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Value-Based Care, Political Doubt to Shape EHR Use in 2017

DirectTrust President and CEO David C. Kibbe says EHR use will be heavily influenced by value-based purchasing and the incoming Trump Administration.

By Sara Heath

- Health IT and EHR use are in for a year shaped by value-based care and political uncertainty, according to DirectTrust President and CEO David C. Kibbe, MD, MBA.


Foremost, healthcare professionals should expect to see value-based care policies to increasingly influence EHR use standards, and an administration likely to reduce EHR regulation and oversight.

“It would not surprise me to see MU Stage 3, still in place for hospitals, but replaced by the Advancing Care Information component of MIPS for most physicians, significantly delayed or even retired completely, and replaced with something similar to and aligned with MIPS,” Kibbe said in a public statement.

“Given that there is strong bipartisan support for MACRA in Congress and the incoming Secretary of HHS, we can expect to see value-based payment reforms for Medicare and Medicaid become the main drivers behind incentives for the uses of health IT, with much less policy momentum behind the adoption of ‘health IT for its own sake.’”

Additionally, Kibbe says the new Administration will likely allow the private sector to determine the best course forward for health IT use standards, especially given that most hospitals and clinicians (90 percent and 70 percent, respectively) use ONC-certified EHR technology.

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“Does this mean a decreased role for ONC? Not necessarily, in my opinion,” Kibbe said. “The EHR and health IT certification role of ONC is important to the statutory integrity of MACRA and is protected under the 21st Century Cures Bill, now law. There is grudging support, even among most Republicans, for a surveillance role for ONC if it’s limited to issues of safety and public health in EHR use.”

Potentially stagnant health IT policy may also have an effect on health IT, keeping the health technology economy relatively predictable under the uncertainty of the Donald Trump Administration.

“For the time being, I don’t expect any major shocks to the health IT economy or to the professionals working in it,” Kibbe asserted. “The themes of using health IT to improve care coordination, to manage patient populations through better collection and data use, and the value of advances in telemedicine, will continue to be heard and supported by both the private sector and the federal government in a bipartisan fashion.”

In the midst of this stagnation, Kibbe predicts interoperability will remain an important priority throughout the industry, as will technology transparency and intentional data blocking – especially now that all of those provisions play a role in the 21st Century Cures Act. However, Kibbe predicts that the advisory groups the Cures Act law enacts will yield little power and not be felt in their first year.

In the backdrop of this change, Kibbe foresees a period of significant uncertainty in the healthcare industry, driven by the upcoming inauguration of President-elect Donald Trump and a Republican Congress.

“One has to begin any set of predictions about health care and health IT during 2017 with the caveat that with Donald Trump as President almost nothing is certain except uncertainty itself,” Kibbe said.

“It may be months or even longer before we know the full impact of his and a Republican Congress’ leadership on the crucial levers of legislation and regulation affecting healthcare funding, insurance coverage and the uses of health IT.”

Specifically, Republican efforts to repeal the Affordable Care Act and add provisions altering Medicare will cause great uncertainty throughout the industry. This could have an effect on health IT improvement.

“Even if Congress simply begins the process in a serious way in January 2017—which is certainly expected—and what follows are months of debate and controversy, the effect will be felt by the entire healthcare industry as uncertainty about the future,” Kibbe explained.

“This could lead possibly to a number of months of inaction that might feel like paralysis, including failures to invest in health IT infrastructure and innovation.”

In addition to commenting on health IT’s role in value-based purchasing, Kibbe made other predictions going into the new year. For example, Kibbe says security will play a bigger role in health IT development, with encryption, authentication networks, and identity management programs coming to the forefront.

Kibbe also predicts more innovative health IT to come to market in the coming year.

“The wild card will be what happens with emergent health technologies capable of aggregating personal health data from multiple providers, managing it for clinical guidance and channeling big data come under the control of patients—not their providers,” he said.

These technologies include those utilizing FHIR application programming interfaces, block chain technology, telemedicine, and personal health records, among several others.

Late last year, Kibbe issued a set of four recommendations for the Trump transition team to ensure health IT and EHR use growth continues under the new Administration.

“We've made significant progress in the areas of increased electronic health records (EHR) adoption and interoperability during the past four years,” said Kibbe. “Our hope is that the momentum established to this point will continue under the new administration.”

Those recommendations included appointing a strong and respected leader as ONC head, not reversing advancements recently made in the health IT domain, calling for stronger health IT and EHR security, and upholding developer and provider accountability systems helping to improve care outcomes.

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