2016 Current ltpac activities
2016 has been a very busy year as John Derr has been building upon the 2015 ONC Brief on the Value Proposition of Long Term & Post Acute Care (LTPAC) and role of LTPAC in the new care and payment models being proposed by CMS and ONC.
The following paragraphs provide a profile of my activities in support of LTPAC Providers and Health Information Technology Developers. Basically I attend meetings and:
Give Presentations on LTPAC Value Proposition;
Write Articles for Publications;
Write Strategic White Papers for Clients;
Provide Strategic Clinical Technology Advice; and
Provide Expert Advice and Opinion.
I also serve on a number of Boards of Directors and Advisory Boards
SUMMARY OF FIRST HALF OF 2016 ACTIVITIES
MEMBER OF THE STANDARDS COMMITTEE (HITSC) - 2009 - 2016
In 2009 the American Restoration and Reinvestment Act was passed and formed the HITECH Act. The HITECH Act established two Federal Health Information Technology (HIT) Advisory Committees. One on HIT Policy and a second on HIT Standards. ONC provides support to these two Federal advisory committees. Their charge is to provide input on the policies and technologies needed to improve health and care. They provide a direct means for private and public sector health IT leaders as well as the public to provide input to U.S. Department of Health and Human Services (HHS). The Health IT Standards Committee (HITSC) is charged with making recommendations to the National Coordinator for Health IT on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. Initially, the Health IT Standards Committee will focus on the policies developed by the Health IT Policy Committee's initial eight areas. (https://www.healthit.gov/FACAS/health-it-standards-committee) After 7 years my appointment term on the Standards Committee expired on June 30, 2016 and cannot legally be extended. I was succeeded by Terrance (Terry) O'Malley, MD of Boston Partners and Harvard.
ACCOMPLISHMENTS: Since LTPAC Providers were not included in the HITECH Act and therefore not eligible for HIT Incentive payments or to be considered an eligible provider of care I was placer in a difficult role as the HITSC could not include LTPAC in any of their recommendations. The members of the HITSC and ONC recognized the error of the Administration in leaving out LTPAC and supported me and LTPAC off line. By 2011, LTPAC was recognized and various initiatives were began to include LTPAC in the Spectrum of care. When what was called Stage # off Meaningful use is implemented LTPAC will be included.
MEMBER OF THE HEALTH IT POLICY COMMITTEE TASK FORCE ON CONSUMER ENGAGEMENT - 2016 - PRESENT
In May of 2016 the Policy Committee formed the Consumer Engagement Task force and Derr was appointed to the Task Force to represent LTPAC. This Task Force is convened on an as needed basis. The task force will provide insight on ONC/HHS projects/initiatives with a consumer focus to ensure the person remains at the center, engaging the experience and feedback of both patients and providers. Without patient engagement in their own health we will not succeed in preventative care.
The Initial focus of the task force will be charged with providing feedback on ONC’s Blue Button Connector site and a tool ONC is developing to help providers with patient activation and engagement. In 2010, Department of Veterans Affairs started the Blue Button initiative. Now over 88 million americans can download their health record for a portal. As of 2016, over 1 million people across the country have downloaded their health record. The Blue Button Connector presents an easy way to use various apps with your Blue Button information.
The Second focus is on the ONC Patient Engagement Playbook for Professionals (https://www.healthit.gov/playbook/pe/). The Playbook introduction Section states:
Patient engagement can have big benefits for your practice and your patients: better communication, better care, and better outcomes. Health information technology (health IT) is a powerful tool to help you get there — so learn how to make it work for you.
Use the Patient Engagement Playbook as your guide. The Playbook is an evolving resource for providers, practice staff, hospital staff, and other innovators: a compilation of tips and best practices we’re collecting from providers and health systems like yours.
CMS TESTING EXPERIENCE AND FUNCTIONAL TOOLS (TEFT) GRANT eLTSS DEVELOPMENT - 2014 - PRESENT
The electronic Long-Term Services & Supports (eLTSS) Initiative is a ONC-CMS partnership that will focus on identifying and harmonizing electronic standards that can enable the creation, exchange and re-use of interoperable service plans for use by health care and community-based long-term services and supports providers, payers and the individuals they serve. These plans can help to improve the coordination of health and social services that support an individual’s mental and physical health.
The eLTSS is very important to Medicaid and Home and Community Based Services (HCBS) and allowing a person to live at the home of their choice to receive care.
This initiative is under the Standards and Information Framework initiative. The S&I Framework supports programs where the public can become involved. Their 6 States that are involved in this ONC/CMS Grant. (http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+(eLTSS))
The eLTSS Schedule as of June 2016 is focusing on the medical elements of the eLTSS before going to pilot. This initiative is also important as it will eventually be in harmony with the longitudinal care record being developed under the HITECH Act. The initiative is also developing the Personal Health Record (PHR) which is also important in person centric care.
MEDICATION REGIMEN REVIEW AND RECONCILIATION - 2016 - PRESENT
It is general knowledge that medication errors are one of the major causes of rehospitalization, poor quality of life, and death from adverse effects from medication mismanagement. Two of the major medication error possibilities are: Medication Reconciliation and Medication Regimen Review. These functions are performed in various ways by the different providers in a persons Spectrum of Care. It is the charge of the members of this CMS Grant to develop approved standards to be used throughout the spectrum of Care.
Medication safety is a primary focus by many groups as we move to person centric electronic longitudinal care. We are looking at Polypharmacy (the taking of multiple medications). The average number of medication an elderly person who has chronic conditions with comorbidities is increasing. With the multitude of prescribers it is a growing concern that many of the the medication are counter indicated. We are also looking at pharmacogenomics to assist in polypharmacy and insurance that the medications a person takes are metabolized.
HEALTH INFORMATION SYSTEMS SOCIETY (HIMSS) LTPAC ROUNDTABLE - 2015 - PRESENT
In 2015 HIMSS finally recognized the role of LTPAC in health information technology. Heretofore HIMSS concentrated on hospitals and physicians. There used to be a special interest group (SIG) at HIMSS but was dissolved for lack of interest. I worked with the National Association of the Support of Long Term Care (NASL) to form an organization that supported the Health IT vendors and in 1998 we formed the NASL IT Committee.
In 2015 HIMSS expanded their representation to include LTPAC and the monthly LTPAC Roundtable Webinar Series began. Dr. Greg Alexander of the University of Missouri and John Derr, RPh were chosen as Co-Chairs of the Roundtable. In the 2015 - 2016 series there were five Roundtables governing a number of subjects. One of the objectives was to inform hospitals and members of HIMSS of the value proposition of LTPAC. We have found that mainly hospitals are not familiar with the value of LTPAC Providers. The Monthly Webinars begin again in September 2016. The focus of the next series will be on coordination of Care.
At the 2016 HIMSS Annual meeting Greg and I held two hour sessions on the clinical technology conversation between the hospital and LTPAC. The focus was on what are the needs of the hospital and LTPAC in the transitions of care and Interoperability. Work is being done on expanding the role of LTPAC at the HIMSS 2017 Annual Meeting. HIMSS was also a Strategic Partner at the 2016 Annual LTPAC Health IT Summit held June 26-28, 2016
MEDICAL HOME TEAM, INC. (MHT) (http://www.medicalhometeam.com) 2015 - 2016
Served as the full time interim CIO for MHT until a full time CIO could be hired. worked with the President on the Clinical Technology infrastructure. Medical Home Team is a healthcare management company that works with physicians to create their own specialized chronic care practice for their Medicare and dual eligible patients. The physician leads the Medical Home Team, who collectively takes responsibility for the ongoing care of patients with chronic conditions. The Medical Home Team is responsible for managing all of the patient’s healthcare needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventative services and end of life care and coordinating all products and services to achieve the highest possible outcomes at the lowest possible cost.
AMERICAN HEALTH CARE ASSOCIATION AND NATIONAL CENTER FOR ASSISTED LIVING (AHCA/NCAL) (https://www.ahcancal.org/) 2002 - PRESENT
Derr was invited to the AHCA/NCAL Strategic Committee meeting in February 2016 to develop the education plans for 2016 and how we can harmonize clinical and technology in the AHCA/NCAL programs. Attended the IT Committee Meeting prior to the June 26-28, 2016 Health IT Summit and contributed to the monthly conference calls of the IT Committee which Derr formed in 2003.
LTPAC HEALTH IT COLLABORATIVE (http://ltpachitcollaborative.wikispaces.com) 2005 - PRESENT
The Collaborative represents the member association membership on issues of clinical technology. The members discuss the issues almost weekly. The Collaborative has held the only LTPAC Clinical Technology Health IT Summit in the US for 12 years. Derr is a member having been one of the three founders. He contributes to the weekly conference calls; is on the Summit Planning Committee and speaks at the Annual Summit; and assists in forming the Collaborative's comments on ONC and CMS Requests for Information (Interoperability RFI) and Proposed Rules (MACRA). Derr gave this years Eye Opener presentation on the Value Proposition of LTPAC and was also the Monitor of the Precision Medicine and Decision Support Software Panels. See Collaborative page on this Website.
THE SOCIETY FOR POST-ACUTE AND LONG TERM CARE MEDICINE (AMDA) (http://www.paltc.org) 2016
Was on the Keynote Panel at the April 2016 AMDA (The Society For Post-Acute and Long-Term Care Medicine). The speech was on the Value Proposition of LTPAC Providers and value of the physician in LTPAC. Attended the meeting of the strategic planning Committee of AMDA and how we can improve the interoperability between the physician and LTPAC Providers
NATIONAL ASSOCIATION FOR THE SUPPORT OF LONG TERM CARE (NASL) (https://www.nasl.org/) 1998 - PRESENT
The National Association for the Support of Long Term Care (NASL) is a trade association representing the legislative and regulatory interests of over 100 companies providing physical, occupational and speech-language pathology therapies; portable x-ray/EKG and ultrasound; health information technology systems; and products such as complex medical equipment, parenteral and enteral supplies, equipment and nutrients; and additional specialized supplies for long term and post acute care settings nationally. The mission of NASL is to represent ancillary service providers and suppliers in the long term and post acute care community on healthcare policy and to advocate for high-quality, cost-effective care. Derr is a member of the IT Committee which he formed in 1998 to represent the Health IT vendors and developers of LTPAC software.
NATIONAL ASSOCIATION FOR HOME & HOSPICE (NAHC) AND HOME CARE TECHNOLOGY ASSOCIATION OF AMERICA (HCTAA) 2010 - PRESENT
The National Association for Home Care & Hospice (NAHC) is the largest and most respected professional association representing the interests of chronically ill, disabled, and dying Americans of all ages and the caregivers who provide them with in-home health and hospice services. NAHC is a unique trade association for several reasons. First, it reflects its membership, placing the concerns of the infirm and dying before its institutional or corporate interests. Second, it represents the interests of those Americans described as being on the “fringes of life”—the elderly and terminally ill facing compound problems of illness in the twilight of life, millions of fragile children with major health problems in the dawn of life, and the disabled and sick, who are too often relegated to the shadows of life. Third, it aspires to excellence in every respect. Fourth, it goes to extraordinary lengths to support the specific needs of its member organizations. Fifth, it understands that its specific mission must be achieved in cooperation with other organizations and individuals. Sixth, NAHC is committed to achieving the highest quality of care at home for vulnerable Americans and thereby winning the last great civil rights battle. Derr serves on the HCTAA Advisory Board and Attends the meetings.