Featured Articles: Meaningful Use of HIT

Ask Adele: Vendors Eliminate Interoperability Cost Barriers

Monday, May 11, 2015   (0 Comments)
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By Adele Allison

Director, Provider Innovation Strategies, DST Health Solutions


Editor's Note: Adele Allison will present four sessions at the Spring Primary Care Conference May 16-19, 2015, in Portland, OR


Question: I recently heard that some EHR vendors are waiving their data-sharing fees to aid the advance of interoperability. Is this true?



Answer: When the 111th Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009, adoption and use ofinteroperable, certified electronic health records (EHRs) technology became part of healthcare legislation. HITECH created a provider entitlement program known as the CMS EHR incentive programs, or more commonly “Meaningful Use,” requiring hospitals, physicians and non-physician providers to digitize the clinical side of the house. Meaningful Use occurs in regulated stages, and stage two requires EHRs to make interoperability of clinical data real.


Using federally-defined standards, certified EHRs are able to populate and move reusable templates known as consolidated clinical document architectures (CCDA) between disparate systems via one of two transport standards: Direct messaging, or through a health information exchange (HIE) engine participating on the national exchange network known as the HealtheWay. Direct messaging works like email between providers, but makes the movement of health information over the Internet secure and trusted. HealtheWay leverages advanced interoperability standards geared to more of a query-retrieve type of information exchange, similar to the type of interoperability found with ATMs in the banking industry.


As providers of emerging technologies, EHR vendors have made substantial investments in research and development to achieve one or both of these interoperability standards, and investments continue as interoperability standards evolve. To defray ongoing capital outlay and create long-term maintainability, EHR vendors have typically associated fees with the implementation and use of interoperability features as required under Meaningful Use. With federal Meaningful Use incentive payments to hospitals and providers exceeding $29.5 billion, legislation was passed late in December 2014 authorizing the Office of National Coordinator (ONC) to de-certify EHRs found practicing “information blocking.”


Mid-April, many of these EHR vendors convened at the Healthcare Information and Management Society’s (HIMSS) annual conferencein Chicago.  Mixing it up with over 1,300 health IT exhibitors across a 600,000 square-foot exhibit hall, two notable EHR vendors – athenahealth and Epic – publicly vowed to eliminate these fees for their customers. With cost the dominant complaint among the 60 unsolicited reports of information blocking made to the ONC in 2014, this growing trend to remove cost barriers should be music to provider ears.


How can organizations leverage newfound interoperability?


Interoperability of health information can directly increase the quality of care, efficiency of providers and accessibility of information, characteristics that play a pivotal role in healthcare reform.  In addition to improving care delivery, the Affordable Care Act (ACA) has sparked a proliferation of alternative payment models that shift the economics of healthcare from a system based on volume to one based on value.  Value-based payment design incorporates measurements of quality and cost accountability, often across a community of providers, all requiring more and better data.


By unleashing data, clinical decision-making becomes more accurate, timely and efficient, leading to fewer complications, improved patient safety and increased patient satisfaction. Done right, data interoperability is extremely underwhelming – providers and patients simply have information whenever and wherever it is needed.  From removing clipboards at check-in, to knowing an unconscious patient’s allergies in the ER, to appropriately risk-adjusting for patients attributed to a provider or accountable care organization (ACO) under risk-based contracting, data movement means life and lasting sustainability.


How will this trend play out?


Cost is but one barrier to realizing full healthcare interoperability. While this trend bodes well for provider adoption and use of these technologies, there remain other hurdles to clear from the track. Among these are:


  • Evolving standards – Millions in research and development have been poured into Direct messaging capabilities and query-based HIE. However, a new HL7 standard known as Fast Health Interoperability Resources (FHIR, pronounced “Fire”) is sprouting. Born of a 2013 JASON task forcereportto the ONC, FHIR uses open application program interfaces (APIs) paired with intermediary applications and services to facilitate data exchange. While this may make great technical sense, all associated policy, legal, governance, development and usual business barriers would have to be overcome.  Speed is a matter of money. How fast do you want to go?
  • Patient Matching – Privacy advocates have promoted policymaking into a corner, resulting in the banning of a unique patient identifier. Without an identifier, health information cannot be accurately matched to the right patient. A major patient safety issue, technology currently uses algorithms to correspond data to patients with anerror rateof 8 to 20 percent. How many Maria Gonzalez’s do you think there are in San Antonio, TX alone? Too many.
  • Lack of resources – The shortage of health IT workers is growing, according to a PriceWaterhouseCooper 2013 report So when the above-noted problems are solved, who will build, implement, train, maintain and support these technologies?


Are there any specific concerns, or potential negatives, associated with EHR vendors sharing data freely?


The only concern I can see today is the industry getting ahead of itself in its rush to achieve interoperability. While having an open system that freely and cheaply shares data is exciting when contemplating the possibilities, there must be a clear definition of data governance and appropriate controls in the system design and architecture to balance innovation with proper security and trust. Healthcare is very personal. Freeing health information has the ability to create real systemic changes in the way healthcare is delivered and provisioned. Nevertheless, those entrusted with personal health information must exercise stewardship which formulates the process, duties and responsibilities of data use, environments and ethics.


Do you have a question? Let us know! Contact membership@nwrpca.org to submit your questions to “Ask Adele.”


NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.

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