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Verma: Health IT Industry Needs to Catch Up to CMS

ORLANDO — The federal government has gone ahead of the private sector when it comes to promoting interoperability of electronic health records (EHRs), and now it’s up to the private sector to catch up, Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma said here Tuesday.

“The federal government has already spent $36 billion on interoperability; we’ve made the investment and it’s up to the private sector to take the next step,” she said at the Healthcare Information and Management Systems Society (HIMSS) annual meeting.

Verma’s remarks came only a day after CMS and the Office of the National Coordinator for Health Information Technology (ONC) released proposed rules for promoting interoperability. Under the proposed rules, patients would have access to their EHRs free of charge, and would be able to transfer them more easily from one provider to another. The rules also would allow the federal government to publish names of companies that participate in “information blocking” — not releasing health records or other information to providers who don’t use the same EHR system.

“I look at this as a marathon toward interoperability,” she said. “My nature has been to deregulate … but in this particular instance, the industry was not doing what was important, what was needed for patients and for the healthcare system. So we’ve gone in this direction.”

“I don’t think that our work is done here,” she continued. “I think there’s a lot more work around interoperability as we move forward. [For example] we need to address the issue of patient ID, patient matching; those are going to be really important.”

Mike Leavitt, a former Republican governor of Utah and former Health and Human Services Secretary under President George W. Bush, agreed. “This is a moment for us in the healthcare industry to step up; we need to see this as a call to action,” said Leavitt, founder of the consulting firm Leavitt Partner. “We need to step up and we need to move forward.”

(l-r) Seema Verma, Centers for Medicare & Medicaid Services; former Utah governor Mike Leavitt (R); former national coordinator for health information technology Karen DeSalvo, MD; former U.S. chief technology officer Aneesh Chopra; Hal Wolf, president and CEO, HIMSS (Photo by Joyce Frieden)

That is not to say that the health information technology industry hasn’t done some things already, said Aneesh Chopra, former U.S. chief technology officer under President Barack Obama. For example, the industry has embraced Fast Healthcare Interoperability Resources (FHIR) as the common application programming interface. “We’re not going to have a Betamax/VHS fight in healthcare; there’s no fight,” he said, referring to a split between videocassette recorder companies over which technology they would use. “We’re moving forward to say, ‘How do we add more content?'”

The Obama administration implemented a rule in January 2010 requiring EHRs to provide a summary of a patient’s record in a machine-readable format, he added. “The notion … was to set the floor — we’ve got to collect blood pressure, we’ve got to have a medication list, we need to know the problem list. The presumption was that it would be a catalyst for industry action, that the government would do initial work and mandate the floor but we would have private-sector collaboration and activity.”

However, it hasn’t really worked out that way, Chopra said. “It’s now 2019 … but the information available has not added a single bit of clinical additional information than what we minimally required in 2010,” he said. For example, “what about people suffering with cancer — their tumor staging data? The nodes? … We didn’t minimally require it, so the the industry didn’t self-organize to say, ‘Let’s voluntarily add this additional bit of data as standardized content,'” even though EHRs contain that information.

“So now we finally have a statement; we need to have the notes; we need to have pathology results and other factors in there … but why did we have to have a rule saying we need the rest of the health record? Why?” he said.

And there are other items that should be added to that content, said Karen DeSalvo, MD, MPH, former national coordinator for health information technology under President Obama. “Health is more than healthcare,” she said. “We have to have more sources of data than just what’s in the EHR — we have to find ways to incorporate data about where we live, learn, work, and play … It may sound fluffy to people not accustomed to the idea …. but the majority of our health outcomes are driven by non-medical factors. It drives health outcomes and determines whether people live or die younger or sooner than their neighbors.”

One other change that CMS has been pushing for might not come so easy: “axing the fax” and implementing safe, secure email. Chopra noted that his brother-in-law, who is a urologist, had been using e-faxing to send his patient visit records to patients’ primary care physicians. So Chopra suggested that his brother-in-law start using the direct address function to securely email the information instead. His brother tried using it, but he couldn’t select the parts of the record that he wanted to send and instead was required to send a 75-page CCDA [a standard clinical document] “and the primary care doctors started yelling at [him] , ‘What are you sending this garbage for?’ So he went back to e-fax.”

2019-02-12T18:00:00-0500

Source: MedicalNewsToday.com