Tag: Health Information Exchange (HIE)
As blockchain continues to spark interest and innovative pilot projects across all corners of healthcare, one area that’s still taking shape is the policy framework that could emerge around to shape how the technology is developed and deployed in the years ahead.
At HIMSS19, officials from the U.S. Department of Health and Human Services are scheduled to offer some updates on how the agency approaches new and fast-evolving technologies such a blockchain.
Policymakers will discuss HHS’ current blockchain strategy and offer their perspectives on how they see distributed ledger technology continuing to have an impact in the near and longer-term future.
They’ll also give some insights into their considerations as they weigh approaches to help ensure the blockchain tools developed in the private sector can have the biggest and most beneficial impact on healthcare delivery.
The session will offer perspective on HHS’ “decision-making processes, with a focus on what makes a new idea stand out, and how technology can become part of the design guidelines that can have far-reaching implications on how we tackle the big problems facing our country today,” according to HIMSS.
HIMSS Media has been focused on blockchain all December long. So far we’ve shown how CIOs should be approaching the technology, which is already at work in leading health systems such as Mayo Clinic and Mass General.
Familiarization with the emerging tech is key since it could soon be helping to transform electronic health records, the healthcare supply chain and much more elsewhere.
As HHS weighs how and when to set policies around blockchain, it’s also working hard to spur the advancement of novel applications and use cases for DLT, through initiatives such as the Use of Blockchain in Health IT and Health-related Research Challenge hosted this year by the Office of the National Coordinator for Health IT.
HHS is also putting blockchain to work within the agency itself: The new HHS Accelerate platform, for instance, leverages DLT’s ability to more efficiently manage data, helping it make acquisitions more quickly and less expensively.
As healthcare organizations share more data with one another, the industry is grappling with a slew of new health IT challenges, including how to make use of newfound data sources and engender trust among patients.
That’s according to a new “Health Trends Report” released by Stanford Medicine, the organization’s second report in as many years. Since its inaugural report in June 2017, the industry has undergone seismic shifts as consumer technology giants increasingly encroached in the healthcare space. Broadly, health data ownership has grown for both consumers and organizations, “and the pace at which these groups exchange data is accelerating,” Lloyd Minor, M.D., dean of Stanford University School of Medicine wrote (PDF).
“Today, we’re starting to see walls come down in the health care industry, allowing data to flow more freely to where it can do the most good,” he added. “Realms of historically siloed expertise are opening up to more and more people. Patients can now get access to their personal health information. And digital tools are giving rise to new health platforms that are increasingly useful to physicians and patients alike.”
Stanford has emerged as a national leader in embracing new digital health solutions like wearables and urging providers to “junk the fax.” Stanford is part of a huge research effort to test the Apple Watch and its ability to detect atrial fibrillation.
The report—based on interviews with experts, a review of publicly available data, and Stanford’s own experts—outlines three pillars of “democratization in healthcare.”
- Intelligent computing: Access to more data is fueling powerful algorithms that will become a critical tool for physicians. But practical and ethic considerations loom large.
- Sharing: Healthcare organizations are sharing more data, but the industry hasn’t reached its full potential. Basic gaps in interoperability will hold back new AI tools, as will “messy” data that renders information unusable.
- Security, privacy and safety: Great data sharing means bigger risks around security and privacy. Although healthcare organizations recognize the need to invest in cybersecurity, budgets don’t always meet that need.
That last pillar is critical to building trust with patients. Blowback against consumer technology companies like Facebook over privacy concerns have thrust the issue into a brighter spotlight. Ensuring the proper guardrails are in place will help chip away at consumer mistrust.
Working with technology companies and embracing new innovations around AI will also be key drivers of data democratization, the report stated.
“Health care democratization has the potential to recast the patient-doctor relationship, giving patients an opportunity to play a much more prominent role than they have before,” the authors wrote. “If we get this right, it could be a very positive development, for both sides.”
As part of its mandate for more widespread interoperability, The 21st Century Cures Act called on the Office of the National Coordinator for Health IT to create a Trusted Exchange Framework, and Common Agreement, outlining an inclusive vision for how healthcare data can and should be exchanged among stakeholders and care settings.
ONC’s draft of TEFCA – which lays out a common set of principles and basic table stakes for trusted exchange and data flow among disparate networks – was published on January 5, 2018. Following months of public comment, final rule is expected by the end of this year.
“The Trusted Exchange Framework and Common Agreement is the concept that the various networks talk together: regional health information exchanges, Carequality, CommonWell, some other ones, getting those to talk and leverage the work they’ve already done,” Dr. Don Rucker, national coordinator for health IT, explained earlier this year at HIMSS18.
Another goal is “getting them to expand their use cases, which today are almost always narrowly defined as provider to provider,” Rucker added. “We should leverage them – direct to patient, to payers who buy all of our healthcare, so we can actually see what we’re getting in this country when we purchase healthcare.
At HIMSS19, ONC Executive Director Steven Posnack and Dr. Terrence O’Malley, a geriatrician at Partners HealthCare who sits on ONC’s Health Information Technology Advisory Committee, will offer policy and practice perspectives of how 21st Century Cures and TEFCA will help catalyze a more efficient and effective health data ecosystem.
They’ll show how ONC’s rulemakings, along with public-private initiatives such as the Argonaut Project, SMART on FHIR and others, are enabling easier and more user-friendly access to information for providers and patients alike.
The big picture, said O’Malley, is that these policies, spurred by the shift to value-based payment are changing the way clinicians practices and “driving up the value of interoperability.”
There are six barriers to the adoption of interoperability, he explained:
- Finding a compelling business case
- Managing the complexity of multi-party information exchange
- Managing the complexity of consent and authorization of using information from that exchange
- Meeting the cost of technology acquisition and management
- Overcoming “technical difficulties” such as uneven adoption of semantic or transport standards
- Managing the impact on workforce, workflow and ongoing training
“New payment models create a compelling business case for entities that now hold financial risk for the total cost of care,” said O’Malley. “These models are profoundly different from fee-for-service.”
These new policy imperatives are changing the game – and speeding the evolution and expansion of the interoperability that’s been sought by so many for so long.
“Someone said that the adoption of interoperability is slow because healthcare is like a giant ocean liner, it takes a long time to change course,” he said.
But an ocean liner “has one captain and a clearly charted course; healthcare is more like a swarm of independent boats each with its own captain; and each sailing in the direction that maximizes FFS revenues. Some are steering towards the rocks and some towards interoperability.”
Moreover, they’re all moving in those directions at different speeds based on the incentives and disincentives that are felt differently across healthcare, he added. “Large healthcare systems and hospitals are different from physician practices, home health agencies, skilled nursing facilities and home and community based service providers.”
By creating a guide to connect such disparate stakeholders, rules such as TEFCA are helping to reshape the playing field and shift those data exchange incentives. But it’s the simple must-do of getting paid that will have the biggest impact, said O’Malley.
“Although technology and the infrastructure to support interoperability have expanded significantly in the last five years, the biggest driver that is increasing the likelihood that interoperability will be adopted as a tool by any health care provider is not the newly available technology,” he said.
“Rather, it is the rollout of new payment models that impact financial survival of each of these players. The work of ONC and new technologies lower the barriers to adopt interoperability but it is the payment models that force the decision to adopt.”
Now, the incentives are finally in place to share data much more freely. The goal is maintain a healthy bottom line, of course, but a welcome side effect is healthier patients, said O’Malley.
“As a clinician taking care of patients with a complex mix of chronic medical issues, depression or cognitive decline, functional impairment and adverse social determinants of health, under fee for service, the time required by me to communicate with a large care teams to manage patients such as these was not reimbursed. As a result, these patients were treated by a federation of service providers each doing their best to meet the needs of the individual but also meet their financial goals.”
Among those different stakeholders, many with competing priorities, “there was no compelling business case to communicate using standard vocabulary or exchange standards,” he said. “Indeed, time spent communicating was time not spent on producing a reimbursable service.”
But now, with a clear shift toward a value-based approach of “outcomes rather than units of service,” the need to exchange information becomes much more apparent, if not imperative, and “interoperability begins to gain value,” said O’Malley.
The Centers for Medicare and Medicaid Services wants home health agencies to accelerate their use of health information technology. The agency is issuing no mandates yet, but certainly is leaving the door open.
CMS’s encouragement of electronic health records and health information exchange is in a proposed rule for the calendar year 2016 Medicare home health prospective payment system. Among the proposed financial provisions in the rule are reductions of 1.72 percent in CY 2016 and 2017 to the national and standardized 60-day episode payment rate, and a home health value-based purchasing model (value-based reimbursement) that would be imposed on all Medicare-certified home health agencies in nine states to be selected under a proposed methodology.
CMS, as it has done in other Medicare payment rules targeting ancillary provider organizations, explains the various initiatives, reports and guidance that can aid home health agencies in starting their journeys toward adopting more health IT.
CMS also makes clear its belief that advanced IT equates to greater success for home health organizations. “While home health providers are not eligible for the Medicare and Medicaid EHR Incentive Programs, effective adoption and use of health information exchange and health IT tools will be essential as these settings seek to improve quality and lower costs through initiatives such as value-based purchasing.”
Consequently, CMS strongly encourages use of HIT to improve care delivery processes and lower costs, engage patients, support care management across the continuum, and enable quality measures. And the regulator adds this note: “As adoption of certified health IT increases and interoperability standards continue to mature, HHS will seek to reinforce standards through relevant policies and programs.”
The fiscal year 2015 Omnibus Appropriations bill passed by Congress includes legislative language directing the Office of the National Coordinator for Health IT to decertify electronic health record products that are effectively blocking the sharing of health information.
“ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange,” states the bill. “ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in [Certified EHR Technology], and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use.”
The legislation instructs ONC to submit a detailed report, not later than 90 days after enactment by Congress, regarding the extent of the information blocking problem. The report would include an estimate of the number of vendors or eligible hospitals or providers who block information, and a strategy on addressing the information blocking issue.
Congressional appropriators also instruct ONC’s Health IT Policy Committee to submit a report to the House and Senate Committees on Appropriations and the appropriate authorizing committees not later than 12 months after enactment regarding the challenges and barriers to interoperability. “The report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee,” states the legislative language.
In March, industry stakeholders at a Federal Trade Commission workshop in Washington on healthcare competition warned that the proliferation of closed data networks are trapping providers and patients into proprietary networks that are barriers to interoperability and competition. Specifically, they charged that some health systems block patient information sharing in ways that have antitrust implications.
Business practices that inhibit or block the electronic sharing or transfer of health information are a serious concern, particularly developers or providers who restrict information exchange with users of other EHR products or HIE services, according to ONC. The agency has publicly pledged to work more closely with FTC to formulate policies that “improve transparency, promote interoperability, create incentives for quality, and reduce barriers to competition and innovation.”
Healthcare information-sharing is largely stuck in neutral, according to the Office of the National Coordinator for Health Information Technology’s annual report on electronic health-record adoption, released Thursday.
While standards and services have been established to support information-sharing, “practice patterns have not changed to the point that healthcare providers share health information electronically across organization, vendor and geographic boundaries,” the report argued.
Information-sharing is seen as a key component in the move from a fee-for-service approach in U.S. healthcare to a quality of care approach, so signs that the sharing isn’t happening could spell trouble for progress toward that shift.
As of June 2014, 75% of eligible professionals and 92% of eligible hospitals had received subsidies from the federal government to kick-start their adoption of electronic records, the report noted. So, EHR adoption is booming, the report noted. But moving beyond that to data-sharing appears problematic.
“Electronic health information is not yet sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed through technical and medical vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care,” the report (PDF) said.
In 2013, 14% of office-based physicians shared patient information with providers outside their institutional walls; 39% shared information with any physician, even those inside the same institution. And 42% of hospitals electronically shared clinical-care summaries outside their systems, up 68% since 2008. In addition, 55% of hospitals shared radiology reports outside of their systems, and 57% laboratory reports.
Information-sharing is particularly problematic when attempting to share with post-acute-care and behavioral health providers, and long-term-care institutions. Those providers were not included in the federal EHR subsidy program and therefore have lower rates of adoption, the report noted.
The report stresses increased use of standards and “rules of the road” to aid interoperability. The report states the second stage of the meaningful-use program will help spur greater information-sharing, and believes HHS, CMS and ONC programs to aid innovation and health information exchanges will bear fruit. The report also argues that the earlier release of the ONC’s 10-year roadmap to interoperability will attract helpful comments on how to boost interoperability.