
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
10. Why Machine-Readability leads to better
Human-Readability
“The Blood Test Gets a
Makeover”
Example from Wired
Magazine 2010
USA’s best designers + Data Standards + Open Source Code = better design for everyone
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
11. Example Use Cases under Consideration:
Emerging Blue Button App & Service Categories
View & Link
• Patient education
• Preference-sensitive care
• Comparing & reconciling patient-level payor EOBs vs. provider bills
Share & Combine
• Care Coordination & PCMH activities & services
• Medication reconciliation & adherence tools
• Care Team indexing & name / ID sharing with other providers
Interpret
• Forecasting and planning a personal healthcare budget
• Integrity (errors, fraud & abuse) detection and assistance services
• Quality-related applications & services for Accountable Care Organizations
• Clinical decision support (evidence-based)
• Navigating affordable care options (e.g. brand vs. generic medication)
• Chronic disease management, including personal health tracking (e.g. diabetes)
• Automatic pre-population of initial visit forms
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
12. Implications for Healthcare Affordability
Comments from an S&I Expert
Comments from Keith Boone
• [Patients will not only] be able to track all of their clinical data, but they'll also be able to track costs of
particular illnesses.
• The apps this content will support will be able link EOB data back to clinical data, so that patients can
understand the true cost of a given diagnosis.
• Patients could also agree to share the content anonymously to third parties (in exchange for other services
using that data).
• Thus, a patient could give access to anonymized data that links services, diagnoses and costs, to particular
aggregators.
• The aggregators could agree (similar to the QH Policy Sandbox) to certain stipulations on use of the
data, with the patient. See http://wiki.siframework.org/Query+Health+Policy+Sandbox
• The aggregator would then be able to analyze and generate cost information for illness, by
provider, payer, policy and region. Such data could be used to enable patients to obtain:
– For a given diagnosis and plan, average costs for services and providers in their region.
– For given diagnoses, the expected annual out-of-pocket costs for providers that the patient
uses, based on historical data.
• The upside for payers is that access to such data across
payers will enable them to drive costs downward.
Source: “What ABBI can do for Healthcare Cost
Transparency”, 9/13/12, http://motorcycleguy.blogspot.com/2012/09/what-abbi-can-for-for-healthcare-
13. Implications for Personal Healthcare Quality:
Clinical Decision Support Example
Claims data-driven analytics focused on Clinical Decision
Support & Quality are currently available to large self-insured
employers, but not directly to consumers
Through analysis of “rough” ICD-9, CPT, and NDC-coded
data, these existing organizations can run “n-of-1” quality
measures for individual patients & consumers.
14. Implications for Personal Health Affordability:
Personal Health Cost Prediction Example
Claims data-driven cost prediction is currently available to
insurers & large employers, but not yet directly to consumers
Individuals may be able to help predict & budget for their
health care spending needs, if they have a level-playing-field &
access to the same data used by actuaries & underwriters.
15. Implications for Public Health & Education:
Immunization Registry Example
Clinics, Reg Patient & Blue Schools &
istries, Payo Parents Button File Camps
r Data
PATIENT
S & CARE-
GIVERS
DIRECT protocol
HISP HISP
(if available)
See directproject.org for more info on the DIRECT protocol
16. Context: 3rd-Party Developer Input
Recommended Financial Data Fields
Recommended Fields Rationale:
Paid amount • Consistent with info
Deductible amount already provided to
Coinsurance amount members in EOBs
Copay amount • Key payment items
COB amount enable individuals to see
Employee member paid past health care spend &
Explanatory codes budget for future
Billed amount • Aims to lower healthcare
Allowed amount costs, protects interest of
payors
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
17. Strawman 1: MyMedicare.gov Blue Button
MyMedicare.gov Blue Button Data File
Current footprint = ~35 million eligible lives
FIELDS SUPPORTED COMMENTS
• Demographics • Financial data by claim • Include clinical quality data
• Name • Charged • A Codes – unbilled codes
• DOB • Approved used for quality reporting
• Address • Paid
• Phone • Patient may be
• Email billed
• Eligibility • Diagnosis Code(s)
• Effective Date(s) • NDC Drug Code(s)
• Plan Contract ID(s) • CPT Codes
• Plan Period(s) • UB04 Codes
• Plan Name(s) • NPI Codes
• Claims Summary
• Claim ID
• Provider ID
• Service Dates
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
19. Strawman 2: ASC X12 835 : Health Care Claim
Payment/Advice
X12 835 Version 5010 : required for nearly every insurance transaction
FIELDS SUPPORTED COMMENTS
(TRANSACTION SET)
• Header Level
• Amount
• Payee
• Payer
• Trace number
• Payment method
• Detail Level
• EOB information
• Adjudicated claims and
services
• Summary level
• Provider adjustment
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
20. ASC X12 Potential Standards
• Standards for sharing claims information with beneficiaries
– ASC X12 835 (Electronic Admittance Advice) - Health plan that contains
multiple patient information to one provider
– NCPDP D.0 telecommunication for pharmacy claims and remittance
– ASC X12 837 (Health Care Claim Transaction Set) - File of 837 claims from
a healthcare provider will contain multiple claims destined to either one
payer or clearinghouse for multiple payers
• Claim Submission
• Post Adjudicated Claims
– No EOB standard identified other than above
• Typically a proprietary format exchanged
– Minnesota print standard format
• Other standards being considered for payer exchange of clinical
information
– Claims attachment to CCD
– Payer data mapping to CCD
– PHR to PHR standard being developed by HL7 / WEDI
20
21. Strawman 3: Create a new CDA EOB template
Potential XML template for CDA Implementation Guide
FIELDS SUPPORTED COMMENTS
(TRANSACTION SET)
• See
• Insurer Information • Service Performed http://motorcycleguy.blogsp
• Payer ID • Date(s) of service ot.com/2012/09/what-abbi-
• Name • Price billed can-for-for-healthcare-
• Policy Info • Negotiated Price cost.html
• Patient Info • Amount Paid
• Identifier • Patient Responsibility
• Name • Notes
• Address
• Provider Info
• NPI
• Identifier
• Name
• Address
• Diagnosis Table
• Diagnosis
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
22. Generic components of an EOB
• Payer’s Name & Address
• Provider of services
• Dates of service
• Services or procedure code numbers
• Diagnosis codes and/or Rx codes
• Amounts billed by the provider
• Reductions or denial codes
• Claim control number
• Subscriber’s and patient’s name and policy numbers
• Analysis of the patient’s total payment responsibility
– Amount not covered
– Co-payment
– Deductibles
– Coinsurance
– Other insurance payment
– Patient’s total responsibility
• Total amount paid by the payer
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
23. Strawman 4:
Microsoft Healthvault EOB Specification
Main Information
http://developer.healthvault.com/types/type.a
spx?id=356fbba9-e0c9-4f4f-b0d9-4594f2490d2f
XML Schema
http://developer.healthvault.com/types/schem
a.aspx?id=356fbba9-e0c9-4f4f-b0d9-
4594f2490d2f
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
26. Strawman 5:
Minnesota Uniform EOB
Source & Standard: http://www.health.state.mn.us/auc/eobremitmanual2007.pdf
• Stems from Minnesota
HealthCare
Administrative
Simplification Act (ASA)
of 1994
• Payers can raise
consumer awareness
and strengthen
customer satisfaction
• Set of administrative
standards and simplified
procedures throughout
the industry
• Consistent industry
guidelines
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
27. Payer Content WG Status & Timeline
☐ Create synopsis, post for comment & feedback
Pre-Discovery ☐ Create charter, challenge, stakeholder, timelines & milestones
☐ Define goals & outcomes
☐ Use Cases & Stories, functional requirements
☐ Identify interoperability gaps, barriers, obstacles, costs
Discovery
☐ Identify alternative approaches, feasibility tests & prototypes
☐ Identify existing standards, models, artifacts for harmonization
☐ Create Harmonized Specification
☐ Relevant documentation e.g. Implementation Guides, Design Documents
Implementation
☐ Revise Harmonized Specification & documentation
☐ Transition Plan to Open Source & public-private consortia/communities
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
28. Payer Content WG Dashboard
Accomplishments Status
Initial Draft of Scope & Aims Timeline
Reviewed 2 “straw-men”
Reviewed 3 use case areas Standards Identified
Engage WEDI community 10/22 Outstanding Issues
Agree upon aims & func. Reqs.
Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13
WG
Launch Define Scope &
(10/5) Aims Proposed accelerated timeline
Solidify Use Cases
Review Revise &assess Generate impl.
standards; (e.g. feasibility guides for suppliers
harmonize vs. utility) and developers
Pre-Discov. Discovery Implementation Guide
S&I Framework Accelerated Lifecycle
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov
29. You’re invited!
ABBI Payor Content Workgroup
– Open to the entire public & private Standards & Interoperability community
– Payor Workgroup Meetings are Fridays from 1:00 – 2:00 pm Eastern.
– “All-Hands” Community Meeting are on Wednesdays
– Meeting information is on the Automate Blue Button Wiki Page:
http://wiki.siframework.org/Automate+Blue+Button+Initiative
29
Contacts: Pierce.Graham-Jones@hhs.gov & Henry.Wei@va.gov