- A recent post by Beth Israel Deaconess Medical Center CIO John Halamka, MD, MS, addressed the trajectory of health IT in the age of value-based care and stated health IT interoperability and usability and patient outcomes will push the industry forward.
Recently proposed changes to MACRA’s Quality Payment Program were the starting point for Halamka’s most recent opinion on the state of health IT.
“The industry is welcoming the delays and accommodations it includes, especially the use of 2014 certified records for the 2018 year and the small practice exemptions which recognize the technologies/people/processes needed to succeed under MACRA/MIPS could overwhelm independent clinicians,” wrote Halamka.
The QPP proposed changes are designed to improve the flexibility of existing requirements and reduce administrative strain on providers. In particular, the proposed rule focuses on meeting the needs of small and rural practices.
With this recent policy update in mind, Halamka enumerated five factors likely to determine the future of health IT policy and development.
First, Halamka acknowledged the role interoperability will play in shaping the industry.
“There seems to be great consensus that all stakeholders need to focus on enhancing interoperability technology and policy in support of care coordination, population health, precision medicine, patient/family engagement, and research,” he wrote.
Next, he addressed the need for health IT vendors to shift their focus primarily to improving usability.
“Although the major EHR vendors are working on usability improvements, I believe the greatest agility will come from the startup community via apps that get/put data with EHRs using APIs based on evolving FHIR standards,” he wrote.
Halamka predicted each vendor will take a different approach to making necessary improvements.
Epic will support open APIs using FHIR at no additional cost for use cases prioritized by the Argonaut project and HL7. Additionally, the Wisconsin-based vendor will support proprietary Epic APIs for its own licensees.
Cerner will adopt the same strategy as Epic with additional SMART on FHIR support. MEDITECH and athenahealth will similarly support open APIs on FHIR, but MEDITECH will encourage developers to work with customers to leverage its data repository at each site while athenahealth will focus on workflow integration.
eClinicalWorks, he said, will focus on additional support for standards-based data exchange following its $155 million lawsuit.
Halamka also echoed the sentiments of healthcare organizations across the industry in pushing for a national patient identifier.
“It’s too early to know what solutions will predominate but leading contenders are biometrics (fingerprint, image recognition, palm vein geometry etc.), a voluntary national identifier issued by some authority (public or private sector), or some creative software solution such as OAuth/OpenID/Blockchain etc,” he wrote. “In July, I will co-chair a national consensus conference on patient identifiers hosted by the Pew Charitable Trust. I’m hoping we achieve consensus on a framework that accelerates the availability of such an identifier for multiple purposes.”
Another likely development in health IT policy will be a move toward patient-centered health data exchange nationwide.
“Several groups are thinking about how best to converge our heterogeneous state privacy policies, specifically focusing on the role of the patient as data steward,” he wrote. “We can radically simplify privacy protection if the patient is the agent by which information is shared.”
Lastly, Halamka stated certification and prescriptive health IT policy will be abandoned in favor of a more outcomes-based focus in assessing the quality of technology.
“Rather than counting the number of Direct messages sent, giving organizations the flexibility to each data using the most locally appropriate technology but then holding them accountable for a result of that data exchange, i.e. reduced readmissions, reduced redundant testing, reduced errors seems to be well aligned with a move to value-based purchasing,” he said.
Halamka stated he expects many of these issues will be addressed by the new Healthcare Information Technology Advisory Standards Committee, which will be announced this month.