Interoperability isn’t just on your mind; the federal government is thinking a lot about it and planning some action that is likely to impact all of us. Speaking at the Office of the National Coordinator (ONC) Interoperability Forum in Washington, DC, last month, Centers for Medicare & Medicaid Services Administration (CMS) Seem Verma said, “CMS and ONC are working together to realize our shared vision for a health ecosystem where data can flow easily between patient, provider, caregivers, researchers, innovators, and payors,” Verma said, adding, “Today, I want talk about the vision of CMS, working in conjunction with ONC, to transform patient care through interoperability as well as opportunities for innovation and digital health.”
Noting that medical technology has enabled a wide range of treatment innovations, she added, “While medical technology is leading to breakthrough therapies and procedures to save and extend human life, the professionals in this room are intimately familiar with the fact that health care information technology remains far behind all other major industries.” She admitted that progress has been made—78% of physicians and 96% of hospitals currently are using certified health information technology (HIT). However, she observed, “Despite the best efforts of innovators…health care providers are in a 1990s’ time warp…where doctors are faxing patient records, medical staff are manually entering results into EHRs, and hospitals are handing out data on a CD-ROM while the rest of the economy is functioning as fully digitalized, integrated data that informs decision-making instantaneously.” She added that although the federal government spent over $35 billion on the effort to get physicians to use EHRs, many still use paper records and are resistant to change for various reasons.
A Future Vision
Verma offered her vision for the future. She said, “Imagine a world in which your health data follows you wherever you go and you can share it with your doctor, all at the push of a button. Imagine if, in turn, your doctor didn’t have to spend so much time faxing records and staring at a computer during an appointment. Imagine if you could track your medical history from your birth throughout your life, aggregating information from each health visit, your claims data, and the health information created every second through wearable technology.” She further suggested her audience envision a world where:
- Health records weren’t just used by physicians in their workflow but also used in third-party applications to access and leverage data in innovative ways for both the patient and the physician.
- Data could be used to predict and prevent illnesses as well as treat them.
- Patients could authorize access to their records by researchers across the country for use in studies that result in cures and innovative treatments.
Verma said, “Once information is freely flowing from the patient to the provider, the advances in coordinated, value-based, and patient-centric care will be even greater than anything we can imagine today.” As head of CMS, she noted that one of her priorities is “to break down any and all barriers to interoperability and create that one-stop shop for health data that will help inform our health care decisions with a complete picture of our medical history.”
A central part of CMS’s efforts, Verma said, in the “MyHealthEData” initiative, based on the premise that patients should be fully informed and empowered to make the best decisions for their own health. This effort, she said, is “about driving a new era of digital health, one that will unleash data to trigger innovation and advance research to cure diseases and provide more evidence-based treatment guidelines that ultimately will drive down costs and improve health outcomes.” She added, “Liberating data will drive innovation throughout the entire health care system and create new tools and solutions that will allow the system to deliver value to patients.”
Part of the MyHealthEData effort is Blue Button 2.0, which Verma described as a developer-friendly, standards-based application programming interface (API), which will allow a majority of Medicare beneficiaries to connect their claims data to third party applications, services, and research program.
To advance interoperability under MyHealthEData, she noted that CMS has created a Chief Health Informatics Officer (CHIO), whose job it will be to accelerate the pace of health IT innovation.
Elsewhere, Verma spoke of some other innovations planned by her agency to promote interoperability, including release of Medicare Advantage, Medicaid, and CHIP data sets to provide researchers and innovators with data on a new population of 74 million beneficiaries.
CMS believes in the future of interoperability, Verma said. “We will not shrink from this vision or delay its implementation. We are committed to requiring that providers begin using 2015 Edition certified EHR technology starting in 2019 because this version opens APIs.” She added, “By committing to the 2015 Edition of EHR-certified technology, we are opening the door to innovators in this room to solve our most confounding challenges.”
Tackling Nuances of Interoperability
Also speaking at the Forum, Don Rucker, MD, ONC National Coordinator for Health IT, said, “Interoperability is a hard thing to do. It’s vey important, but very nuanced. It’s at the heart of modern health care. If we are to have empowered patients who will control their medical care, it’s hard to believe this will happen without interoperability.” He added that this is at the heart of economically, efficient health care as well.
All of this is why Congress passed the 21st Century Cures Act, he said. Signed into law in December of 2016, the act:
- Promotes and funds the acceleration of research into preventing and curing serious illnesses.
- Accelerates drug and medical device development.
- Attempt to address the opioid crisis.
- Tries to improve mental health service.
A key part of these efforts is interoperability, and the act addresses this as well. It defines interoperability as health information technology that:
- Enables the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user.
- Allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law; and
The drive toward interoperability has just begun, Rucker stressed. “What fuels this is the desire everyone has to control data for themselves and, when they are moving between providers, to ensure data flows seamlessly among them. This is the problem we’re working on solving,” he said.
Rucker stressed that interoperability requires re-examining how things are done. For instance, he noted that US patient charts and office notes are four times as long as similar documentation in the rest of the world, and this is prohibitive to interoperability. He said the government is looking at a proposal to find ways to pay for sicker, more complex patients with a blended payment rate that involves add-on codes for complexity. Additionally, ONC and others are looking at issues such as information blocking, the desire to have Health Information Exchanges (HIEs) talk to each other, and how to enable and ensure open APIs. This last item, Rucker noted, “is fueling the modern world. You can’t travel anywhere without open APIs [through banking or travel plans, for instance]. It is the glue of modern computing.”
Listen to audio from the ONC Forum sessions at https://www.healthit.gov/news/events/oncs-2nd-interoperability-forum. Read more about the government’s plans for interoperability in our July 17th blog at http://ltcmanagement.com/ltpac-hit-summit-2018-recap/.