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Interoperability: The Unfinished Health IT Agenda

Interoperability: The Unfinished Health IT Agenda

Center for Healthcare Regulatory Insight Forum


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On February 15, the Center for Healthcare Regulatory Insight hosted its fourth thought leadership forum on “Interoperability: The Unfinished Health IT Agenda”, which included a discussion of progress to-date on the adoption of EHRs and other health care IT systems, barriers to more effective use and transmission of health data, and potential policy, regulatory and private sector solutions.  

Farzad Mostashari, MD, ScM, Founder and CEO of Aledade, and former National Coordinator for Health IT at the Department of Health and Human Services delivered keynote remarks that focused on the history, current landscape, and ongoing challenges for interoperable health IT systems.  Specifically, Mostashari focused on the following points:

  • What is the goal/purpose of interoperability? That is a really critical piece to keep in mind as the industry looks to next steps. What’s the goal; how do we use the levers we have, including technology, to achieve those goals? A number of building blocks are in place, but industry users have not realized the full value proposition and potential of the investment in the infrastructure. 
  • With regulation alone, without a business case, providers tend to adopt a ‘compliance framework’ mentality to simply ‘check the box’ to meet reporting requirements while potentially sacrificing impact to patient care quality. We need to focus on improving data exchange while also improving the health of populations.
  • An important government responsibility is to challenge the market imbalances of data ownership and information-blocking to give providers the necessary access to data and limiting the burden to obtaining data. Scale is an essential component to reducing the economic cost point for obtaining and mapping data. 
  • The ideal state would be expedited access to real-time quality metrics with streamlined vocabulary, aligned definitions, and standardized mapping without high cost for providers across commercial and private payers. Standardization is a building block to use for additional use cases for public reporting. 
  • There are two keys needed to change the outcome; the first is patients’ right to demand their medical record; the second is providers sharing the information in the form or format preferred by the patient. HIPAA achieves the first key and certification does the second. 
  • One of the next big challenges is figuring how to increase the demand from patients for their health data and making them aware that they can ask for that data. We need to make sure the data can be shared and not controlled by the doctor; if a patient asks for data to be emailed to them, according to OCR, the doctor should do it, even if security concerns might exist. 

After the keynote address, Larry Kocot, National Leader of the KPMG Center for Healthcare Regulatory Insight moderated a distinguished panel to discuss potential strategies and next steps for ensuring more effective data sharing and use, as well as the development of a clearer business case for continued investment in health IT.  The panel highlighted the challenges and possible solutions for furthering the unfinished interoperability agenda, including the need for a demand of information to push technological innovation and overcoming barriers to data sharing in a time of growth in the value-based healthcare environment.  In his introduction, Kocot noted that the recently passed 21st Century Cures Act, attempts to further the agenda by taking several steps to encourage usability, interoperability, and security in the exchange of health information, but that the implementation of MACRA, will only increase the pressures for more meaningful data exchange and positive population health outcomes. 

Given the reliance on quality metrics and reporting for positive performance payments, the panelists discussed the potential opportunities for a public/private partnership to help providers process and submit quality measures to the government.  The panel agreed that pulling data from providers versus having them push data to reporting agencies while simultaneously seeking to change patient behavior would relieve some of the reporting burden and cost to providers. Optimizing the health IT infrastructure to lessen the burden on providers to report with workflows and no-cost access to data is essential to success. While achieving improvements in interoperability and meaningful information exchange should remain the primary goal, there is opportunity to couple improvements with an intuitive user experience that provide more usable and useful data for users. 

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