healthcare policy – Health Care

healthcare policy


For the past few weeks, Epic’s opposition to the Department of Health and Human Services’ (HHS’) interoperability and information blocking rules has dominated the digital health news cycle and continued to draw ire from the industry.

Rightfully so, much of the focus has been on patients’ rights to their health data—especially given Epic CEO Judy Faulkner’s apparent opposition to making patient data access easier.

But much less attention has been given to solving for provider-to-provider information exchange, despite the enormous challenges and barriers that still exist in that arena. 

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

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With the Trusted Exchange Framework and Common Agreement and information blocking rules, the Office of the National Coordinator for Health IT (ONC) has an undoubtedly admirable goal: Create a “single onramp” for nationwide health information exchange and interoperability using a variety of policy levers. 

What’s missing from the policy levers, however, is an understanding of the role and nature of networks, also called multisided platforms (MSPs), or what most in healthcare will recognize more generally as health information exchanges. Specifically, how networks create value, how they compete and what they need to make various interoperability use cases a reality. 

ELATED: Epic’s Judy Faulkner: ONC data blocking rule undermines privacy, intellectual property protections

Also missing from consideration? The underlying issue that, with these policies, the ONC is attempting to regulate a market into existence—and with this approach comes a ripple of negative effects standing to undermine the very result the ONC is trying to achieve. 

MSPs: Policy design versus time to develop

While they may be dominant in their respective markets today, Amazon, Uber and Lyft and Airbnb—all examples of networks/MSPs—were certainly not overnight success stories. Each network took time to grow, amass users and evolve into the well-oiled versions we know today. 

Similarly, to build a successful network for health information exchange, any policies or implementation frameworks must provide enough time and flexibility for the networks to develop and scale. Unfortunately, this is not the case in the latest ONC guidance, which has the first group of Qualified Health Information Networks up and operating by August 2020.

This accelerated timeline does not provide nearly enough of an on-ramp for proper network setup and development, let alone growth and optimization. And this isn’t the first time the industry has seen this play.

For instance, while e-prescribing between doctors and pharmacies may now be routine (85% of all prescriptions were e-prescribed in 2018), remember that Surescripts—the health information network responsible for routing the majority of the country’s e-prescriptions—started on its interoperability journey nearly 20 years ago and took about a decade to scale. 

Policy design versus market demands

On top of a lacking understanding of MSP development and optimization, perhaps the biggest issue with the federal guidance is that ONC is attempting to regulate a market into existence.

This is a problem because, outside of the growing patient desire (PDF) for health data access and utility, there hasn’t been sufficient industry demand for this level of information exchange, as evidenced by a lack of willingness to pay. 

Case in point: Almost a decade after the U.S. government invested more than $35 billion in the creation of the meaningful use program to spur electronic health record (EHR) adoption, a seamless exchange of health information between providers is a rarity, despite the fact that the majority of providers today use an EHR.  

Moreover, under ONC’s information blocking rule, health systems, EHRs and health information networks would be required to “open up” their APIs to improve the exchange of health data. The problem with this is networks compete on a variety of measures, including price, business model, quality, governance and how they uniquely facilitate the exchanges between users.

By attempting to commoditize and regulate the means and methods of health information exchange (e.g., through fees), the ONC is establishing a network value “ceiling” and thus effectively short-circuiting the way networks compete and develop.

Lastly, by removing an economic upside for MSP developers/operators, rather than having the “best network win” in the market, the industry may be left with: 1. a handful of “zombie” networks (unable to invest in improving the quality and value of exchange), or 2. a monopoly or duopoly situation, as smaller regional health information networks find themselves unable to compete with larger, national networks.

More time, fewer constraints: Interoperability depends on proper MSP development

Creating a single on-ramp for nationwide health information exchange is a commendable goal, worthy of industry action and investment in a solution. 

But taking a rushed, “one-size-fits-all” approach to MSP development—one that stands to undermine the very goal the policies were designed to achieve—is not the right way to do it.  

Will MSPs be the prescription nationwide interoperability needs to succeed? Only time will tell.

Seth Joseph is managing director of Summit Health, a recognized expert in digital health technology and author of several articles on the space. He has spent more than a decade helping companies successfully bring novel digital technology to healthcare markets. Previous to founding Summit Health, Seth led corporate strategy at Surescripts. Prior to Surescripts, Seth led eHealth strategy for Caremark, part of CVS Health. 

Federal regulators have listened to physicians’ complaints about health IT burdens and they have some solutions.

The Department of Health and Human Services (HHS) released Friday a final version of an overarching strategy to reduce clinician burden revolving around entering information into the electronic health records (EHRs), meeting regulatory requirements and improving EHR ease of use.

The new report (PDF), which includes 43 recommendations around clinical documentation and health IT usability, is a follow-up to a draft strategy released in November 2018.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

The overall goal is to improve patient care by enabling physicians to spend more time focused on them instead of their keyboards, HHS officials said.

“Physicians and other healthcare providers have long identified regulatory and administrative burdens as a key contributor to the many challenges they face. They also note these burdens weigh down the overall healthcare delivery system as well. Clinicians have pointed to an ever-increasing and poorly coordinated set of requirements they must meet to deliver and receive payment for patient care,” senior officials with the Office of the National Coordinator for Health IT (ONC) wrote in a blog post Friday.

The clinical community frequently links the increased burden of meeting these requirements with the tasks and use of health IT, such as EHRs, Andrew Gettinger, chief clinical officer for ONC, and Thomas Mason, ONC’s chief medical officer, wrote.

The report targets burdens tied to regulatory and administrative requirements that the federal government can directly impact through the rule-making process.

When looking at the steps HHS could take to mitigate EHR-related burden for healthcare providers, ONC and the Centers for Medicare & Medicaid Services (CMS) focused on strategies that are achievable within the near to medium term, roughly a three- to five-year window, according to the report.

And HHS is looking at strategies it can implement through existing or easily expanded authority.

EHR burdens have been a near-constant complaint from physicians that see the technology as an impediment to their relationship with patients. Numerous studies have documented the time suck of the technology.

The finalized strategy, required under the 21st Century Cures Act, reflects feedback from industry stakeholders and healthcare groups, including 200 comments submitted to the draft strategy, HHS said.

In several recommendations, the agency vowed to continue its work stripping down regulations and working with the industry to find solutions to growing problems. 

CMS already has taken some steps to reduce administrative burden such as changes to the more-than-two-decades-old E/M documentation and coding framework that clinicians use to bill Medicare for common office visits. 

HHS also wants to see health IT vendors doing more to improve technology usability. EHR vendors need to work with clinicians when designing systems or new features and should consult with experts in user-centered design during development, HHS officials said.

Specifically, EHR vendors should take the lead in developing health IT-specific user interface best practices and should collaborate to develop a shared repository of EHR usability practices.

This collaboration would help provide better consistency with user interface best practices while still enabling EHRs to compete with each other, HHS said in the report.

HHS also wants an EHR vendor’s user-centered design process to be highlighted on the ONC Certified Health IT Product List so potential EHR customers can see the efforts that went into the products they are considering acquiring.

“A shift from check-box interface elements to intelligent features that extract needed data from routine clinical workflows would provide a substantial reduction in usability-related clinician burdens,” HHS officials wrote in the report.

HHS’ recommendations represent the “best next steps” to address the growing problem of clinician burden related to their use of health IT and EHRs, ONC chief Donald Rucker, M.D., said in the report.

As part of its ongoing strategy, ONC plans to work to enable further automation in healthcare, with a focus on prior authorization and quality reporting.

“Through this HHS strategy, we look forward to advancing the premise of how to accurately model and support the clinical cognitive process in the EHR—a shift away from a strictly linear, logic-based model to a more sophisticated design that supports the complex pattern recognition inherent in the diagnostic and treatment process,” Rucker said in the report.

“We envision a time when clinicians will use the medical record not as an encounter-based document to support billing, but rather as a tool to fulfill its original intention: supporting the best possible care for the patient.”