Teleoperating robots with virtual reality

October 2, 2017

MIT CSAIL\’s VR system could make it easier for factory workers to telecommute

Certain industries have not traditionally had the luxury of telecommuting. For example, many manufacturing jobs require a physical presence to operate machinery.

But what if such jobs could be done remotely? This week researchers from MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL) presented a virtual-reality (VR) system that lets you teleoperate a robot using an Oculus Rift headset.

Credit \”Jason Dorfman, MIT CSAIL

The system embeds the user in a VR control room with multiple sensor displays, making it feel like they’re inside the robot’s head. By using hand controllers, users can match their movements to the robot’s to complete various tasks.

“A system like this could eventually help humans supervise robots from a distance,” says CSAIL postdoctoral associate Jeffrey Lipton, who was lead author on a related paper about the system. “By teleoperating robots from home, blue-collar workers would be able to tele-commute and benefit from the IT revolution just as white-collars workers do now.\”

The researchers even imagine that such a system could help employ increasing numbers of jobless video-gamers by “game-ifying” manufacturing positions.

The team used the Baxter humanoid robot from Rethink Robotics, but said that it can work on other robot platforms and is also compatible with the HTC Vive headset.

Lipton co-wrote the paper with CSAIL director Daniela Rus and researcher Aidan Fay. They presented the paper this week at the IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS) in Vancouver.

How it works

There have traditionally been two main approaches to using VR for teleoperation.

In a “direct” model, the user\’s vision is directly coupled to the robot\’s state. With these systems, a delayed signal could lead to nausea and headaches, and the user’s viewpoint is limited to one perspective.

In a “cyber-physical” model, the user is separate from the robot. The user interacts with a virtual copy of the robot and the environment. This requires much more data, and specialized spaces.

The CSAIL team’s system is halfway between these two methods. It solves the delay problem, since the user is constantly receiving visual feedback from the virtual world. It also solves the the cyber-physical issue of being distinct from the robot: once a user puts on the headset and logs into the system, they’ll feel as if they’re inside Baxter’s head.

The system mimics the “homunculus model of mind” – the idea that there’s a small human inside our brains controlling our actions, viewing the images we see and understanding them for us. While it’s a peculiar idea for humans, for robots it fits: “inside” the robot is a human in a control room, seeing through its eyes and controlling its actions.

Using Oculus’ controllers, users can interact with controls that appear in the virtual space to open and close the hand grippers to pick up, move, and retrieve items. A user can plan movements based on the distance between the arm’s location marker and their hand while looking at the live display of the arm.

To make these movements possible, the human’s space is mapped into the virtual space, and the virtual space is then mapped into the robot space to provide a sense of co-location.

The system is also more flexible compared to previous systems that require many resources. Other systems might extract 2-D information from each camera, build out a full 3-D model of the environment, and then process and redisplay the data.

In contrast, the CSAIL team’s approach bypasses all of that by simply taking the 2-D images that are displayed to each eye. (The human brain does the rest by automatically inferring the 3-D information.)

To test the system, the team first teleoperated Baxter to do simple tasks like picking up screws or stapling wires. They then had the test users teleoperate the robot to pick up and stack blocks.

Users successfully completed the tasks at a much higher rate compared to the “direct” model. Unsurprisingly, users with gaming experience had much more ease with the system.

Tested against state-of-the-art systems, CSAIL’s system was better at grasping objects 95 percent of the time and 57 percent faster at doing tasks. The team also showed that the system could pilot the robot from hundreds of miles away, testing it on a hotel’s wireless network in Washington, DC to control Baxter at MIT.

\”This contribution represents a major milestone in the effort to connect the user with the robot\’s space in an intuitive, natural, and effective manner.\” says Oussama Khatib, a computer science professor at Stanford University who was not involved in the paper.

The team eventually wants to focus on making the system more scalable, with many users and different types of robots that can be compatible with current automation technologies.

The project was funded in part by the Boeing Company and the National Science Foundation.
Materials provided by MIT-CSAIL

Unlock the Power of Your Data

August 1, 2017

I have a confession to make – I am a data geek. I love the clear and precise nature of data. Data are foundational to everything. Properly organized data become the building blocks for information, which leads to knowledge and ultimately, wisdom. Medicine is a data rich science, with both structured and unstructured data of a variety of types. If you are a data geek like me then health care should be in your sweet spot. And nowhere are health data and data management processes discussed, analyzed and examined more than at the annual HIMSS conference. However, gathering and aggregating these data, even as discrete elements, is of limited value if they can not be shared. Interoperability is required to really make use of these data and a business model that considers hoarding data to be some sort of advantage is doomed to fail. Data longs to be free.


Interoperability is a hot topic in health care right now, and we are sure to see it come into focus at HIMSS17. Interoperability between systems and platforms helps improve performance and helps ensure the right data, at the right time, is where and when it is needed to provide the best possible care. Nationwide interoperability is expected from the U.S. Congress, based on the MACRA Law as well as the 21st Century Cures Act. The entire health care industry, including providers, payers, vendors, policy makers and patients, have come to understand the critical need for interoperability to succeed in a transformed health system that pays for value and outcomes rather than procedures or number of visits. A physician friend of mine puts it like this: \”I want to get paid for what I do for my patients not what I do to them,\” she says. \”But I can\’t manage what I can\’t measure, and gaps in data lead to gaps in care.\”
There are a number of initiatives and coalitions attempting to address this need; the Sequoia Project (with the eHealth Exchange and Carequality), the Commonwell Health Alliance, and DirectTrust, just to name a few. These are all admirable and successful efforts (disclosure: I am on the Board of Directors for both DirectTrust and the Sequoia Project). However, once standards-based exchange is achieved then it is the use of these data that becomes the key focus. Interoperability is the ability of computer systems or software to exchange and make use of information, without special effort on the part of the end user. Simply transferring bits and bytes around is not the end of the story, but only the beginning. Most exchange today centers around transactional data, but patients should be the focus, not transactions.
Of course peer-to-peer connectivity using industry standards do help systems to be interoperable, providing possibilities for improved care, and yet clinicians still have gaps in care as the data picture is often incomplete. There is also the problem of electronic health record (EHR) fatigue from having to click through too many screens, which can lead to burnout and further damage the care process. It takes a robust clinical data network to provide a full longitudinal care record, and a well-designed user interface to make workflow adjustments seamless. Extending network reach by getting the data clinicians need more quickly and efficiently will help to solve for some of these issues.
With a powerful network clinicians can focus on the latest, consolidated clinical data which are relevant to a specific encounter. By injecting concise clinical views into workflows more quickly, clinicians are able to spend more time caring and less time searching. The Cain Brothers consider data in their Healthcare Success Hierarchy and state, \”The best way to think about data is to picture it as the middle layer in a three-part hierarchy that depicts the climb between care delivery and customer engagement.\”
Data storage today is almost boundless and very inexpensive. Hard drive capacity has increased 250,000 times over the past 60 years, while the cost per MB has dropped more than 99.99 percent. My smartphone has way more data storage capacity than my first computer did 30 years ago. With cheap, ubiquitous data, we are aggregating massive data repositories, creating what many people call \”Big Data.\” These data are valuable, but only if they can be combined and analyzed in ways that provide actionable insights. Today\’s search algorithms can find targeted data almost instantaneously, identifying patterns and building a foundation for analytics tools that collate, assess, interpret and visualize data and bring meaning to unstructured information. These tools, when used intelligently, foster informed decision-making.


As the movement towards value based care continues to accelerate, the value of your data asset increases. As I have said – data is the currency of the next century. Others have drawn an analogy to energy calling data the electricity of our generation. Any way you look at it, data is right in the midst of health reform and innovation. I agree with Andy Slavitt, former head of CMS, and Dr. Vindell Washington, former National Coordinator for Health Information Technology, when they wrote in Health Affairs  data are “the lifeblood of the value-based payment environment,” and they identified the elements needed to “ensure a data-rich, patient-centered, and value-based health care system.”
In the real world, data is often dirty and messy: using incorrect or overly complex terminology, values with incorrect units and no interpretation, or unstructured data which is difficult to parse. Therefore, data normalization is an important concept to keep in mind. Normalization occurs by organizing data such that we reduce data redundancy and improve data integrity. Clean \”good\” data obviously has greater value. We look at the value of a strategic data asset in three tiers:
  • Data has value 
  • Organized data has increased value 
  • Organized and normalized data has exponential value
Scott Fowler, MD the CEO of Holston Medical Group, recently wrote  \”collaboration is the only way to accelerate solving problems and achieving the Triple Aim—and open platforms enable the brightest minds from all corners of the industry to work together.\” He is exactly right. It is only by working together that we can fix our broken health care system. Together, we can do this.

The AI For Good Global Summit

June 8, 2017

The world\’s brightest minds in Artificial Intelligence (AI) and humanitarian action meet with industry leaders and academia at the AI for Good Global Summit, 7-9 June 2017, to discuss how AI will assist global efforts to address poverty, hunger, education, healthcare and the protection of our environment. The event will in parallel explore means to ensure the safe, ethical development of AI, protecting against unintended consequences of advances in AI. 

The event is co-organized by ITU and the XPRIZE Foundation, in partnership with 20 other United Nations (UN) agencies, and with the participation of more than 70 leading companies and academic and research institutes. 

\”Artificial Intelligence has the potential to accelerate progress towards a dignified life, in peace and prosperity, for all people,\” said UN Secretary-General António Guterres. \”The time has arrived for all of us – governments, industry and civil society – to consider how AI will affect our future. The AI for Good Global Summit represents the beginnings of our efforts to ensure that AI charts a course that will benefit all of humanity.\”

The AI for Good Global Summit will emphasize AI\’s potential to contribute to the pursuit of the UN Sustainable Development Goals. 

Opening sessions will share expert insight into the state of play in AI, with leading minds in AI giving voice to their greatest ambitions in driving AI towards social good. \’Breakthrough\’ sessions will propose strategies for the development of AI applications and systems able to promote sustainable living, reduce poverty and deliver citizen-centric public services.

\”Today, we\’ve gathered here to discuss how far AI can go, how much it will improve our lives, and how we can all work together to make it a force for good,\” said ITU Secretary-General Houlin Zhao. \”This event will assist us in determining how the UN, ITU and other UN Agencies can work together with industry and the academic community to promote AI innovation and create a good environment for the development of artificial intelligence.\” 

\”The AI for Good Global Summit has assembled an impressive, diverse ecosystem of thought leaders who recognize the opportunity to use AI to solve some of the world\’s grandest challenges,\” said Marcus Shingles, CEO of the XPRIZE Foundation. \”We look forward to this Summit providing a unique opportunity for international dialogue and collaboration that will ideally start to pave the path forward for a new future of problem solvers working with XPRIZE and beyond.\”

The AI for Good Global Summit will be broadcast globally as well as captioned to ensure accessibility. 

View the live webcast at:

Sophia, a humanoid created by the Hong Kong robotic company Hanson Robotic is presented at the \’AI for Good\’ world summit in Geneva. FABRICE COFFRINI / AFP

via  ITU + xprize

Snowmageddon and the 2017 Digital Health Evangelist Award

January 9, 2017

Each year fifty of the leading entrepreneurs, investors, technologists, reporters, and providers dedicated to bringing technological advancements to healthcare are recognized at the Top 50 in Digital Health dinner hosted by Rock Health, Fenwick & West, Goldman Sachs, and Square 1 Bank. I was honored to win the Digital Health Evangelist 2017 category and planning to attend the gala event to receive my award, and happily it was even during during #JPM17 week in San Francisco.

columbia river gorge photo blog by blaine franger

Unhappily, my flight was cancelled due to a pretty big snowstorm which socked the Pacific Northwest and halted almost all air travel. But I\’m still a winner because I have many friends and colleagues who voted for me, I have a loving family, and most of all my devoted wife who has to put up with all the stuff most of you never see. And of course there are a host of people along my journey in life that have been so instrumental in any success I may have – and certainly God has richly blessed me beyond measure. What a long strange trip it\’s been indeed

So it is with a happy heart that I share this Facebook video my wife took of me, using our mailbox as a snow podium and with only birds, cats, and our dogs in attendance 😀

Seemed appropriate to me and I am still truly humbled by the honor of winning this award and I will try to live up to the high standard that the 2016 Digital Health Evangelist set – Daniel Kraft, MD sets the bar pretty high!

I am going to make it my mission in 2017 to redouble my efforts to building consensus among diverse stakeholders to use new and forward leaning technology tools in order to solve big problems. In this year of transition (in so many ways) it will be even more important that we all pull together to fix this broken healthcare system.

Accepting my Digital Health Evangelist 2017 award (in absentia due to the PacNW snowmageddon).

So again, thank you to all who voted and now it\’s time to get packing for sunny Orlando. See you at HIMSS!

Exit Memo: Department of Health and Human Services

January 8, 2017

Secretary Sylvia Mathews Burwell | January 5, 2017


In 1798, President John Adams signed the “Act for the Relief of Sick and Disabled Seamen,” creating a network of hospitals to care for merchant seamen and setting the foundation for what would become the United States Public Health Service Corps. In the more than 200 years since then, scientific advances and social progress have resulted in dramatic improvements in the health of the American people. Specifically, life expectancy has nearly doubled, and mortality rates from infectious disease have plummeted.  
Yet in January of 2009, as President Obama took office, more than 40 million people did not have health insurance. Health care costs were growing at rates that far exceeded the growth of our economy, and our nation lagged in key measures of health care quality. Poverty was rising and, consequently, more families struggled to make ends meet. Childcare programs and Head Start, the very ladders of opportunity for children born into difficult circumstances, often failed to incorporate the latest research on early childhood development, and too many children could not access these programs. Refugees fleeing persecution and war needed assistance so they could transition to living in a new country and begin contributing to their local economy and their community. And our nation needed important investments to break new ground in medical science, innovation, and digital technologies.  
Over the years, the dedicated and hardworking employees of the Department of Health and Human Services have been committed to the mission of helping Americans access the building blocks of healthy and productive lives. During the past eight years, the Department has worked tirelessly to advance this core goal and make progress on the many important issues that the Administration faced over the President’s tenure. In addition, the Department has met the challenges of new and unexpected public health issues, such as H1N1, the opioid crisis, Ebola, and Zika, that emerged during President Obama’s time in office. In this memo, I will outline some of the progress that our nation has made during the past eight years and highlight some of the steps ahead to continue to build on that progress. 

Record of Progress


We have helped millions of Americans access quality, affordable health care with the Affordable Care Act (ACA), the most comprehensive reform of our health care system in a generation. The ACA expanded coverage, provided tools to control costs, and addressed gaps in coverage that persisted in some of our existing programs. We have supplemented the progress made by the ACA with further improvements in Medicare and Medicaid to provide high quality, comprehensive health care coverage for all Americans. 
  • Historic reduction in the percentage of uninsured Americans. Twenty million more Americans have health coverage because of the Medicaid expansion, the Marketplaces, and other ACA coverage provisions, such as allowing young adults to stay on their parent’s plan until they turn 26. Our uninsured rate is the lowest in our nation’s history. Today, no American can be denied health coverage because of a pre-existing condition. 
  • Improved quality of health coverage no matter how you are insured. Today, more than 138 million Americans can get immunizations, cancer screenings, and other recommended preventive services without a copayment. No insurer can impose annual or lifetime dollar limits on coverage, all plans are required to place dollar limits on out-of-pocket costs, and women can’t be charged more than men just because of their gender.  
  • Improved quality of care through collaboration with health care providers and hospitals. From 2010 through 2015, hospitals prevented an estimated 565,000 patient readmissions through changes that improve the quality of care and avoid unnecessary costs. Similarly, hospital acquired conditions such as ulcers, infections, and other avoidable traumas are down, leading to an estimated 125,000 lives saved and nearly $28 billion in cost savings. To build on this progress and further reduce avoidable readmissions, we updated the requirements for nursing homes and other long-term care facilities that service Medicare and Medicaid beneficiaries, setting high standards for quality and safety while providing these facilities with important flexibilities to assist with the preservation of quality of life and quality of care. 
  • Bending the health care cost curve. Since 2010, health care prices across the entire health care system have grown at the slowest rate in 50 years. For the 157 million Americans who have health insurance through their employer, family premiums have grown at an average rate of 4.7 percent since 2010 – down from an average of almost 8 percent over the previous decade. The average family saved $3,600 in premiums in 2016 compared to if trends before the ACA had continued. The life of the Medicare Trust Fund has been extended by 11 years, and Medicare spent $473.1 billion less on personal health care expenditures between 2009 and 2014 thanks to lower rates of cost growth.  
  • Reducing the cost of prescription drugs. The ACA closed the Part D “donut hole,” helping more than 11 million people with Medicare save over $23.5 billion on prescription drugs so far, an average of $2,217 per beneficiary. The ACA also created a new pathway for FDA approval of biosimilars, which will increase patient access to affordable treatments. 


Since the beginning, the Administration has been driving efforts to increase access to high quality, affordable care. By combining new tools and programs provided by the ACA with existing flexibilities, and with a wide variety of business, professional, and patient stakeholders, we have charted a path to a better health care system that puts patients at the center of their care.  
  • Paying for the quality of care, not the quantity of services. The Administration has made historic progress in reforming how our health care system pays for care. For the first time in Medicare’s history, we set explicit goals to move Medicare to pay for value, not volume. We proposed to tie 30 percent of Medicare payments to alternative payment models by the end of 2016, and 50 percent by the end of 2018. We reached our first goal ahead of schedule. In 2016, building on the bipartisan passage of the Medicare Access and CHIP Reauthorization Act (MACRA), our nation took another important step forward by finalizing the Quality Payment Program, a new payment system that will equip clinicians with the information, tools, and flexibility to provide high-quality, patient-centered care. A critical tool in implementing MACRA and the Quality Payment Program is the Center for Medicare and Medicaid Innovation (CMMI), which develops the innovative payment models that clinicians are encouraged to participate in under MACRA. The non-partisan Congressional Budget Office projects that successful innovations, including those that are scaled up through CMMI, will save Medicare $34 billion gross over 10 years. The Administration has also launched the first national quality measures in Medicare and CHIP. 
  • Improved care delivery by promoting care coordination, wellness, and prevention.  To improve care delivery, we are supporting providers with the tools they need to practice in the ways they think work best, like paying providers a fixed or bundled payment for all the services a patient needs to have to recover from a knee replacement or other procedure; and paying for the quality of care provided to the patient and allowing providers the flexibility to provide care in the manner they deem best.  Through CMMI we also tested and expanded initiatives like the Diabetes Prevention Program, operated in YMCAs around the country.  The pilot program showed that program participants diagnosed with pre-diabetes lost about five percent of their body weight, substantially reducing their risk of diabetes and saving the Medicare program an estimated $2,650 per enrollee and helping patients live healthier lives.  We provided states the option to establish Health Home entities to coordinate care for people with Medicaid who have chronic conditions and launched a CMMI model, called Comprehensive Primary Care Plus (CPC+), establishing primary care Medical Homes for Medicare beneficiaries. And in 2013, for the first time in the history of the program, the majority of Medicaid spending on long-term services and supports was for home and community-based services.  More seniors and people with disabilities are able to receive long-term services and supports in their own homes instead of a nursing home, as we have worked to rebalance how Medicaid provides these important benefits.

    To support state efforts to provide care delivery that is aligned across all payers, we launched the State Innovation Model.  This initiative provides financial and technical assistance for the development and testing of state-led, multi-payer health care payment and service delivery models.  For example, with the support of this model, Vermont has invested the past several years in establishing key building blocks for health care reform, such as engaging stakeholders, designing commercial and Medicaid Accountable Care Organization (ACO) models, and investing in health information technology.  We also committed to supporting state delivery system transformation through Delivery System Reform Incentive Payment initiatives that provide states with funding that can be used to support providers in changing how they provide care to Medicaid beneficiaries. 
  • Making health data accessible and secure.  In order to put people at the center of their care, their doctors need to be able to get, review, use, and share copies of their health information.  When patients have ownership over their own data, they are better able to monitor chronic conditions, make sure that their health information is accurate, and share their information with others, including health care providers, family, and for research.  The passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 mobilized a national effort to digitize medical information.  While we know we still have important work ahead, the adoption of electronic health records has tripled in six years, allowing us to make advances in areas like e-prescribing.  Our partners across industry see the value of an open and connected system.  In February 2016, companies that provide 90 percent of electronic health records to U.S. hospitals publicly committed to make progress to improve the flow of health information.  We also have worked to provide unprecedented access to privacy-protected data to improve the ability of consumers, providers, and payers to track performance and make informed choices. 


We helped keep the American people safe from threats to their health and helped them live healthier lives. 
  • Improving the health of Americans by helping to make the healthy choice the easy choice.  The Department has helped to lead the Administration-wide advancement of nutrition policy through actions such as eliminating trans fat in processed foods, updating the Dietary Guidelines for Americans, proposing major revisions to the Nutrition Facts label to provide consumers with more information to make informed choices, and ensuring that chain restaurants provide calorie information to consumers. This work helps to build on and implement the First Lady’s focus on healthy lifestyles through the Let’s Move initiative. 
  • Fought health threats posed by H1N1, the Ebola virus and the Zika virus.
    • H1N1 – From 2009 to 2010, HHS and other international health organizations led the fight against the H1N1 virus. As a result of that work, we made marked improvements in vaccine development and manufacturing – developing, producing, and distributing 126.9 million doses of H1N1 vaccine in the U.S. to help 81 million people get immunized.  We rapidly developed a diagnostic test for H1N1 and within weeks distributed reagents to laboratories around the world.   
    • Ebola – In response to the outbreak of Ebola in West Africa during 2014, our Department made significant contributions to the world effort to slow the spread in West Africa, and protect Americans.  We built a system that can identify passengers entering the United States who are at higher risk of having Ebola from affected countries so that at the first sign of symptoms, the health care system — from ambulance to emergency room — would be prepared, including monitoring 36,100 people to prevent potential spread. NIH successfully treated two patients with Ebola at its clinical center.  We also established a network of 55 hospitals around the country that are Ebola treatment centers, including ten Regional Treatment Centers that are prepared to handle Ebola, and we also have enhanced capabilities to take care of new, or particularly dangerous, infectious diseases.  We also made significant contributions to the development and testing of several vaccine candidates and therapeutics.  We are currently working with the WHO on a pathway to licensing one of the vaccine candidates.  During the 2014 outbreak, we treated 11 Ebola patients in the United States. Seven of those patients required complex medical evacuations from West Africa.  One patient died.  All received top-notch and sometimes groundbreaking care at one of four hospital biocontainment units across the country.  
    • Zika – With over 38,000 cases of Zika in the United States as of December 7, 2016, with more than 32,000 in Puerto Rico alone, HHS has worked aggressively to prevent, detect, and respond to the virus. Throughout the crisis, HHS has communicated quickly and thoroughly in order to give the American people the latest information that they need to take the necessary steps to protect themselves from Zika.  According to an October 2016 Kaiser Health Tracking Poll, nine in ten Americans (92 percent) said they have heard or read at least a little about the Zika virus.  The NIH has taken the lead in developing a Zika vaccine and began Phase I testing of vaccine candidates ahead of schedule. CDC has led our efforts to work with States, Territories, and localities on strategies to detect and control mosquitoes that carry Zika, and on establishing systems to help public health officials track, monitor, and support mothers and babies affected by Zika. CMS will provide over $66 million to affected territories and states to support prevention activities and treatment services for health conditions related to the Zika virus. Researchers across the Department are making important breakthroughs in our understanding of the virus. The Biomedical Advanced Research and Development Authority (BARDA) is working closely with diagnostic manufacturers to facilitate the development of tests, and FDA has issued Emergency Use Authorizations for 14 tests, including 10 commercially developed tests.   
  • Modernized the nation’s food safety system.  The FDA took the most significant steps in decades to combat potentially deadly foodborne illness in both people and animals, finalizing seven major rules to implement the bipartisan FDA Food Safety Modernization Act (FSMA), which was signed by President Obama in 2011. The seven FSMA rules finalized in 2016 will help prevent food contamination during the food production and transportation process, enhance safety requirements for imported foods, and better protect the public health. An estimated 48 million people (1 in 6 Americans) get sick each year from foodborne diseases, according to data from the Centers for Disease Control and Prevention. Preventing foodborne illnesses through FSMA implementation will improve public health, reduce medical costs, and avoid the costly disruptions of the food system caused by illness outbreaks and large-scale recalls.  
  • Launched the Global Health Security Agenda (GHSA) to better confront global epidemic threats and keep the world safe and secure.  The Global Health Security Agenda (GHSA) works to prepare countries to prevent and reduce the likelihood of outbreaks, detect threats early to save lives, and effectively respond to infectious disease threats. It builds upon efforts in previous Administrations to improve global preparedness and, in particular, to implement the 2005 International Health Regulations; it now includes nearly 60 countries and dozens of international organizations and non-governmental and private sector partners with representatives from across sectors.  The United States government has leveraged the momentum and political support for GHSA, along with significant USG funding support to 17 partner countries and technical support to 14 others, to secure strong commitments from international partners.  These commitments include G7 support, through a coordinated approach, to 76 countries to build and strengthen their health security capacities. GHSA successfully piloted global best practices for external evaluations of national health security preparedness and target-based national planning. 
  • Improved antibiotic stewardship, surveillance, and research.  In the United States, over 2 million persons become ill every year with antibiotic resistant infections and over 23,000 die. In addition to the tragic toll in human lives, antibiotic resistant bacterial infections cost over $25 billion in direct health care costs, and over $35 billion in indirect costs due to loss of productivity. Since 2015 when the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) was released in response to the President’s Executive Order and the report from the President’s Council of Advisors on Science and Technology, the U.S. Government worked collaboratively to not only lay a strong foundation to prevent infections, improve antibiotic use, enhance surveillance and slow the emergence of resistant bacteria, but also implemented strategies to advance research and development of new antibiotics through public and private sector engagement and enhanced the global efforts to counter antibiotic resistance. Highlights include: national acute care hospitals reported reductions of 13 and 8 percent in methicillin-resistant Staphylococcus aureus (MRSA) and C. difficile infections, respectively, between 2011 and 2014, new funding was provided for more than 50 new drug candidates to treat antibiotic resistant diseases, and the percentage of U.S. hospitals reporting antibiotic stewardship programs rose by almost 10 percent.  
  • Protected children from the dangers of nicotine and provided adults with clearer information to help them make informed decisions about tobacco. Through a historic rule issued as part of the implementation of the bipartisan Family Smoking Prevention and Tobacco Control Act, signed by the President in 2009, FDA extended its regulatory authority to all tobacco products — including e-cigarettes, cigars, and hookah tobacco – improving public health and protecting future generations from the dangers of tobacco use. Most notably, this rule restricts the sale of these tobacco products to minors nationwide, and helps FDA prevent misleading claims by tobacco product manufacturers, evaluate the ingredients of tobacco products and how they are made, as well as communicate their potential risks to the public.  A report issued in December 2016 by the Surgeon General outlined the danger of e-cigarettes to America’s youth. The report is a call to action for our nation to continue our work to ensure a tobacco-free generation. 
  • Helped families and communities fight the opioid epidemic. In helping to lead the Administration’s government-wide efforts to combat the heroin and prescription opioid epidemic, HHS is combatting the opioid crisis with an evidence-based three-part strategy, focused on improving prescriber practices, expanding access to medication-assisted treatment to help people fight addiction, and expanding the use of naloxone to save people from an overdose. The CDC released guidelines for providers prescribing opioids. In August 2016, the Surgeon General sent a letter, including the CDC opioid prescriber guideline, to 2.3 million American health professionals asking them to help lead a national movement to turn the tide on the nation’s prescription opioid epidemic. SAMHSA raised the patient limit on the number of patients to whom a qualified practitioner can prescribe buprenorphine. CMS released guidance highlighting emerging Medicaid strategies for preventing opioid-related harms and established a new approach for states to address substance use disorder. And the FDA approved several consumer-friendly naloxone products, including the first intranasal naloxone product. We also brought state leaders together in this effort – hosting two convenings so state officials could share how they are fighting the opioid epidemic and strengthen their regional work together. 
  • Worked to strengthen biosafety and biosecurity of laboratories in the United States. Improving laboratory safety has been a top priority for the Department. At HHS, we have instituted reforms that promote a strong culture around laboratory safety and security; putting the right processes in place – relating to our work both as regulators and operators of labs. We have taken the following actions: HHS agencies are implementing both internal and external recommendations to continuously improve lab safety and security practices and reporting on progress in implementing these recommendations, including the establishment of an HHS Biosafety and Biosecurity Coordinating Council, which is a high-level and formal mechanism to coordinate and collaborate on biosafety and biosecurity issues across the Department. 


Divisions across the Department have advanced the frontiers of medicine and research across critical priority areas. Long-term investments in NIH-supported research have generated scientific and technological innovations and breakthroughs that support the gains in our nation’s health.  
  • Worked with partners in Congress to pass the 21st Century Cures Act. As an example of the progress our nation can make when we commit to finding common ground, this legislation will help end cancer as we know it, unlock cures for diseases like Alzheimer’s, and help people seeking treatment for opioid addiction finally get the help they need. The Act also makes important updates to HHS mental health programs in key areas such as suicide-prevention, integration of primary and behavioral health care, and early intervention for serious mental illness. 
  • Launched the President’s Precision Medicine Initiative, a research effort to revolutionize how we improve health and treat disease. The President’s Precision Medicine Initiative will pioneer a new model of patient-powered research by having volunteers share their information for research to speed the time to discovery of new treatments. With bipartisan Congressional support and with our partners across the Federal government, the NIH is launching a million-person research cohort that will fuel scientific discoveries and launch a new era of health care tailored to each person. Much of this progress results from the innovative approach by FDA to the oversight of next generation sequencing, and work by OCR to clarify patients’ rights to their own health care data. We are making great strides in building the data, technology, and regulatory framework—along with private sector partnerships—to support this effort and begin recruitment of more than a million research volunteers. 
  • Doubling the speed of progress in cancer research, development of treatments, and prevention through the Cancer Moonshot Initiative. Too many American families know the devastation that cancer can bring, and its incidence is increasing worldwide. Under the leadership of Vice President Biden, this initiative is accelerating research efforts, enhancing access to data, and facilitating strategic collaborations across the public and private sector. As the Vice President has said, we are working to accomplish in five years what otherwise would take a decade. 
  • Advanced our understanding of the human brain. Despite the many advances in neuroscience research in recent years, the underlying causes of most neurological and psychiatric conditions remain largely unknown due to the vast complexity of the human brain. Since President Obama announced the BRAIN Initiative in April 2013, entities across the government, including HHS, as well as dozens of leading technology firms, academic institutions, and other partners have made significant commitments to advancing the initiative. NIH grants have facilitated the development and advancement of new tools and techniques, and FDA has worked to enhance the transparency of the regulatory landscape for neurological medical devices. For instance, BRAIN Initiative researchers at the University of California, San Francisco developed a system to rapidly analyze the genes of thousands of newborn brain cells. Using this approach they discovered clues as to how the Zika virus may adversely impact the brain. 
  • Launched the first update of biotech regulations in a quarter century. For the first time in nearly 25 years, the FDA, working closely with EPA and USDA, is reviewing and modernizing the regulatory system for biotechnology products to improve transparency and ensure continued safety in biotechnology while supporting innovation.  


We have invested in Americans at every stage of life, to ensure that they have a chance to live healthy, productive lives and aspire to their full potential. 
  • In the midst of the worst recession since the Great Depression, HHS helped stabilize income and health care for millions of low-income Americans. The American Recovery and Reinvestment Act of 2009 (ARRA) was created to jumpstart the economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century. HHS was responsible for the implementation and management of health and human service ARRA programs. HHS awarded more than $150 billion to help stabilize state budgets and maintain health care services for struggling families; expand child care services and Head Start, while improving quality; support state efforts that created subsidized jobs for low-income parents and disconnected youth at a time when jobs were scarce; promote the adoption of electronic health records; and advance cutting edge scientific research. 
  • Improved and expanded early learning programs like Head Start. HHS comprehensively revised the Head Start Performance Standards for the first time in 40 years to incorporate the best practices and the latest research on early childhood development and brain science, while also reducing regulatory requirements by nearly 30 percent and strengthening quality and safety. These revisions will expand the number of children attending Head Start for a full school day and year, ultimately ensuring that nearly all eligible children have access to such programs by 2021. In addition, HHS implemented the “Designation Renewal System” in Head Start to require lower-quality programs to compete for continued funding, ensuring that all Head Start programs are focused on the quality of service they provide. HHS has also implemented the landmark reauthorization of the child care program with its emphasis on improving the quality of care, including stronger health and safety requirements. The innovative Early Head Start – Child Care Partnership grants have brought together providers of both programs to expand the availability of high-quality early learning for infants and toddlers in creative ways. In collaboration with colleagues at the Department of Education, 18 states have been funded to create comprehensive and coordinated early learning systems from birth until kindergarten through the Preschool Development Grants.  
  • Created the Maternal, Infant, and Early Childhood Home Visiting Program. We know that the most important job is the job of being a parent. The Maternal, Infant, and Early Childhood Home Visiting program supports, created by the ACA and most recently extended under MACRA, supports voluntary, evidence-based home visiting services, where trained professionals meet with expectant parents and families with young children in their homes to teach them effective parenting skills and promote early learning. Home visitors can also connect families to a range of services — including health care, early education, and early intervention — to ensure that children are healthy and prepared for school, and for life. Between FY 2012 and FY 2015, the Home Visiting Program state and territory grantees provided approximately 2.3 million home visits. State Medicaid programs are also advancing this promising new model. This effort was built on research showing that home visiting programs can improve health outcomes for children. 
  • Improved Mental Health and Substance Use Disorder Coverage. Untreated mental health and substance use disorders can be debilitating and life-threatening. The ACA made mental health and substance use disorder services an essential health benefit that plans in the individual and small group markets must cover. The Obama Administration has made mental health and substance use disorder parity a priority, and because of these efforts, more than 170 million Americans will benefit from improved insurance coverage for mental health and substance use disorder care. Mental health parity eliminates restrictions on mental health and substance use coverage – like annual visit limits, higher copayments, or different rules on how care is managed such as more frequent pre-authorization requirements or medical necessity reviews – if comparable restrictions are not placed on medical and surgical benefits.  
  • Improving the child welfare system. HHS has worked with more than half of the states to implement child welfare demonstration programs to test innovative approaches to helping children and families who are involved with the child welfare system. The waivers have been flexible enough to allow states that have seen rising need for child welfare services and foster care – including states where the increase appears to be driven in part by opioid and other drug use – respond to that increase in need. HHS also continues to promote adoption and “forever families” for children in foster care when it becomes clear they will not be reunified with birth families.  
  • Caring for the caregivers of people with disabilities and older adults. Our Department provides support to many of the caregivers nationwide who provide an estimated $522 billion in care annually. We support about 900,000 caregivers with counseling and training services to help them, and with respite care services to provide temporary relief from caregiving responsibilities. Research has found that caregiver stress is an important predictor of nursing home entry for those they are helping, which is both expensive and often where people receiving care do not prefer to be. Data from the Administration for Community Living’s (ACL’s) Family Caregiver program found that nearly half the caregivers of nursing home eligible care recipients indicated that the care recipient would be unable to remain at home without support services. In addition, through the ACA, Medicaid has significantly expanded the options available to states to provide caregiving services that support older Americans remaining in their homes as they age. 
  • Helped reduce homelessness with new resources and interagency partners. Since 2010, HHS has helped contribute to reducing homelessness by 11 percent nationwide. In 2010 the Administration laid out bold goals in “Opening Doors,” the first federal strategic plan to prevent and end homelessness. Since then, unsheltered homelessness has been reduced by almost 26 percent, including a reduction in unsheltered families with children of 60 percent. Veteran homelessness has been reduced by 47 percent, including a 56 percent reduction in the estimated number of Veterans experiencing unsheltered homelessness. An impressive 33 communities and three states have ended homelessness among Veterans. Chronic homelessness has been reduced by 22 percent, including a 13 percent reduction in unsheltered chronic homelessness. HHS contributed to these reductions both through our homelessness-specific programs, such as ACF’s Runaway and Homeless Youth program and HRSA’s Health Care for the Homelessness program, as well as through support from our mainstream programs, such as Medicaid and Temporary Assistance for Needy Families. 
  • Enhanced funding and initiatives to promote the health of the American Indian and Alaska Native population. Throughout this Administration, HHS has substantially increased funding to the Indian Health Service (IHS) to support direct health care services, construction projects, and tribal partnerships. Funding for the IHS has increased by 43 percent under President Obama through FY 2016. In addition, ACA included a permanent reauthorization of the Indian Health Care Improvement Act. As part of the President’s Generation Indigenous initiative to help Native youth, HHS has expanded resources for behavioral health support and suicide prevention, such as through SAMHSA’s Native Connections grants. More recently, HHS has focused on improving the quality of care at IHS hospitals, including a Quality Innovation Network Quality Improvement Organization grant from CMS to support best health care practices at IHS hospitals participating in the Medicare program. The Secretary’s Tribal Advisory Committee (STAC) was the first-ever such body at the Cabinet level, established by Secretary Sebelius in 2010. The STAC signals a new level of attention to Government-to-Government relationship between HHS and Indian Tribal Governments, providing a platform for Tribes to elevate their concerns to the highest levels through quarterly meetings with the Secretary and senior leadership from across HHS. As a result of this increased engagement, HHS has accomplished several tribal priorities that will benefit people in tribal communities, such as expanding full federal reimbursement for more services to Medicaid-eligible American Indians and Alaska Natives, raising the profile of their issues within the Administration for Children and Families that funds many tribal social service programs, and creating the Tribal Behavioral Health Agenda to lay the groundwork for strengthening help that American Indians and Alaska Natives can receive for substance use and mental health issues. 
  • For the first time in history, individuals are broadly protected from discrimination in health care on the basis of sex. Thanks to the ACA individuals can no longer be denied health care or health coverage based on their sex; individuals must be treated consistent with their gender identity; and explicit categorical exclusions in coverage for all health care services related to gender transition are considered discriminatory. 


Advancing innovation, strengthening program integrity and supporting and developing human resources have been a commitment for this organization.  
  • Strengthened programs and protected taxpayer dollars by eliminating fraud, waste, and abuse. Through partnerships with other federal agencies, states, and private businesses, we have used new, innovative tools to recover billions of dollars for American taxpayers and take hundreds of criminal and civil actions against people engaged in crimes against our programs. In particular, we’ve enhanced our fight against health care fraud – in part through $350 million in new ACA funds. In FY 2015, DOJ and HHS recovered $6.10 for every dollar spent on fighting health care fraud. Using enhanced data analysis capabilities, we’ve also been able to boost fraud prevention. Since 2011, CMS has used its Fraud Prevention System to review more than 4.5 million pre-paid claims a day for fraudulent activity, resulting in more than $1 billion in savings, with an $11.50 return on investment for each federal dollar spent in 2015. 
  • Opening Data to the Public. We’ve supported innovation across the industry, in both technology and operations, by opening more of our data to the public, elevating innovative staff-level initiatives, and focusing on public-private partnerships. Through the IDEA (Innovation, Design, Entrepreneurship and Action) Lab, we have equipped and empowered employees and members of the public to improve agency performance by experimenting with new approaches and led a series of agency-wide innovation initiatives. In 2010, we launched the Health Data Initiative to make health data more openly available so that public and private sector institutions could find innovative ways to improve health, health care, and the delivery of human services. In 2012, the FDA launched the Kidney Health Initiative with the American Society of Nephrology to combat the unmet clinical need in kidney disease, a disease which affects more than 20 million Americans at a huge cost to the American taxpayer. More than 2,000 data sets are now available on, many in machine-readable form, so that companies can easily create new products and tools. ONC has galvanized the Blue Button initiative, a coalition of public and private organizations committed to giving patients access to their digital health data. As part of these efforts, CMS launched Medicare Blue Button, which lets Medicare beneficiaries download their CMS claims history via the portal in an easy-to-read document. HHS has recognized and cultivated over 500 staff-driven innovations like the 100K Genome Project and the NIH 3D Print Exchange. Over 200 employee innovators have been trained in design, entrepreneurship, and business methodologies.  
  • Promoting Innovation through Partnerships with the Private Sector. HHS has increased the number of public competitions held to address challenges our nation faces. For example, the FDA Food Safety Challenge sought solutions that will directly impact how the FDA performs its regulatory duties. NIH launched the Antimicrobial Resistance Diagnostic Challenge, to develop new diagnostic tests that health care providers can use to quickly identify antibiotic-resistant bacteria, and distinguish between viral and bacterial infections. Finally, the agency’s Digital Services is guiding projects to improve efficiencies and customer satisfaction, including the new Quality Payment Program, which is the most integrated and technology enabled program yet, with the goal of easy interactions and providing valuable information back to physicians from across several programs.  
  • Built a foundation for a health care system that’s ready to fight cyber threats. We took significant steps to improve the safety of Americans’ health data and the security of life-saving medical devices across our health care system. We brought together a cross-sector partnership to identify gaps and risks and share best practices in cybersecurity, and funded the first-ever information sharing and analysis organization for the health care and public health sector. We have also deployed state-of-the-art tools and strategies to protect HHS data and assets from cyber events so that when threats occur, we can immediately detect and respond. 
  • Improving Service Delivery.  This Department learned several lessons about improving service delivery from its management of – lessons that are important for any organization directing large and complex projects. First, we learned the importance of leadership and accountability, and putting in place a management structure that sets up our teams to succeed.  Second, the need for constant prioritization in terms of tasks and projects in order to ensure projects are launched and completed in a way that is efficient and effective. Third, the need for a nimble and adaptive IT strategy. Above all, we continue to work every day to put the consumer at the center through steps that make enrollment quicker and smoother, and through efforts to meet consumers where they are. 

Vision for the Future  

We believe that this record of progress sets a strong foundation on which to build. We believe these accomplishments chart the path toward a better health care system, a strong and united front to support prevention, promote public health and combat public health threats, and a society that invests in the children and families that represent its hope for the future. 
For decades, patients and health care providers operated in a system that rewarded the volume of care over the value of that care. It was a system that left tens of millions without coverage, pushed health care costs to grow far faster than our economy, and resulted in thousands of lives lost from avoidable errors. But today, doctors, nurses, hospitals, payers and patients, along with private-sector partners, are coming together to build a better system, powered by the tools and provisions of the Affordable Care Act. 
This better system is one where providers are paid based on outcomes. It’s a system in which health care is integrated, with a focus on prevention. It’s a system where patients are at the center of their care.  
In the health care system of the future, providers work together to create a coherent care experience; they have easy and secure access to electronic records and other technology tools that can inform treatment and reveal patterns in health; and they are compensated in ways that give them the flexibility to innovate. We reward them for providing the best care for their patients.  
In this system, people are the most important part of their own care. They can access their medical records and use them as they need. They can easily make appointments and read medical bills. They understand how they can best use their benefits, and they have the support they need to manage their care. 
The Department’s experience throughout this Administration proves that by improving access and investing in quality care, we can have a stronger health care system that also lifts the burden of costs for families, businesses, and government alike. 
A stronger health care system also contributes to our defense against future threats to public health. Health threats do not operate on a predictable timeline, nor do they recognize borders, which is why rapid action and international coordination is so important.  
Our partners overseas and across borders are the other key element of a strong defense, and we must all work together to build a world where all of our partners are able to prevent, detect and respond to future health threats. This means improving and working closely through existing entities like the World Health Organization and the United Nations. It also means working with new entities like the Global Health Security Agenda, and regional groups like the Pan American Health Organization. 
Policymakers here in the United States should have funds readily available to respond to health threats as they arise and protect the American people. Our vision for the future is one where fighting a new health threat does not force us to divert funds from other vital health priorities.  
By empowering policymakers to respond quickly to public health threats, and working in concert with partners around the globe, not only can we ensure a safer future for millions of Americans, but we can improve the health and well-being of people from every nation. 
We have also fought public health threats at home, like the epidemic of opioid abuse and overdose. By working closely with both public health professionals and law enforcement, we have been able to treat this epidemic in multiple ways to ensure people escape addiction and get the treatment they need. 
At the Department of Health and Human Services, we also have the chance to improve the health and well-being of our fellow Americans by investing in the success of children and families at every stage of life. Any vision for the future of our nation has to focus on how well our nation’s children and families are thriving today.  
I envision a future where every child growing up in America has access to the building blocks of a healthy and productive life – no matter who she is, what kind of neighborhood she grows up in or the color of her skin. It is a future where every family has an open door to quality, affordable health care – physical, mental, and behavioral. It is a future that invests in stronger families and communities – giving every person the opportunity to reach for the American dream. 

Actions Needed 


As the President has said, we still have work to do to make the health care system work better for everyone. There are important steps that policymakers can take to build on this progress.  
  • Continue progress under the Affordable Care Act to expand access and improve coverage quality. The first opportunity for the new Administration will be concluding a strong fourth Open Enrollment, which ends on January 31. There is also more work to be done at HHS to strengthen the Marketplaces, including by strengthening stabilization programs, facilitating issuer entry, and taking steps to broaden the risk pool. HHS also plays a key role in working with insurers to share best practices as they continue to find better ways to provide affordable care. Congress can consider legislation on recommendations that President Obama laid out in the August 2016 article in the Journal of the American Medical Association, including enhancing financial assistance, creating a fallback public option to ensure strong competition in insurance markets around the country, and giving the federal government the authority to negotiate prices for certain high-priced drugs. These and other changes would build on the progress that our nation has made rather than rolling it back or starting from scratch. Repealing the ACA, as some have suggested, risks eliminating consumer protections – like making it illegal to discriminate against those with pre-existing conditions and protecting benefits – for Americans who get health insurance through the Marketplace, Medicare, Medicaid or through their job. A recent study shows that under one version of repeal without a replacement, nearly 30 million Americans would lose their coverage altogether. We can work together to make our health care system even better, but we should build on the progress we’ve made, not go backwards. Finally, the remaining 19 states that have not yet expanded Medicaid have the opportunity to provide coverage to 4 million of their citizens, while strengthening their economies and their health care systems. 
  • Improve health care affordability and quality through delivery system reform. When this Administration set payment goals for the Medicare program, it catalyzed action among stakeholders across the health care system, and it brought together powerful collaborative efforts to improve the way we pay for health care. The work of CMMI is crucial to this progress. Innovative CMMI alternative payment models have already improved care quality for many Medicare and Medicaid beneficiaries, and continuing to pursue these goals will ensure that these benefits are felt both within Medicare and the broader health care system. Building on the successful models developed during this Administration, while seeking out opportunities to extend value-based payment to an even broader range of providers and health care services, including high-cost drugs, not only benefits patients but allows clinicians the flexibility to practice medicine in the way that best meets the needs of their patients. The passage of MACRA was a monumental step forward in the effort to reward quality and value in physician payments; however, additional federal legislation should be considered that would use payment incentives to drive the delivery of value-based health care throughout the entire health care system, improve the interoperability of data, and integrate care. 
  • Sustain a focus on improving the quality of services provided by the Indian Health Service. It is important to continue the historic level of additional investment in IHS, which has long been under-resourced. While more funding is necessary, it is not sufficient. The next Administration should build on the work we have done to deploy assets (i.e., new policies, detailing personnel that are experts in operations and other needed areas to IHS, convening HHS quality experts to work specifically on the hospital quality/safety issues) from across HHS to make as many meaningful changes as we can to shore up IHS and its hospitals. It should also look to ensure attention to quality of care on a system-wide basis, something that had become too decentralized, leading to serious issues at critical facilities such as Rosebud and Pine Ridge in South Dakota. The problems are complex and require longer term solutions (e.g., strengthening the health care workforce pipeline by attracting and supporting American Indian students pursuing health careers). While we’re also working on initiating long-term solutions, work will need to continue beyond the end of this Administration.  


As we have outlined in our Budget, we need to continue to take steps to protect our nation from public health threats and invest in a public health infrastructure that keeps our people healthy. 
  • Continue this Administration’s efforts to fight the opioid epidemic. This includes aggressive implementation of the Comprehensive Addiction and Recovery Act and 21st Century Cures legislation, which fulfills the President’s request for $1 billion to fight the opioid epidemic. 
  • Combat the threat of infectious diseases through the Global Health Security Agenda. Continued high level U.S. leadership will be critical to maintain momentum and further institutionalize the gains that have been made, including through support to WHO and partners for external evaluations and country planning. U.S. leadership should include working with partners to follow through on their commitments, emphasizing the importance of country preparedness as a national priority, and highlighting the need for sectors beyond health, including the animal health, development, security, technology, and foreign affairs sectors, to support this work. Strengthening the multi-sectoral approach will create stronger and more resilient health systems with the ability to respond effectively to outbreaks.  
  • Invest in efforts to combat antimicrobial resistance. Although we have made great progress in implementing actions in the National Action Plan for CARB, we must remain vigilant to see this critical work through. This will require additional resources for USDA and FDA to enhance surveillance work and to protect our food supply. 
  • Establish a Public Health Emergency Fund. The federal government needs a new process to rapidly respond to urgent health threats. While a reserve fund may not fully eliminate the need for additional funding in response to a large outbreak or for unexpected threats, a ready supply of financial resources is necessary for rapid response to emerging public health threats and would save lives, save money, and protect America’s health security. The fund should come with appropriate triggers, guidelines, and reporting requirements set by Congress.  
  • Protect more Americans from Tobacco and Nicotine. Despite decades of efforts to reduce tobacco use, it continues to be the leading cause of preventable disease and death in the United States. Protecting America’s youth from the harmful effects of tobacco products, such as e-cigarettes and flavored cigars, should continue to be a top priority for the federal government. The federal government should continue to conduct research on the harms associated with the use of tobacco products as well as prevention techniques that focus on at-risk populations.  
  • Empower families with information about the foods and beverages they consume. Under the leadership of First Lady, Michelle Obama, and her Let’s Move! initiative, we have made great strides in making sure consumers have the tools they need to enjoy a healthy diet. In 2015, HHS and USDA worked together to update the Dietary Guidelines for Americans, which provides critical information about a healthy diet. The FDA modernized the Nutrition Facts label, which will make it easier for consumers to see essential information at a glance, including calories and information about serving sizes and servings per container. The updated label also includes information about added sugars for the first time, so consumers have complete information about the amount of sugar contained in the products they buy. The FDA also published draft, voluntary targets for industry to reduce sodium in various foods. The link between sodium consumption and blood pressure is strong and well documented. High blood pressure is a key risk factor for heart disease and stroke. Continuing the work of the First Lady and the Let’s Move! Initiative should remain a top priority for improving the nation’s public health, especially working with industry to finalize and implement FDA’s voluntary sodium reduction targets.  
  • Continue to Invest in FDA for the Future. As medical technology continues to evolve and the global marketplace continues to expand, we must make sure the FDA is fully equipped to carry out its mission in the 21st century. While FDA continues to be a global leader in first-to-market medical products, greater investment in the FDA, including improving regulatory science, will help ensure the agency can help advance emerging technologies while continuing to protect the public health. A robust FDA will also help improve competition in the marketplace, especially the pharmaceutical marketplace where health care consumers want access to safe and affordable options.  


To promote the well-being of our nation’s children and youth and help seniors and people with disabilities live as independently as possible, we need to continue to invest in key HHS priorities. 
  • Invest in Children and Families.  
    • Expanding access to high quality early childhood education is among the smartest investments that our nation can make. The President’s vision is that all children should have safe, high-quality early care and education from birth through age four that nurture their healthy development to help them grow, thrive, be successful in school, and even find better jobs and earn more as adults. This support will also help their parents succeed in the workforce, strengthening our economy. While the goal will take some time to achieve, important steps on the way include additional funding for Head Start to ensure that nearly all children in the program can benefit from a full-day/full-year schedule as well as further investment in child care to reach more working low-wage families that need assistance and to fully realize the quality improvements called for in the 2014 law. Implementation of the “Designated Renewal System” in Head Start has been a fundamental change to the program; the next Administration should ensure that the focus on quality in brings continues, even while considering whether any operational adjustments are needed.  
    • In child welfare, the next Administration should build on the work that has been done to build an infrastructure of evidence-based prevention efforts that would keep children from being abused or neglected and needing foster care. While legislation to reform the child welfare system to focus more on up-front prevention did not pass in 2016, it had strong bipartisan support, passing the House of Representatives on a voice vote.  Bipartisan support for increasing the focus on prevention is clear. The current opioid crisis is a reminder that effective substance use disorder treatment can be a prevention effort in child welfare, where too many children are taken into foster care due to parental substance use issues. Stronger families are better for children – and can be cost-effective, in light of the expense involved in providing foster care. 
    • Finally, it is clear that the TANF program does not address the needs of families in poverty, especially deep poverty, as well as it could. We need to do more to help families in crisis and those struggling to get a foothold in the economy. The FY 2017 Budget proposed giving states more ability to test innovative and individualized approaches to helping families get jobs, sustain employment, and make progress in the labor force, while emphasizing the need for outcomes accountability and taking steps to help more families facing emergencies. While these have not moved forward, the next Administration should focus on improving TANF to make it a less bureaucratic program that does more to help families and is less about whether states comply with detailed federal rules that have little to do with what families need to succeed. 
  • Responsibly manage the Unaccompanied Children program. HHS has the legal obligation to care for children who are apprehended by immigration authorities without a parent or guardian. HHS cares for these children until they can be safely placed with a sponsor, typically a family member, while their immigration cases proceed. In recent years, the number of children referred to HHS has varied, but has been significantly higher than earlier in the decade, creating challenges both for HHS as well as for other parts of the federal government. HHS has been able to expand its shelter capacity to care for a larger number of children. Going forward, it is important that the federal government continues to have a coordinated, comprehensive effort to address migration, including the root issues facing Central America – the region of origin for most children referred to HHS care – that lead children to undertake this dangerous journey. 


A little more than four decades ago, a young girl took a seat in a classroom in a small town in West Virginia for a new program called Head Start. In that room, she would make lifelong friends and spark a love of learning that she would carry with her into a career of public service, and eventually the chance to serve as Secretary of the Department of Health and Human Services.  
My path to serve this Department and the American people was made possible by generations before me—generations of men and women who knew that the role of public service is to lift up families and empower communities.  
I have been lucky to visit many of those communities during my tenure as Secretary. I have met Americans wrestling with questions about health coverage and health care, concerns about new health threats, and thoughts about how to give their children the best chance to succeed. In all of these cases, families across our country are facing real choices and challenges: What kind of health coverage is best for my family and me? What steps do I need to take to keep my pregnant wife safe from the Zika virus? What resources can help my cousin get the treatment he needs to fight his addiction? How can I afford high quality preschool for my child? 
Our Department shines the brightest when we connect those Americans with the realities of the challenges and opportunities ahead. We fulfill our mission every time we help the American people have real conversations about the real choices they face. Whenever we put the American people at the center of their decisions and empower them, our nation grows stronger. That has been our goal at the Department of Health and Human Services throughout President Obama’s Administration, and I hope it continues to be the legacy of this Department well into the future. It has been a privilege to serve with this team.

Posted from

National Governors Association publishes an interoperability roadmap and website

December 19, 2016

As more of healthcare is turned to the purview of the states this document will have increasing importance

New and innovative health care delivery and the payment infrastructure to support those reforms must be built on the interoperable exchange of health data. Interoperable health data exchange requires that systems and devices be able to exchange data and interpret that shared data. The ability to share and use health information within and across systems plays an important role in achieving the triple aim of improving health, improving health care, and reducing costs.

However, despite recent and significant investment in health information technology, particularly electronic medical record systems, the exchange of data has not kept pace with the development of technology. Without interoperable data, health systems are not appropriately equipped to deliver high-quality, coordinated care to patients. States are committed to improving delivery of high quality and coordinated patient care by increasing interoperability between providers while carefully ensuring the privacy of patients.

Exchange of clinical health information is critical to ensuring that providers have the best information possible when making decisions about patient care, minimizing repetition and errors, ensuring high-quality transitions of care and lowering costs.

The United States has experienced significant advancements in medical diagnostics and treatments for complex health problems in recent years; however, health care still lags far behind other sectors of the economy in the exchange of information to improve efficiency. Due to a variety of legal and market-based barriers, exchange of clinical health information between providers often does not occur, or occurs in a manner that does not allow for meaningful use of data to support optimal patient care.

\”Not only has the NGA published its road map, it has begun assisting several states in executing the road map’s recommendations. NGA will issue a report on these efforts next year. We look forward to continued collaboration with NGA and state governments, policymakers, and private sector health care leaders\”
Lucia Savage, J.D. ONC Chief Privacy Officer, and Peyton Isaac J.D., B.S.N. ONC Senior Privacy Policy Analyst

The road map – “Getting the Right Information to the Right Health Care Providers at the Right Time: A Road Map for States to Improve Health Information Flow Between Providers” – was developed to activate governors and their senior state leaders to drive forward policies that support the seamless flow of clinical patient health care information between providers while protecting patient privacy, as a step toward nationwide interoperability.

Interoperability current state and future state

The National Governors Association Center for Best Practices Health Division has published a website devoted to the report at

via National Governors Association


July 4, 2016

The much anticipated proposed regulations on the implementation of MACRA relating to the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) in Medicare Fee-for-Service have finally been released. MACRA consolidates the current programs of the Physician Quality Reporting System, the Value-Based Modifier, and the Electronic Health Records Incentive Program into one program, MIPS, that streamlines and improves on the three distinct incentive programs. Additionally, MACRA authorizes incentive payments for providers who participate in eligible APMs.

Under MACRA, payment adjustments to eligible professional (EP) payments through MIPS and incentive payments for qualifying APM participants will be applied beginning January 1, 2019. EPs under MIPS will be assessed a payment adjustment using four performance categories: quality, resource use, clinical practice improvement activities, and meaningful use of certified electronic health record (EHR) technology. Qualifying APM participants must have a specified amount of their Medicare expenditures or patients through an eligible APM that meets legislative criteria that include quality measures comparable to those in MIPS, required use of certified EHR technology, and either more than nominal financial risk or a structure as a medical home model. Additionally, specific to physician-focused APMs, the legislation creates a Technical Advisory Committee whose role is to receive and evaluate proposed APMs from the public and requires that the Secretary establish criteria for physician-focused payment models, including models for specialist physicians, by November 1, 2016.

I have followed the progress of the legislation to repeal the SGR and saw back in February 2014 that the Medicare Provider Payment Modernization Act precursor to MACRA was likely to eventually wind its way through Congress to ultimately be signed by the President. It took Republicans taking control of the Senate to finally see the legislation pass and be signed into law by President Obama on April 16, 2015.

And now we have the first set of proposed rules to wade through with a public comment period open until June 27, 2016. The we shall see the final rules published in the Federal Register around the August time frame this summer. The proposed rules are 962 pages long and below is an executive summary and below that is the document:

1. Purpose

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (Pub. L. 114-10, enacted April 16, 2015), amended title XVIII of the Social Security Act (the Act) to repeal the Medicare sustainable growth rate and strengthen Medicare access by improving physician payments and making other improvements, to reauthorize the Children’s Health Insurance Program (CHIP), and for other purposes. This rule is needed to propose policies to improve physician payments by changing the way Medicare incorporates quality measurement into payments and by developing new policies to address and incentivize participation in alternative payment models.

This proposed rule would establish the Merit-Based Incentive Payment System (MIPS), a new program for certain Medicare-participating practitioners. MIPS would consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the
Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for eligible professionals (EPs), and would continue the focus on quality, resource use, and use of certified EHR technology in a cohesive program that avoids redundancies. This proposed rule also would establish incentives for participation in certain alternative payment models (APMs), supporting the Administration’s goals of moving more fee-for-service payments into APMs that focus on better care, smarter spending, and healthier people. This proposed rule also includes proposed criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations to the Secretary on physician-focused payment models (PFPMs).

In this proposed rule we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that would be more easily identified and understood by our stakeholders. We discuss these terminology changes in greater detail in the following sections of this proposed rule.

2. Summary of the Major Provisions

This proposed rule would sunset payment adjustments under the current PQRS, VM, and the Medicare EHR Incentive Program for EPs. Components of these three programs would be carried forward into the new MIPS program.

This proposed rule would establish a new subpart O of our regulations at 42 CFR 414.1300 to implement the new MIPS program as required by the MACRA.

(a) MIPS

In establishing MIPS, this rule would define MIPS program participants as “MIPS
eligible clinicians” rather than “MIPS EPs” as that term is defined at section 1848(q)(1)(C) and used throughout section 1848(q) of the Act. MIPS eligible clinicians will include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and groups that include such clinicians. The rule proposes definitions and requirements for groups. In addition to proposing definitions for MIPS eligible clinicians, the rule also proposes rules for the specific Medicare-enrolled practitioners that would be excluded from MIPS, including newly Medicare-enrolled eligible clinicians, Qualifying APM Participants (QPs), certain Partial Qualifying APM Participants (Partial QPs), and clinicians that fall under the proposed low-volume threshold.

This rule proposes MIPS performance standards and a MIPS performance period of 1 calendar year (January 1 through December 31) for all measures and activities applicable to the four performance categories. Further, we propose to use 2017 as the performance period for the 2019 payment adjustment. Therefore, the first performance period would start in 2017 for payments adjusted in 2019. This time frame is needed to allow data and claims to be submitted and data analysis to occur. In addition, it would allow for a full year of measurement and sufficient time to base adjustments on complete and accurate information.

As directed by the MACRA, this rule proposes measures, activities, reporting, and data submission standards across four performance categories: quality, resource use, clinical practice improvement activities (CPIAs), and meaningful use of certified EHR technology (referred to in this proposed rule as “advancing care information”). Measures and activities would vary by category and include outcome measures, performance measures, and global and population based measures. Consideration would be given to the application of measures to non-patient facing MIPS eligible clinicians.

Quality measures would be selected annually through a call for quality measures process. Selection of these measures is proposed to be based on certain criteria that align with CMS priorities, and a final list of quality measures will be published in the Federal Register by November 1 of each year. Under the standards proposed in this rule, there would be options for reporting as an individual MIPS eligible clinician or as part of a group. Some data could be submitted via relevant third party data submission entities, such as qualified clinical data registries (QCDRs), health IT vendors1, qualified registries, and CMS-approved survey vendors.

Within each performance category, we propose some specific standards, including:

● Quality: For most MIPS eligible clinicians, we propose to include a minimum of six measures with at least one cross-cutting measure (for patient-facing MIPS eligible clinicians) and an outcome measure if available; if an outcome measure is not available, then the eligible clinician would report one other high priority measure (appropriate use, patient safety, efficiency, patient experience, and care coordination measures) in lieu of an outcome measure. MIPS eligible clinicians can meet this criterion by selecting measures either individually or from a specialty-specific measure set.

● Resource Use: Continuation of two measures from the VM: total per costs capita for all attributed beneficiaries and Medicare Spending per Beneficiaries (MSPB) with minor technical adjustments. In addition, episode-based measures, as applicable to the MIPS eligible clinician.

● CPIA: We generally encourage but are not requiring a minimum number of CPIAs.

● Advancing Care Information: Assessment based on advancing care information measures and objectives.

We propose standards for measures, scoring, and reporting for MIPS eligible clinicians across all four performance categories outlined in this section. We propose that MIPS eligible clinicians who participate in certain types of APMs will be scored using an APM scoring standard instead of the generally applicable MIPS scoring standard.

The U.S. Department of Health & Human Services’ (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) is conducting studies and making recommendations on the issue of risk adjustment for socioeconomic status on quality measures and resource use as required by section 2(d) of the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act) and expects to issue a report to Congress by October 2016. We will closely examine the recommendations issued by ASPE and incorporate them, as feasible and appropriate, in future rulemaking.

We are proposing MIPS eligible clinicians have the flexibility to submit information individually or via a group or an APM Entity group; however, the MIPS eligible clinician would use the same identifier for all performance categories. The proposed scoring methodology has a unified approach across all performance categories, would allow MIPS eligible clinicians to know in advance what they need to do to perform well in MIPS, and eliminates the need for an “all or nothing” scoring as has been the case under some other CMS programs. The four performance category scores (quality, resource use, CPIA, and advancing care information) would be aggregated into a MIPS composite performance score (CPS). The MIPS CPS would be compared against a MIPS performance threshold. The CPS would be used to determine whether a MIPS eligible clinician receives an upward payment adjustment, no payment adjustment, or a downward payment adjustment as appropriate. Payment adjustments would be scaled for budget neutrality, as required by statute. The CPS would also be used to determine whether a MIPS eligible clinician qualifies for an additional positive adjustment factor for exceptional performance.

To ensure that MIPS results are useful and accurate, we propose a process for providing performance feedback to MIPS eligible clinicians. Beginning July 1, 2017, we propose to include information on the quality and resource use performance categories in the performance feedback. Initially, we propose to provide performance feedback on an annual basis. In future years, we may consider providing performance feedback on a more frequent basis as well as adding feedback on the performance categories of CPIA and advancing care information. We propose to make performance feedback available using a CMS designated system. Further, we propose to leverage additional mechanisms such as health IT vendors, registries, and QCDRs to help disseminate data/information contained in the performance feedback to eligible clinicians where applicable.

We propose to adopt a targeted review process under MIPS wherein a MIPS eligible clinician may request that we review the calculation of the MIPS adjustment factor and, as applicable, the calculation of the additional MIPS adjustment factor applicable to such MIPS eligible clinician for a year. We further propose a general process by which a MIPS eligible clinician could request targeted review.

We propose requirements for third-party data submission to MIPS. Specifically, qualified registries, QCDRs, health IT vendors, and CMS-approved survey vendors would have the ability to act as intermediaries on behalf of MIPS eligible clinicians and groups for submission of data to us across the quality, CPIA, and advancing care information performance categories.

We also propose a process for public reporting of MIPS information through the Physician Compare Web site. We propose public reporting of a MIPS eligible clinician\’s data; in that for each program year, we will post on a public Web site (for example, Physician Compare), in an easily understandable format, information regarding the performance of MIPS eligible clinicians or groups under the MIPS.

(b) APMs

In this rule, we propose standards we would use for the purposes of the Alternative Payment Model (APM) incentive. The MACRA defines APM for the purposes of the incentive as a model under section 1115A of the Social Security Act (the Act) (excluding a health care innovation award), the Shared Savings Program under section 1899 of the Act, a demonstration under section 1866C of the Act, or a demonstration required by federal law. We propose to define the term “Other Payer APMs” to refer to arrangements in which eligible clinicians may participate through other payers. We also propose to define the term APM Entity as an entity that participates in an APM through a contract with a payer.

APMs that meet the criteria to be Advanced APMs provide the pathway through which eligible clinicians can become QPs and earn incentive payments for participation in APMs as specified under the MACRA. This rule proposes two types of Advanced APMs: Advanced APMs and Other Payer Advanced APMs. To be an Advanced APM, an APM must meet three requirements: (1) require participants to use certified EHR technology; (2) provide payment for covered professional services based on quality measures comparable to those used in the quality performance category of MIPS; and (3) be either a Medical Home Model expanded under section 1115A of the Act or bear more than a nominal amount of risk for monetary loses. In this rule, we propose criteria for each of the requirements to be an Advanced APM.

To be an Other Payer Advanced APM, a commercial or Medicaid APM must meet three requirements similar to the CMS Advanced APM requirements: (1) require participants to use certified EHR technology; (2) provide payment based on quality measures comparable to those used in the quality performance category of MIPS; and (3) be either a Medicaid Medical Home Model that is comparable to Medical Home Models expanded under section 1115A of the Act or bear more than a nominal amount of risk for monetary losses.

We propose that we would notify the public of which APMs will be Advanced APMs prior to each QP Performance Period, starting no later than January 1, 2017. This information will be posted on our Web site. We propose that professional services furnished at Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) that meet certain criteria be counted towards the QP determination.

The MACRA sets a Medicare threshold for the level of participation in Advanced APMs required for an eligible clinician to become a QP for a year. The Medicare Option, based on Part B payments for covered professional services or counts of patients furnished covered professional services under Part B, is applicable beginning with CY 2019. The All-Payer Combination Option, based on the Medicare Option, as well as an eligible clinician’s participation in Other Payer Advanced APMs, is applicable beginning with CY 2021. For eligible clinicians to become QPs through the All-Payer Combination Option, an Advanced APM Entity or eligible clinician must submit information to us so that we can determine whether an Other Payer APM is an Other Payer Advanced APM and whether an eligible clinician meets the requisite QP threshold of participation. We propose a methodology and criteria to evaluate eligible clinicians using the All-Payer Combination Option. For purposes of evaluating Other Payer APMs, we also propose criteria for the definition of Medicaid Medical Homes and Medical Home Model.

We propose to identify individual eligible clinicians by a unique APM participant identifier using the individuals’ TIN/NPI combinations, and to assess as an APM Entity group all individual eligible clinicians listed as participating in an Advanced APM Entity to determine QP status for a year. We also propose that if an individual eligible clinician who participates in multiple Advanced APM Entities does not achieve QP status through participation in any single APM Entity, we would assess the eligible clinician individually to determine QP status based on combined participation in Advanced APMs.

We propose the method that CMS would use to calculate and disburse the APM Incentive Payments to QPs. We propose specific rules for calculating the APM Incentive Payment when a QP also receives non-fee-for-service payments or payment adjustments through the Medicare EHR Incentive Program, PQRS, VM, MIPS, or other payment adjustment programs.

We propose a process for eligible clinicians to choose whether or not to be subject to the
MIPS payment adjustment in the event that they are determined to be Partial QPs

We propose that we would perform monitoring and compliance around APM Incentive Payments.

We propose a definition for Physician-Focused Payment Models (PFPMs), criteria that would be used by the PFPM Technical Advisory Committee (PTAC), the Secretary, and CMS to evaluate proposals for PFPMs, and the process by which PFPMs would be considered for testing and implementation by CMS after review by the PTAC.

We propose to require MIPS eligible clinicians, as well as EPs, eligible hospitals, and Critical Access Hospitals (CAHs) under the existing EHR Incentive Programs to make a demonstration related to the provisions concerning blocking the sharing of information under section 106(b)(2) of the MACRA and, separately, to demonstrate cooperation with authorized ONC surveillance of certified EHR technology.

3. Summary of Costs & Benefits

Under the MACRA’s requirements, MIPS would distribute payment adjustments to between approximately 687,000 and 746,000 eligible clinicians in 2019. Payment adjustments would be based on MIPS eligible clinicians’ performance on specified measures and activities within the four performance categories. We estimate that MIPS payment adjustments would be approximately equally distributed between negative adjustments ($833 million) and positive adjustments ($833 million) to MIPS eligible clinicians, to ensure budget neutrality. Additionally, MIPS would distribute approximately $500 million in exceptional performance payments to MIPS eligible clinicians whose performance exceeds a specified threshold. These payment adjustments are expected to drive quality improvement in the provision of MIPS eligible clinicians’ care to Medicare beneficiaries and to all patients in the health care system. However, the distribution could change based on the final population of MIPS eligible clinicians for CY 2019 and the distribution of scores under the program.

We estimate that between approximately 30,658 and 90,000 eligible clinicians would become QPs through participation in Advanced APMs, and are estimated to receive between $146 million and $429 million in APM Incentive Payments for CY 2019. As with MIPS, we expect that APM participation would drive quality improvement for clinical care provided to Medicare beneficiaries and to all patients in the health care system.

1 We note that, for this proposed rule, a health IT vendor that serves as a third party intermediary to collect or submit data on behalf MIPS eligible clinicians may or may not also be a “health IT developer.” Under the ONC Health IT Certification Program (Program), a health IT developer constitutes a vendor, self-developer, or other entity that presents health IT for certification or has health IT certified under the Program. The use of “health IT developer” is consistent with the use of the term “health IT” in place of “EHR” or “EHR technology” under the Program (see 80 FR 62604; and the advancing care information performance category in this rule). Throughout this proposed rule, we use the term “health IT vendor” to refer to entities that support the health IT requirements of a clinician participating in the proposed Quality Payment Program.

Here is the document:

Merit-Based Incentive Payment System and Alternative Payment Model Incentive under the Physician Fee Schedu…

June 21, 2016

Artificial intelligence: A timeline viaThe Telegraph

The major events in artificial intelligence
  • 1950

    Turing test

    Alan Turing proposes a test for computer intelligence: A computer would have passed when its text-based conversation is indistinguishable from humans
  • 1956

    \’Artificial intelligence\’ coined

    Leading minds gather to discuss possibility of machines that think at Dartmouth University in New Hampshire. The term stuck
  • 1968

    2001: A Space Odyssey

    Stanley Kubrick\’s space epic introduced HAL 9000, a paranoid computer that attempted to kill the spacemen on the spacecraft it controlled.
  • 1970s

    AI Winter

    Amid disappointment about a lack of progress, organisations including US government arm DARPA reduce investment
  • 1984

    Terminator released

    Arnold Schwarzenegger\’s blockbuster has been the doomsday scenario for artificial intelligence since it was released
  • 1997

    Deep Blue defeats Kasparov

    IBM\’s computer beats the world chess champion over six games
  • 2011

    Watson wins Jeopardy

    Another IBM victory: The artificially-intelligent system defeated two human players at the popular quiz show
  • 2011


    Apple\’s intelligent assistant debuts on the iPhone. It has improved dramatically since then
  • 2012

    Driverless cars

    Google\’s driverless cars, announced in 2009, make their way onto California\’s roads
  • 2016

    DeepMind beats champion Go player

    Seen as a major breakthrough, the deep learning system used by DeepMind\’s AlphaGo breaks one of the holy grails of AI

National Coordinator for Health IT Speaks at #ONC2016

May 31, 2016

Remarks below are (loosely) transcribed from remarks at the 2016 ONC Annual Meeting by Dr. Karen DeSalvo, Acting Assistant Secretary for Health, HHS; National Coordinator for Health Information Technology, ONC:

How is everybody doing? A little louder! I\’m going to have to rally up the crowd for the last visitor, former Secretary Sebelius. It is wonderful to be here today with all of you and so many of the team, a special welcome for those watching via web cast, we have 750 people who are watching online. Can you believe that?

Nice to see a lot of familiar faces and new faces, thank you for being a part of this not only work today, but part of our journey in health IT. I want to take a minute to acknowledge the ONC grantees in the audience today, this is where I do the part where you get to stand up. Can I have the former REC grantee stand up because of the work you have done to move so rapidly toward adoption. Thank you.

And Beacon Grantees.


So we have old and new, we have those that work in part of the workforce development, they are in the process of bringing those folks into health IT, so if you are in the room, please stand and be recognized.

And then we had a grant announced last year to bring in new sources of data and providers, whether they were from EMS, social services, or behavioral health and those grantees went through a competitive process too. If you could please stand and be recognized.

And finally, the folks from the Hill, some are here, and you have seen the videos. These folks on The Hill have been terrific partners at helping us think about how we build on the foundation of health IT to a brighter future to everyone.

This is a meeting I look forward to because it is a chance to see so many old friends. I used to be a grantee of ONC, so I got to stand up and I want to recognize what the work is like in the field, it is tough and we are changing technology and culture and this is a chance to bring you into one place so you can learn from each other and those that we are here to serve, the consumers on the third day of the event. We have been doing a tremendous amount of work in a short period of time in a dizzying pace and we can see that not only can we digitize the care and health experience of every American, but we are reaching a place where that data is going to be available when and where it matters most.

We have seen progress in the data with EHR adoption and it is worth taking a moment to look at this from the brief we put out today, from the American hospital association, they are great partners in helping us keep track of the progress we are making. When ONC was started by President Bush, the charge was to see that every American would have access to their electronic health information and this has been carried forward by President Obama and with the passage of the high-tech act in 2009 and we have been working, all of us, all of you out there watching, on seeing that we can have a digital record of the care experience that people in this country, and I think it is so important for us to take a moment to recognize that we have made significant advancements in the goal I rode out.

And I will go way back before 2008 and tell you that, when I was training at Charity Hospital as a medical student in the early 90s, one of my jobs was to go to the lab floor where there were wooden boxes and pull out the labs for the patients today, they were written on carbon copies, this is the potassium, and then we would prescribe it to the patient and move it down the line, and that process happened during my career, and you think about where we are today, that some of you all might be checking your patient\’s labs on your smart phone to see the results, that is a great opportunity clinically for those of us practicing and there\’s a lot of unexpected challenges and opportunities that you have heard about.

This EHR adoption rate, it is 9 times the rate that we were at in 2008, is the beginning of the journey that we are taking. As a doctor, as a daughter, and a policy maker, I know that we need to see that actionable, usable, electronic health information is available when and where it matters to consumers and all of us who are users of that data and it is coming from so many sources today, even compared to where it was in 2008 when we started measuring. It is all sorts of information and our chapter ahead is to bring it all together to make it usable and actionable for everybody that wants it.

This is what I hear loudly and clearly: Everywhere I go, in every community where I have a listening session or visit a clinic or health center or hospital or scientific environment or public health agency or any place we go, what the people of the country they are ready for is the electronic health information to be available when and where it matters to them. They are impatient with the progress and they want the data to be free, thank you John White.

It is also something we are hearing increasingly from scientists, you are hearing about the use for precision management and moon shot, and we are hearing it from the President and the Vice President, that the time is now to build on the success of adoption that we have already seen.

The office of national coordinator believes that this is a process moving forward that will require the partnership with the private sector and all of our federal partners. We have taken an approach that is about public/private partnership, a shared vision and strategy ahead, we laid out around interoperability and we said what we wid do by when and when the private sector and states ask weigh in. And I want to thank everyone, including the federal partners, states, private sector and individuals that have stepped forward to meet those expectations, whether working on patient identification, or creating apps or maturing fire, it is all of us working together to get to the kind of health system we are all dreaming of.

The way that we have been boiling down the way we are thinking of moving forward, Dr. Washington shared this morning, this is the 3 Cs, common standards, culture change, and a business case for data to move. As we think about the work we have laid out, whether it is high-level like the federal health IT strategic plan or in the road map and understanding how we need to move forward on key critical path issues and taking what we have learned in the field, these areas capture the most important and impactful work that we need to be doing every day at ONC. And just as we are celebrating the success of adoption, we are still seeing challenges in the integration of data, and we have so much work in an ecosystem that itself is interoperable. We want to work to where we have on the same language, so there is no frustration and expense of not having national standards, and creating opportunities to advance new kinds of standards that can advance the field.

The first area includes, most importantly for us, the notions of privacy and cybersecurity of data and we want to make sure that the kinds of standards that we lay out, as the federal part of this, resonate with you all and are reaching every corner of this country so people are understanding expectations around privacy and security.

And that blends into changing the culture of data sharing in this country, for too long and even today, we think about data as something that we have to hold tightly on to, it is built into our DNA of medicine that we want to hold data and we\’re worried about exposing it because we don\’t want to violate HIPPA. Consumers are expecting that we share their data and HIPPA allows it, which is way why have the office of civil rights to understand what it is and it is not, not just for the providers, but the folks in compliance and for consumers, and the work that we\’re going to keep doing is making is sure that we are lifting up that message so we can get people to understand that data should by default be held securely and privately, but it needs to be so on behalf of the consumers.

And finally, we have been hearing very clearly that there needs to be a better case for sharing data. We spent very much of this effort on creating a payment case in the health care environment, and what you heard earlier today about researchers who are creating an additional business case for data sharing where we can see the acceleration of science and the revolution on the forefront and that\’s an addition where we can help data to get pushed and also pulled.

We asked for many in the field to work with us in addressing these drivers of success to do it in a way that it wouldn\’t just be the federal partners, but a public/private partnership and we asked for people to take a pledge publicly about three commitments. Consumers should have access to their electronic health care information where and when it matters to them, we should not engage in health information blocking that is unreasonable, and we would agree to move to federally recognized national standards, including those around privacy and security, and you have heard a lot about that today in how it is being brought to life and it is flowing appropriately and we are moving to a set of standards that move us to a seamless flow of data and community of health.

We are working to do our part on that end and we believe that one of the ways that we can continue to advance on those commitments is to push for market transparency, and one of the things that we want to make sure you are aware of, tomorrow, we are going to be posting on the website a detailed listing of easy to understand information about certified health IT. It will be, on this website, what we have available now and we will update, this is to put plain language out there for providers wanting to purchase health IT. I had to do this several times looking to purchase, it but it can be confusing.

We want you to see this is a way to let folks know what they are purchasing and allow for a more transparent marketplace.

And we asked vendors to say what actions they are going to take to support more transparency and many are moving to be more transparent on the website. So I encourage you to take a look and give feedback on ways to improve it.

All of these efforts, whether creating road maps with you or setting guide posts through the rule making process, working with partners to create a business case for advancing interoperability and improving health IT, or putting a challenge grant so health records are a tap away, or to collaborate with you, we know that we cannot do this alone. It requires strong partnership from those already invested, and we need to make a tent big enough for consumers, investigators, and researchers that want to begin this journey and entrepreneurs that will show us ways to improve the health of this country that we have not been able to imagine.

So thank you for getting us successfully to this place and for helping us see where we are in data exchange, interoperability, and for the many purposes you are using it today and thank you for being with us this week as we roll up our sleeves and think about the how, not just the what, and close it off with the who, the consumer, because that\’s who we are here to serve.

Military Health System EHR is Christened GENESIS

May 21, 2016

The new system to transform military health records has an official name. Military Health System (MHS) officials say the new electronic health record (EHR) will be called MHS GENESIS and will launch at the end of calendar year 2016. To keep pace with medical advances and innovations in technology, the DOD has purchased a new state of the art EHR that will support us in our mission to continue to provide high quality healthcare to our beneficiaries, as well as an agile, responsive system for our healthcare professionals.

The configuration and deployment of MHS GENESIS constitute a multi-year effort to provide a state-of-the-market system of sharing health records electronically and documenting the continuum of care. The new EHR will begin implementation in the Pacific Northwest at the end of this year, followed by a pre-planned, programmed installation expected to be completed over a several-year period. Whether on a ship at sea, at a local clinic, or in a major hospital, MHS GENESIS will be available throughout all Department of Defense facilities, and accessible to all members of the DoD\’s healthcare team.

While on the surface it appears just a system for health records, Dr. William M. Roberts, a retired Navy rear admiral who serves as the MHS functional champion, said it really reflects a whole new way of doing business for the MHS.

\”We\’ve looked at this process as finding what is best for the MHS as a whole, not just in individual areas,\” said Roberts. \”We see this as the latest step in making sure patients are able to be fully engaged in their own health.\”

\”We want people to know MHS GENESIS is a safe, secure accessible record for patients and health care professionals that is easily transferred to external providers, including major medical systems and Department of Veterans Affairs hospitals and clinics,\” emphasized Roberts. \”When our beneficiaries see this logo or hear the name, they\’ll know their records will be seamlessly and efficiently shared with their chosen care provider.\”