Lygeia Ricciardi, Acting Director of Consumer eHealth Office of the National Coordinator

(Music)

Mark Masse ll i: This is Conversations on Health Care . I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masse l li: Well Margaret, here we are in the midst of a pretty dramatic flu
outbreak. Hundreds of thousands of America ns are flooding the nation’s
hospitals, several states declaring a state of emergency because of the severity
of the flu epidemic as well as Norovirus and just seasonal --

Margaret Flinter: But you know Mark, it makes a pretty compelling case for why
gett ing the flu shot in a timely fashion is so important. We are seeing the cost in
lives as well as productivity and the burden on the health care system, all things
that can at least be moderated by widespread use of the flu vaccine.

Mark Masselli: You kn ow and it really takes an epidemic like this sometimes to
remind people. I know that we struggled a lot as we were encouraging them to
come on down for their flu shot.

Margaret Flinter: And remember, it’s not too late. The Centers f or Disease
Control i s telling folks who have not yet gotten the flu shot please get one
immediately. It takes about two weeks for your immunity to build but it will still
give you a fighting chance to avoid getting sick and of course, not sickening
others in the process.

Ma rk Masselli: Speaking of the CDC, Margaret, they have a great flu tracking
map on their website for anyone concerned about traveling to high risk areas.

Margaret Flinter: And Mark, I have actually downloaded, I bet you have too, an
app to my smartphone that lets me follow all the latest information on the flu
epidemic.

Mark Masselli: Our guest today knows quite a bit about health information
st
technology and the government’s effort to bring it up to speed in the 21 Century.

Margaret Flinter: Lygeia R icciardi is the Acting Director of Consumer e H ealth at
the Office of the National Coordinator at Health and Human Services.

Mark Masselli: She will be talking about the agency’s efforts to improve access
to the electronic health record and their efforts to empower Americans to engage
in the eHealth movement by gaining control of their personal health records.

Margaret Flinter: And FactCheck.org’s Managing Editor, Lori Robertson, comes
to us and checks out a claim that 11 states reportedly have more peop le
receiving welfare checks than paychecks.

Mark Masselli: And as always, no matter what the topic, you can hear all of our
shows by Googling CHC Radio.

Margaret Flinter: And if you have comments, remember, email us at
www.chcradio.com or find us on Facebook or Twitter because we love to hear
from you. We will get to our interview with Lygeia Ricciardi in just a moment.

Mark Masselli: But first, here is our producer Marianne O'Hare with this week’s
Headline Ne ws.

(Music)

Marianne O'Hare: I am Marianne O'Hare with th is Headline News . President
Obama made an announcement this week aimed at curbing the national
epidemic of gun violence a t a White House briefing with several children nearby
and family members f rom the Sandy Hook shooting. The President outlined 23
measured aimed at beefing up background checks for those seeking to purchase
guns , more security resources in the nation’s schools and more avenues for
behavioral health clinicians to report those sus pected of considering violence.
Some measures will require just the President’s signature, others will need
approval from Congress.

The American College of Physicians in the meantime is urging the nation to take
up the issue of gun control as a public he alth issue. New York State has become
the first in the nation to issue stronger gun control laws signed this week by
Governor Cuomo . Two of the nation’s largest pharmacies, CVS and Rite Aid,
say they are running out of flu vaccines in the wake of an earl y an d virulent
outbreak and increased demand with outbreaks in 47 states , and health
emergencies being declared in Boston and New York, the demand continues to
grow. About 135 million vaccine doses were produced in advance of this year’s
outbreak so far, a 128 million have been distributed. Meanwhile, a spokesperson
for the CDC say there are pockets of vaccines being stored for various
populations that if needed can be moved to where they need to be.

The Department of Health and Human Services kicks off an awareness
campaign this week aimed at the tens of millions of Americans who currently
don’t have health insurance. They are re - launching their website to better inform
folks on how to navigate those online insurance exchanges where they will be
able to purchase plans for a variety of choices. Failure to purchase insurance by
January 2014 could result in a tax penalty. I am Marianne O'Hare with this
Headline News.

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Mark Masselli: We are speaking today with Lygeia Ricciardi, Acting Director of
Consumer e H ealth at the Office of the National Coordinator for Health
Information Technology at the Department of Health and Human Services. Ms.
Ricciardi is responsible for developing and managing a national consumer
eHealth program which seeks to bette r enable consumers to be engaged
partners in their health care through the use of health information technology.
Before joining the Office of the National Coordinator, Ms. Ricciardi was the health
specialist and speechwriter for the Chairman of FCC and ea rned her Master’s in
Technology and Education from Harvard with extensive study at the MIT Media
Lab, our favorite place. Lygeia, welcome to Conversations on Health Care.

Lygeia Ricciardi: Thank you so much; glad to be here.

Mark Masselli: You know, s ort of between the Affordable Care Act and advances
in technology health care, America is undergoing significant changes, some
would say a revolution spurred on by dramatic developments in Information
Technology. So in this changing landscape, patients ar e increasingly expected
to take a greater role in their own health care, and grabbing a quote from
somebody which is kind of exciting, “The engaged patient is the super drug of the
st
21 Century”, I love that. So one of your tasks of better enabling consum ers to
take an active role in their health care is a daunting task, one I know you are
probably excited about. So tell our listeners how your team is helping patients
unlock the power of the new health information technology.

Lygeia Ricciardi: Sure. I think it’s important to realize how much we as patients
or consumers play an incredibly humongous role in determining our own health
on a daily basis anyway. Sometimes when we think about health and health
care, we think about doctors and hospitals and nu rses and other providers, and
certainly they are essential components of health and well - being but it’s also
essential to remember that the biggest factors that shape our own health are the
choices that we make everyday ranging from what we eat, whether we sleep
enough, whether we exercise, that kind of thing to when we seek medical care,
where we seek it, all these kinds of things. But with the advent of new
technology and with some of the policy changes coming about as well as a result
of the Affordable Care Act, increasingly there is a recognition that patients need
to be engaged in the process of improving health and health care. And
technology provid es us a lot of tools to do so.

And what we do in our office at ONC in the Consumer eHealth Program is to
really follow a three - pronged strategy that involves the three As as we call them
Access, Action and Attitudes. And Access is about giving consumers access to
their health information in an electronic format. Action has to do with the idea
that once you get this information, you want to do something useful with it so,
really supporting the growth of an ecosystem of tools and services that let you
take your health information and do something worthwhile with it. And the third
A, Attitudes, has to do w ith the point that we are really undergoing a

transformation in health care that’s not just technical or payment oriented but it’s
about roles and responsibilities and the way people think about their roles vis - à -
vis their health. And we want to encourage people increasingly to feel like they
can partner with their health care providers, rather than kind of waiting to get
direction from their doctors or nurses or others, they can work with them toward
better health together.

Margaret Flinter: I want to p ull the tread on a few things you said there. I think
we are approaching about half of our nation’s primary care practices having
made the swit ch to electronic health records, like getting the patients to engage
and to use their patient portal to access i nformation, that’s been a heavier lift.
And I just the other day had a conversation with some leaders in this area and
they said that where patients are accessing not just their labs and immunizations
and the list of things but where they are actually abl e to see the notes that their
providers have written, it’s really a very emotional experience and one that
further strengthens their relationship with their primary care provider. I wonder if
you would like to comment on any of that.

Lygeia Ricciardi: Y eah. Well I think it sounds like the project you are referring to
is the Open Notes Project which was funded by the Robert Wood Johnson
Foundation and developed by a number of organizations in partnership in the
Boston area primarily. And they have shown some really exciting results that
indicate that patients are interested not only in getting a list of basic sort of
medical numerical facts but also some of the information that helps to articulate
the context for them which is a lot of what they would fi nd in getting ac cess to
their provider’s notes.

Countless studies show that when patients get the idea when they are introduced
to this concept of having access to their own health information, they think it’s a
good idea. I think part of what’s going on here is many people haven’t really
even thought about it until now because it just hasn’t been a part of our typical
medical care and practice. And as you say, we are about reaching the 50% point
in terms of provider electronic health record adoption but that increase has come
about only in the last few years. So now that you are getting more and more
doctors online, they are able to push the information or increasingly will be able
to out to their patients. So I think we will start to see a change in t hese numbers.
66% of patients were actually so interested in getting online access to their
information, their health information, that they would consider switching doctors
to get it, and the Open Notes Project backs up this enthusiasm.

Mark Masselli: Lygeia, one of the programs that we have been following on this
radio show has been the Obama’s Administration’s focusing on the Blue Button
Initiative at the VA, and it called for all of the VA health records to be available
electronically to patients and providers. Now we are approaching one million
vets whose records are now easily accessible via Blue Button. But your
department was not going to stop there; it’s going to move from one million using

Blue Button to 100 million of the broader national pat ient population. Tell us
about what’s going on with these expansion plans to improve access.

Lygeia Ricciardi : The Blue Button is just basically a simple concise way of
saying as a consumer, a patient, give me an electronic copy of my health
information . So through the VA, what people did, was they log on to a portal and
they would click on a literal blue button that had a picture of an arrow that
showed download my data, and they could take that data and have it stored on
their computer or on a mobile device so that they could take it and use it however
they liked. The point is it was not locked into the VA system or any other system.
They could take that data and data with it what they wished. So there are some
great stories coming out of the VA of people who for example were able to take
an iPad into the emergency room and show an emergency physician who was
caring for them what kind of conditions they had or what kind of medications they
were on even if they themselves were say unable to speak.

An d we are interested in really expanding upon Blue Button and making it
available way beyond veterans to Americans widely across the nation. So one of
the things that we are doing is our office, the Office of the National Coordinator,
together with CMS, th e Centers for Medicare and Medicaid Services, are working
on a program called Meaningful Use. And in order to qualify for those incentives,
providers need to agree not only to use an electronic system or to purchase one
but to use it in certain ways that lead toward or support better patient care. And
one of the things that we have built into that is the requirement that patients
should be able to export their data electronically just the way the folks did at VA
with the Blue Button. And so that’s becomi ng a requirement for providers
nationwide who participate in this program.

Margaret Flinter: Well I understand there’s something called a Blue Button Mash
Up which invites innovation from the developer community. Are you setting
priorities and are you c apturing from the next generation of developers of this?
Are we going to see the youngsters of the tech world coming forth with ideas as
part of this mash up?

Lygeia Ricciardi: Yeah. So one of the tools that we use in our office to
encourage people to get involved and really to encourage the growth of that
market ecosystem I was talking about is challenges, Prizes and Challenges. So
we issue challenges for technology developers and also for the general public.
So for example, in the case of the genera l public, we have put out a number of
video contests in which we ask the public to submit a short video about their
experience using technology for one thing or another or in a certain context. For
the technology developer community, we have put out some contests looking for
people to address certain kinds of gaps in the marketplace where we think there
are some. For example, we put out a challenge called the Mash Up Challenge, I
think it was last June, in which we encouraged developers to take data that
comes out of a blue button download and take that data and combine it with

some other kind or kinds of data that would make it useful. So instead of just
getting a simple download that says, here is your blood pressure reading, here
are the medications yo u are on and your allergies and those basic facts, how can
you combine that with other data to sort of elucidate what that means either
relative to other people in your community, relative to norms.

So that’s an example of one contest that we put out, a c ompany called Humetrix
won that. And you can see actually on our website HealthIT.gov, you can see
some of the winning entries and other entrants into that and other challenges that
we have sponsored. But that is one of several ways through Prizes and
Ch allenges t hat we engage a broad community. Another, to go back to a
question that Mark asked earlier, is through our Pledge Program , and through
that, we basically expand the audience we can reach beyond the providers and
others who are eligible for Meani ngful Use incentive to encourage a lot of other
kinds of organizations to join the movement and be part of getting electronic
health information in consumers’ hands and in a wa y that they can really use it.

So we started that program little bit more than a year ago with about 30 mostly
companies and organizations who agreed to do a couple of things. One was if
they are the kind of organization like a hospital or a health plan, they agreed to
make health information electronically available to patients. B ut this was folks
who weren’t necessarily required to do it under Meaningful Use because they
weren’t even in many cases eligible for these incentives. But they recognized
that this was a good thing to do and agreed to do it and do it relatively quickly.
So that’s one kind of way that organizations can fulfill a pledge. The second way
was by getting the word out and really encouraging people, helping members of
the general public to understand the benefits of getting access to your health
information and using it to really engage more fully in your care whether that
means helping to coordinate care among numerous providers who might be
caring for you or whether that means communicating with your doctor on a much
more frequent basis or whether that means u sing a whole variety of apps and
tools like maybe remote monitoring devices, a digital pedometer or a glucose
reader, and taking that information and using it either on your own or through on
online community but kind of using health information technology and sometimes
they are called eHealth tools to be more apprised of your health and more
engaged in improving it.

So we use the Pledge Community as well as Prizes and Challenges of ways to
engage a broader community and get them all to work collaborativel y toward this
shared goal.

Mark Masselli: We are speaking today with Lygeia Ricciardi , Acting Director of
the Consumer eHealth at the Office of the National Coordinator for Health
Information Technology at the Department of Health and Human Services, whi ch
seeks to better enable consumers to be partners in their health care, through the
use of health information technology. Lygeia, we have had the opportunity of

talking with Dr. Patricia Mechael over at the mHealth Alliance, which is doing
work out of th e United Nations Foundation. And they have really got so many
exciting partnerships going on with NGOs, business communities all over the
world. What are you seeing that’s happening around consumer engagement
around the world that you wish was going to h appen here in America? Are there
things that you are chomping at the bit to say, let’s crosswalk that over from
Africa to the United States to help further the work that we are doing here?

Lygeia Ricciardi : There are a lot of interesting things going on in other parts of
the world that I think we can learn from, and many other countries have health
systems that are more streamlined or simple than that in the US so it can be
easier to adopt new technologies. But I really do think actually sometimes
chang e is a little bit slower than we like but I do really see it taking off and I feel
like we don’t need to look across international borders to see change. What I like
to do is look across industry borders. So health care is a little bit behind. But if
yo u just look at how much we are using technology in other parts of our lives, I
think people are really empowered by Information Technology, by the Internet, by
mobile devices, by online communities, and we now have, many of us, the power
of what would have been a huge computer years ago in our pockets that we are
able to access immediately. And I think that there is so much we can learn from
other industries and increasingly from the fact that there is so much data being
generated which can be sort of shar ed across boundaries so that we can
understand new things by combining data about how we shop and how we eat
and how we feel, those kinds of things. So kind of mashing up data in ways that
yield new knowledge is something that’s really exciting to me.

Ma rgaret Flinter: Lygeia, we had ePatient Dave on the show, as I am sure you
know, talking about the ePatient Movement which certainly has gained
momentum. But often, people don’t make the jump on to something new without
some personal experience to spur t hem into action, and storytelling is certainly
one of the great ways that happens. You have worked as a speechwriter. I
know you are an expert in communications along with so many other things. Tell
us about your relationship with members of the ePatien t Movement and how you
are tapping into their efforts to help grow this movement to the broader
population.

Lygeia Ricciardi: So first of all, I would say I think of myself personally as an
ePatient, somebody who is engaged and empowered and enabled by t echnology
but somebody who really tries to be involved in my own health and health care
whether for myself or for my family members. As a brief illustration of that, I have
a young daughter, and to make a long story short, I think that by being an
engaged patient or a caregiver in this case, my husband and I were able to spare
her unnecessary open heart surgery. So definitely I mean I come from this from
a personal perspective. I was an ePatient before that even occurred certainly but
it really resonates and makes sense to me.

In terms of how we work with ePatient Dave and many other ePatients whom I
respect greatly, we try to incorporate consumers and patients into every single
thing we do whether it’s policy making or public meetings or even participat ing in
judges the Prizes and Challenges I was talking about, being part of things that
the Pledge community does, really everything. I mean we really feel that the
patient and consumer voice is critical to helping to grow our understanding but
that of all of our other colleagues in the policy - making world and in the private
sector too. And patients are perhaps the central player in health and health care
so it’s essential that they be part of everything we do.

Mark Masselli: We have been speaking today with Lygeia Ricciardi, Deputy
Director of the Consumer eHealth at the Office of the National Coordinator for
Health IT at the Department of Health and Human Services , which is seeking to
enable consumers to be better partners in their heath care through he alth
information technology. You can find out more about the work they are doing by
going to www.healthit.gov . Lygeia, thank you so much for joining us on
Conversations on Health Care today.

Lygeia Ricciardi: Th anks so much.

(Music)

Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care reform and policy.
Lori Robertson is an award - winning journalist and managing editor of
Fact Check.org, a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in U . S . politics. Lori, what have you got for us this
week ?

Lori Robe rtson: Well, Mark and Margaret, we received a lot of questions from
readers a bout a viral email claiming that 11 states have more people on welfare
than they have employed. As with the vast majority of viral claims, this one is
false. It’s a distortion of a Forbes Magazine article by an investment strategies
writer who compared t he number of private sector workers with those he said
were “dependant on the government including government workers and
pensioners and Medicare recipients not just those on welfare”. In fact, none of
the 11 states on his list has more Medicaid recipient s than workers, either
workers total or just workers in the private sector. And Medicaid recipients can
also work in the private sector but they earn low incomes that qualify them for
Medicaid coverage. That means Medicaid recipients could be counted as both
takers and makers, the label that the Forbes writer, William Baldwin, uses.

We also looked at the number of food stamp recipients or those receiving cash
assistance through the Temporary Assistance for Needy Families Program, what
most people think o f as welfare. But workers in these 11 states also
outnumbered those receiving that assistance. The email that’s making the

rounds twist Baldwin’s article claiming that these 11 states which Baldwin
described as death spiral states have more people on wel fare than working.
That’s off base. Baldwin told us that his article and the viral email “are not the
same thing at all”. And that’s my fact check for this week. I am Lori Robertson,
Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org i s committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact, that you would like
checked, email us at www.chcradio.com . We will have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on Health Care.

(Music)

Mar garet Flinter : Each week, Conversations highlights a bright idea about how
to make wellness a part of our c o mmunities and everyday lives. Smoking
remains one of the world’s leading causes of preventable death, and yet, quitting
is still a challenge for so many smokers. Pregnant women who smoke pose a
greater health risk to their growing babies, increasing the likelihood for preterm
birth and other lifelong health consequences, and that’s to say nothing of the
health danger for infants exposed to secondhand smoke. A recent study
published in the Journal of Women’s Health highlights another promising
interventio n, municipal smoking bans. Municipal smoking bans are a relatively
recent phenomena so there has been very little study of their impact on maternal
smoking cessatio n and infant health until now.

In 2003, Pueblo , Colorado , initiated a citywide smoking ban that was strictly
enforced. Researchers compared Pueblo to El Paso, Colorado which had similar
population demographics but no municipal smoking ban. During a two year
period, they compared maternal smoking rates in each city and infant health
statistics as well, and what they found was pretty astonishing. 38% fewer
pregnant women in Pueblo smoked and there were 23% fewer preterm births
compared to the maternal and infant population in El Paso. They say the
smoking ban had a direct improving impact on m aternal and infant health in a
short period of time. The report suggests that the evidence should be fodder for
communities around the nation to consider following suit. A strongly enforced
municipal ban on smoking, leading to significant improvements in maternal and
infant health outcomes, not to mention for the entire community, now that’s a
bright idea.

(Music)

Margaret Flinter: This is Conversations on Health Care. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org and brought to you by
the Community Health Center .