The Office of the National Coordinator for Health Information Technology (ONC) appears to be clearly committed to improving the quality and value of healthcare using IT as a primary agent of change. Attendees at this year’s ONC annual meeting in Washington, DC included organizations from across the healthcare ecosystem, including government, HIEs, healthcare providers and IT vendors. Discussion on a number of national healthcare initiatives for which IT is critical included the National Precision Medicine Initiative, National Cancer Moon Shot, and national health care issues such as the opioid epidemic, public health, research and innovation, and needed healthcare delivery system reform.
Significant IT investment has already occurred, especially among hospitals. Recent survey data from the American Hospital Association reported:
- Nearly all hospitals (96 percent), used certified EHR technology in 2015
- 83.8 percent of hospitals adopted at least a basic EHR in 2015 – a nine-fold increase since 2008
- 85 percent of hospitals sent data outside their organizations in 2015, an increase of 78 percent from 2014
Although data sharing across organizations has increased, the technology that focuses on improving data sharing within technical and process workflows remains a critical issue for the ONC. Three important themes emerged during the ONC conference:
- Navigating payment reform, arising from the Medicare Access and CHIP Reauthorization Act (MACRA), and being able to understand and thrive through upcoming changes is critical for health care providers. This payment reform, which includes the Merit-Based Incentive Payment System (MIPS) for eligible clinicians, restructures Meaningful Use into a new advanced care information (ACI) performance category as part of MIPS for purposes of calculating payment. Payment reform has long been discussed in healthcare, as escalating costs have spurred calls for changes in healthcare delivery and changes to the historical fee-for-service model which has been in place for decades.
Calls for rapid adoption of reform have become louder and more urgent in recent years as the burden of the cost of care continues to escalate. Generating greater value for the cost of care is clearly an ONC objective, especially when healthcare costs have escalated so rapidly since 1980 and are expected to continue rising dramatically until 2050. Something must be done to stem the tide of spending while working to more effectively and efficiently deliver quality healthcare services. As this environment continues to emerge, the ability to effectively use all the information that is available to the provider will be necessary to successfully address changes in provider payment reform. MACRA now creates the required incentives, utilizing a scoring program, to maintain payment and create incentives for quality outcomes which will impact Medicare providers.
To earn points toward a base score, a MIP-eligible provider must report the numerator and denominator of certain measures for the ACI performance category. The measures in that category are based upon the EHR incentive programs for stage three that were part of the 2015 EHR incentive programs final rule. These incentives account for 50 percent of the ACI performance category score. The MIPS performance period starts on January 1, 2017 with the first MIPS payment year impacting Medicare providers beginning in 2019. During this period, health care providers will need to continue to enhance their EHR systems and address missing information that may be part of the complete medical record. Although there is a lot of talk and hype in the marketplace, the ability to share information with other providers in a workflow-enhanced method is a challenge that continues to plague health care system providers and the vendor community alike. Significant efforts toward improving information sharing will need to be undertaken.
- Health IT systems require a program of continuous enhancement to address the way younger healthcare consumers will demand access to healthcare services in the future. Coming generations of healthcare consumers will demand new means of accessing services. Whether care is paid for by them or through third parties, the new generation of healthcare consumer is more tech-savvy and more focused on using the Internet, particularly through mobile devices, to make life simpler. Increasingly, this generation will demand more than just the option of face-to-face communication with healthcare providers. Emerging consumers will be looking for solutions that today’s healthcare provider is not positioned to provide. Although health IT has been readily-adopted over the past few years, these consumers will further challenge healthcare providers to provide care more efficiently, using a digitally-enhanced approach. These methods are being actively discussed by the ONC so that new ways of assessing and delivering care and services remain in the forefront.
- Interoperability, both from a technical and provider standpoint, is critical for the ONC to achieve its national goals. By far, the issue of system interoperability that enhances care delivery, reduces costs and improves quality appears to be of critical importance to the Federal government. Without significant improvements in interoperability of health IT systems, few of the objectives set forth by the ONC will be achievable. Sharing and capturing healthcare content is a key enabler to achieving ONC’s goals. Technical standards, cultural change on the part of healthcare providers, and a true business case for interoperable systems continue to be elusive goals. In spite of this, ONC will continue embrace and pursue interoperable development.
There is hope for the future, as some organizations have already moved forward to establish themselves in a better position concerning payment reform. David Kendrick, MD, CEO of @MyHealthAccess at the University of Oklahoma, shared his organization’s experiences implementing alternative provider models. They have established a patient-entered data home model where local providers have committed to data sharing that is organized around this model of care. The model is beginning to show a return on investment as provider-based data blocking among participants has been reduced. The program offers centralized consent management and works to align payment incentives among a diverse set of local providers in Oklahoma.
Major vendors and healthcare providers are also responding. The Argonaut Project, announced in early 2015, is supported by a group of key vendors implementing new API-based FHIR (Fast Healthcare Interoperability Resources pronounced “FIRE”) interface specifications. The FHIR specifications are an exciting, new standard for electronically exchanging healthcare information. FHIR aims to simplify implementation without sacrificing information integrity. It leverages existing logical and theoretical models to provide a consistent, easy-to-implement and rigorous mechanism for exchanging data between healthcare applications. FHIR should enable expanded information sharing for electronic health records and other health information technology based on internet standards, opening up the ability to share information and improve healthcare quality while reducing costs.
To achieve ONC’s ultimate health IT goals, providers must recognize that investment in health IT must continue. Concurrently, healthcare providers must work within local regions to break down barriers to information sharing and work to create a culture where the patient has more control of records than does the healthcare facility. Sharing of healthcare data among providers should enhance healthcare decisions and help with provider payment incentives that assist in payment for services, while improving overall quality of care. Vendors must continue to work together to improve the ability to exchange information that enhances the workflow of all applications. Patients and consumers of care should expect easier access to healthcare information while also being assured that information can be provided in a secure, cost-effective and high-quality delivery model.