- In reporting its latest work to enable increased health IT use to lead to improved health data exchange interoperability to Congress, the Office of the National Coordinator for Health Information Technology (ONC) has identified “critical” actions necessary for advancing healthcare interoperability in the near term.
The actions comprising the bulk of ONC’s most recent annual report to Congress on the state of health IT across the country are threefold: promoting the use of common health IT standards, building use cases for healthcare interoperability, and changing attitudes around patient access to health information.
The ONC report makes clear that the table is set for improving the flow of electronic health information.
“Today, most hospitals and physicians report use of certified health IT. The health care system is seeing unprecedented levels of electronic health information exchange. And patients, clinicians, hospitals, communities, scientists, and researchers have experienced tangible benefits, such as reduced drug-drug or drug-allergy errors and more efficient and coordinated care,” the federal states.
“But despite this widespread progress in modernizing the U.S. health IT infrastructure,” it continues, “there is more work to do to achieve truly seamless and secure flow of electronic health information for all clinicians, hospitals, communities, and individuals.”
This is where the aforementioned health data exchange-related actions come into play.
The first action focuses on using recognized health IT standards to unlock data in current systems and make them available to other stakeholders and new and emerging technologies through the use of application programming interfaces (APIs).
One such API identified in the report is Fast Healthcare Interoperability Resources (FHIR), which ONC has promoted the use of via its health IT certification criteria as recently as the 2015 Edition and contests focused on operationalizing the set of specifications and API.
As HL7 CEO Charles Jaffe, MD, PhD, told HealthITInteroperability.com this past summer, those looking to take advantage of the potential of FHIR and API use should avoid viewing the draft status health IT standard and API as a sign of its lack of readiness.
"ONC is entirely behind the use of FHIR, but the fact is that the marketplace will decide the utility of FHIR," he maintained. "We use the WIFI standard, which has always been a draft standard, so now we're up to 802.11ac. The industry is making modems and receivers to use that specification. It's not a normative standard, yet it works, yet it's hundreds of times faster than we had 2-3 years ago. Whether ANSI gives it its blessing or not, we have advances in technology which make it difference in how we communicate. And I believe FHIR will be the same way."
Beyond promoting common health IT standard and API use, sharing real-world use cases for healthcare interoperability represents a second critical action to improving health data exchange in the near-term at ONC.
The ONC report to Congress singles out programs such as the Quality Payment Program and other value-based care initiatives as part of as well as outside of MACRA implementation as the means for demonstrating the benefits of effective health data exchange to care coordination, patient outcomes, and resource use. Likewise, the report calls for moving beyond EHR Incentive Programs and meaningful use requirements as primary drivers of information sharing.
Proof of the value in that rationale was on display at DirectTrust which announced significant growth in the use of Direct standard for health data exchange between the third quarters of 2015 and 2016. Over that time, the number of healthcare organizations connected to DirectTrust health information service providers (HISPs) and using Direct exchange increased by 62 percent to 69,000 organizations, and the number of transactions grew by 64 percent to approximately 22 million.
DirectTrust President & CEO David Kibbe, MD, MBA, attributed the growth to use cases beyond the EHR Incentive Programs and meaningful use, whose requirements for health data exchange have promoted Direct.
“We’ve entered a new phase of growth for Direct exchange; one in which Meaningful Use (MU) is no longer the single major driver of adoption," he said. "New and often innovative use-cases are springing up in which Direct replaces fax, phone, and/or mail in the workflows of healthcare-related organizations whose professionals don’t necessarily use EHRs and don’t directly benefit from the MU incentive bonuses."
Lastly, ONC called attention to the need to foster a culture of robust health data exchange, highlighting its recent work to discourage information blocking and perform direct review of certified EHR technology and other health IT systems to ensure their performance remains in line certification criteria.
Weeks ago, National Coordinator Vindell Washington, MD, MHCM, addressed the unintended effects of HIPAA on the propensity of providers to participate in health information exchange as part as a keynote address at a healthcare journalism workshop.
“People insist that HIPAA makes it difficult, if not impossible, to move electronic health data when and where it is needed for patient care and health. I wish I could talk to every doc and patient in the country to tell them, ‘This just isn’t true.’ But unfortunately, this misconception is widespread,” he said.
While the ONC report to Congress includes a significant amount of focus on new regulatory actions, these address symptoms of condition tied in large part to pre-existing regulations and the demands on providers to compete for dollars. More than likely the transition to value-based care underway within the Centers for Medicare & Medicaid Services (CMS) stands more of a chance at removing cultural obstacles to information sharing by tying payment to health data exchange.