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Halamka Offers Guidance for Health IT Implementation, Policies

John D. Halamka, MD, MS, posted recommendations for improving ONC EHR certification requirements, MACRA/MIPS requirements, and establishing a national patient identifier.

ONC EHR Certification

Source: Thinkstock

- Beth Israel Deaconess Medical Center CIO John Halamka, MD, MS, recently published comments on the future of national healthcare IT after attending HIMSS17.

The list contained 10 guiding principles for maintaining and improving health IT regulations and reevaluating health IT priorities to optimize healthcare for patients and providers alike. 

In his blog, Halamka, who is also Chairman of the New England Healthcare Exchange Network (NEHEN) and Co-Chair of the HIT standards Committee, discussed potential changes to ONC regulations, MACRA/MIPS requirements, and interoperability.

First, Halamka suggested designing health IT by regulation.

Many healthcare organizations have voiced concern over the burdensome value-based care incentive program, EHR certification, meaningful use, and MACRA/MIPS implementation requirements. Halamka asserts the ONC should focus more on encouraging innovators to fulfill clinician’s needs and meet the demands of the marketplace instead of bogging providers down with government requirements.

“The certification program has established a culture of compliance in an industry ready for data-driven innovations,” Halamka wrote in his blog. “ONC’s role in the health IT industry made sense eight years ago when IT adoption in healthcare lagged considerably behind all other sectors, but today the certification program impedes a functioning market and must be reformed.”

While ONC is supporting health IT innovation in other ways, including with recent application programming interface (API) innovation challenges, current certification programs and requirements are not designed to support development so much as monitor health IT use.

Halamka also touched on the meaningful use certification and MACRA/MIPS requirements.

As the healthcare industry transitions from a pay-for-service-based care system to a value-based care system, it is important to simplify meaningful use requirements, and by extension, MIPS requirements.

Halamka stated that CMS has made an effort in this area to keep the focus on value-based care, but ONC has not done its part to tailor requirements to suit the industry’s readjusted objectives. Limiting ONC’s certification program to that which supports functionality needed for success in Medicare and Medicaid payment programs is imperative to keeping the industry forward-facing, Halamka noted.

It is also important to promote interoperability through market dynamics versus government mandates, he wrote.

While federal organizations have good intentions when creating policies and programs to encourage interoperability in healthcare, Halamka said the private sector will be more successful in promoting seamless health information exchange than the government policies aimed at driving providers toward EHR optimization.

Halamka suggested allowing the market to stimulate progress instead of stifling providers and EHR vendors with stringent policies aimed at coaxing the industry toward true interoperability.

Establishing a national patient identifier will also be critical, Halamka wrote.

Services such as Surescripts NRLS are attempting to establish a nationwide network allowing for streamlined EHR exchange and identification, he noted. However, a unique numerical system slotting each patient into a nationally standardized identification structure is still an unrealized dream.

“HIPAA called for the creation of a national patient identifier to improve efficiency and safety,” Halamka explained. “While patient-matching technology and processes have improved tremendously since HIPAA was enacted, a national patient identifier would still offer considerable efficiency and safety benefits and would remove a barrier to seamless interoperability.”

Given the progress of programs bridging providers across the country onto standard platforms and networks, a national patient identifier is the next logical step toward electronic health record sharing with associations including CHIME heavily vying for such an endeavor.

With these recommendations—including others regarding patient safety, CMS data access, and patient privacy laws—Halamka points the healthcare industry toward streamlined health data exchange and away from muddled, inhibiting government regulations to promote innovative and efficient health IT.  

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