- Health information technology, particularly capabilities tied to health data exchange, has an important role to play in the federal government’s push to improve the cost and quality American healthcare.
Recently, the National Academy of Medicine’s Vital Directions for Health and Health Care Initiative published four policy priorities for the current administration and healthcare leaders to address in order to achieve better health at a lower cost:
• Pay for value—deliver better health and better results for all
• Empower people—democratize action for health
• Activate communities—collaborate to mobilize resources for health progress
• Connect care—implement seamless digital interfaces for best care
The list of four priorities, which are complemented by recommended policy reforms, is the product of an NAM initiative which convened a steering committee of health, healthcare, science, and policy leaders that oversaw a review of nineteen issues areas and discussion papers analyzed by more than 150 subject-matter experts.
While aspects of health IT infrastructure contributed to various policy priorities, it featured most prominently in the fourth and final — connecting care.
“Health information technology (HIT) has had tremendous impact on health care, driving greater accountability and value, enhanced public engagement and purpose, improved public health surveillance, and more rapid development and diffusion of new therapies,” states the Vital Directions for Health and Health Care discussion paper.
“Yet critical challenges remain, including the ability of providers to amass and share electronic health record (EHR) data for individual patients longitudinally, which is essential to harnessing the economic and clinical benefits of EHRs,” the paper continued. “Despite the rapid advancement and broadening technical capacity of digital technology for health, digital interoperability — the extent to which systems can share and make use of data — remains extraordinarily limited.”
The paper detail several adverse effects of limited information sharing ranging from impediments to care coordination and threats to patient safety to high end-user costs and health IT-related physician stress.
The NAM initiative recognized as a priority the integration of health IT infrastructure to promote efficient health data exchange:
Develop standards, specifications, regulatory policies, and interfaces to ensure that patient care data and services are seamlessly and securely integrated, and that patient experience is captured in real-time for continuous system-wide learning and improvement.
On the subject policy reforms in this area, the paper identifies three.
The first focuses on the accessibility and use of clinical data:
Specific infrastructure and regulatory barriers exist to clinical data accessibility and use that require attention and remediation. Among the most critical are: specifications for data that have been developed but not adopted; commercially protective coding practices; proprietary data ownership and use restrictions; and misinterpretation of control requirements for use of clinical data as a resource for new knowledge. The recently passed 21st Century Cures Act does include provisions to encourage and facilitate sharing and use of clinical data, but those provisions will still require local action and leadership.
The second calls for principles and standards to advance healthcare interoperability:
Either through federally-facilitated or mandated efforts, or through direct federal action, specific standards need to be supported for end-to-end (system/clinician/patient) interoperability, so as to allow private and secure data transmission among EHRs and FDA-approved medical devices, and to provide a path toward data exchange with consumer health technologies
The third and final centers on promoting strategies for the continuous improvement of health IT infrastructure:
The technical capacity exists for continuous communication and learning throughout health care, ranging from the activities of different clinicians and institutions, to the operation and interplay among relevant medical devices, to readings from mobile biomonitoring devices. Taking full advantage of this transformative capacity requires comprehensive strategy and action to strengthen data infrastructure, build public trust around data privacy and security, and harmonize inconsistent state and local policies on data use and sharing.
As for examples of policy initiatives drawn from the review of discussion papers, the NAM initiative includes efforts on the part of HHS to use a combination of regulatory and reimbursement mechanisms to promote interoperability; the development of a national patient identifier for the purpose of effective patient matching; and requirements for EHR use as a condition of participation in federal healthcare programs.