View from the Bridge

Look for Durability, not Disruption, in HIT for 2018

By Diane M. Carr, Advisor

The Office of the National Coordinator for Health Information Technology recently held its annual meeting in Washington DC. This is an opportunity for policy wonks, HIT geeks, healthcare providers and vendors to get together and get a sense of the national issues facing our industry and government priorities for addressing them. The two-day session focused on “Tackling Barriers to Interoperability and Usability”, with emphasis on reducing the burden on providers through health IT. Two top federal HIT officials set the tone.

In her keynote address, Seema Verma, Administrator for the Centers for Medicare and Medicaid Services, characterized her priorities for CMS as patient empowerment initiatives. Representing the nation’s largest health insurers, she outlined the concept of “Digital Seniors”, where electronic information is easily available for Medicare beneficiaries and providers, for example, provider directories and claims.

Ms. Verma described her approach as “patients over paperwork” and spoke of streamlining regulatory burdens on clinicians and payers. The interoperability limitations of many EMRs, which still necessitate that hospitals manually abstract data to share for clinical or financial purposes, are seen as a major impediment to patients who should have their health information with them. She made specific mention of the onerous reporting requirements imposed on hospitals and physicians by Meaningful Use, and voiced support for collapsing and aligning quality measures that can be overlapping or duplicative.

A frequent theme throughout the two-day event was dissatisfaction with having vast stores of data now available to us, yet difficult, first, to translate into useful information and next, to share to improve care quality and reduce cost. In his keynote address, the National Coordinator, Dr. Donald Rucker, discussed what makes interoperability so hard: biologic complexity is immense and “no neuron is like the next neuron”. The ER doctor, for example, will have an entirely different view from the neurologist and the intensivist, and the challenge is still to get the right data to the right doctor at the right time.

Patient empowerment poses additional challenges, he said, as IT systems thus far have been designed primarily to support provider-to-provider interactions. Now we must consider how to use and improve this technology to support use cases such as patient control, including choice of providers and payment. Cost for services and institutional accountability must be accessible to patients wherever they are. The 21st Century Cures Act requires the aggregation, analysis and exchange of highly sensitive and highly regulated health data at the population level, a new frontier of machine learning and AI.

The question is: how do we break through to attain the full value of HIT? We have been developing standards for decades, and still require data in different formats for different purposes. HIEs in various states have demonstrated that the technology exists to exchange health information. Individual right of access to one’s health information should not be hindered by business models based on competition. We need to figure out the (mostly) non-technical barriers of inconsistency, e.g., identity assurance, consent authorization, in order to achieve that “last mile connectivity”.

Starbridge Advisors offers the knowledge and expertise to help you move forward in resolving both technical and organizational issues on the path to true interoperability.

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