SVP, R&D, Change Healthcare; member HITAC, former co-chair HITSC; Direct Project, S&I Framework for ONC; HIT, pharma geek. Randomly serious. Make many typo.
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Dec 31, 2021 • 6 tweets • 2 min read
At various times, I've said "hey, let's not make the same mistake about public health funding that we made in 2001" & gotten the cold long "just the way the world works, son" stare from people who were there in '01
& look, I get it. There's so much stuff in public health that nobody thinks is sensible, but there's too much structural inertia to change.
- splitting public health from health care is dumb but secondary to how we fund health care in this country & *that's* been easy to change.
Dec 31, 2021 • 10 tweets • 4 min read
@ezraklein Some structural issues here: 1) Congress allocates funding to Big Bang moonshots after major crises (e.g., 9/11/anthrax, now) 2) Most infrastructure needed at the STLT level, not Fed, but funding allocated at Fed level 3) Hard to hire technologists at SLTLs
@ezraklein We *should* invest in modular services that are built around STLT needs; should sustain funding over time to avoid pinching public health in financial crises, and build multiple-use infrastructure (e.g., contact tracing infra for STDs/food-born illness usable in pandemics)
I'm going to take this as a "where does money flow in the US health care system". So where does every 💸 originate?
"Payers" right?
Nah.
Jan 17, 2021 • 12 tweets • 4 min read
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Thinking about this tweetstorm, one of the issues I’ve run into as an engineering leader is what to call the software engineering stuff that’s “agile” given that the Agile Community(tm) has killed the brand.
And by & large, I’ve taken to call it “DevOps”, because the DevOps community have taken up much of the mantle @KentBeck & the XP community started with. & Kent has independently focused on safe small changes deployed to production. Which is DevOps.
Jan 16, 2021 • 4 tweets • 2 min read
Here, by the way, was the #HITAC recommendations letter in question.
If I were public health interoperability czar with the power to pull the Levers Of Power
A 🧵
2/
ELR:
- Unify FDA, CLIA & CMS powers to tie payment & lab certification to reporting, work w/ CDC to create a registry of reportable tests & include public health reporting in analyte machine test scenarios
- Require reporting of demographics & contact info as COP
Jun 11, 2020 • 15 tweets • 3 min read
1/ Sorry for the top quote, but imma thread(*):
I'm on the "Intersection of Clinical and Administrative Data Task Force" which is a joint task force of NCVHS and HITAC.
So, there are *two* FACAs that deal with health technology standards.
NCVHS was created forever ago, but it's mission was updated w/ HIPAA to advise the secretary on, among other things, the administrative transactions created for HIPAA (& as a reminder, the privacy & security stuff in HIPAA was sideline in the day…
Apr 15, 2020 • 31 tweets • 8 min read
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Participating in #HITAC call and will summarize here.
CDC rolling out eCR more rapidly & working on an eCR Now FHIR app for electronic case reporting. Epic streamlining implementation to 3 days.
A tweetstorm that will make some people mad. I apologize in advance.
There are two perspectives on the IHE SOAP-based specifications (primarily XDS, XCA and XCPD), not mutually exclusive
2) a) They have worked in practice, so should not be ripped and replaced
b) They are legacy technology and we should work on more modern alternatives.
A 3rd perspective, enshrined in #TEFCA#QTF is:
c) We should continue to make them the core of our health infrastructure
To start with, a basic question: are market forces for interoperability good, or nah?
2/
There are three basic positions that I hear articulated
a) "making money on interoperability is immoral"
b) "making 'unreasonable' profit on interoperability is immoral"
c) "extracting monopoly rents as an interoperability gatekeeper is immoral"
Mar 8, 2019 • 11 tweets • 2 min read
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Who is a Heath Information Network under #CuresNPRM?
Easy, right? a HIN is a network that shares health information, yes?
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🤔🤔🤔
"Health Information Network or HIN means an individual or entity that satisfies one or both of the following— (1) Determines, oversees, administers, controls, or substantially influences policies or agreements that define business, operational, technical, or…"
For context, the way "Information Blocking" provisions work is that electronic health information *must* flow for all permissible purposes, unless there's a good reason.
171.201-7 enumerate the possible good reasons information wouldn't flow
As a reminder, the PHSA defines "provider" broadly & "permitted purposes" are purposes that are, well, permitted.
2/ Therefore, unless there are specific exceptions noted, the legislative intent of #21CC could be interpreted that....
Nov 3, 2018 • 7 tweets • 1 min read
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I used to work for a company that did high end technology & engineering consulting mostly for the government.
They helped build ARPANet
We ran the NOC for the Internet in Boston & California
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The company started with MIT acoustical engineers. It got into computing early on b/c acoustic modeling is computationally expensive.
Anyway…
Nov 1, 2018 • 10 tweets • 1 min read
Health Care Start-Up Ideas That Sound Plausible But Don't Work: A Random And Partial List
Skin In The Game + Transparency
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