The good people in Congress recently asked ONC: When it comes to the nationwide roll-out of a connected health IT system, are we getting our 28 billion dollars’ worth?
Since one of the advantages of health IT is the potential for creating interoperable systems and the means of delivering data to patients, providers and payors when and where they need it, in order to provide better, more cost-effective care, it seems like a fair question. The more pointed question from the Hill was: How many actors in the health data ecosystem are blocking data, and what should we do about it?
ONC’s report on health information blocking broke down the root causes behind the lack of clear and easy communication into two buckets.
The first is the collection of generally non-malevolent lack of coordination of technical or practical standards that are “beyond the control of any individual actor” and represent what ONC called “systemic barriers to interoperability that the HITECH Act and other reforms directly seek to address.” Per ONC, the Ten Year Plan (aka the interoperability roadmap) describes what needs to happen to set these things straight. (If I were on the receiving end of this report, I might ask, Aren’t we already six years and $28 billion into this? Why don’t we have results yet?)
The second includes information blocking, “where persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information.” Some choice examples of information blocking (well, categories, really, no naming names in this report), when undertaken knowingly and without reasonable justification:
- Contract terms, policies, or other business or organizational practices that restrict individuals’ access to their electronic health information or restrict the exchange or use of that information for treatment and other permitted purposes.
- Charging prices or fees (such as for data exchange, portability, and interfaces) that make exchanging and using electronic health information cost prohibitive.
- Developing or implementing health IT in non-standard ways that are likely to substantially increase the costs, complexity, or burden of sharing electronic health information, especially when relevant interoperability standards have been adopted by the Secretary.
- Developing or implementing health IT in ways that are likely to “lock in” users or electronic health information; lead to fraud, waste, or abuse;or impede innovations and advancements in health information exchange and health IT-enabled care delivery.
How will ONC deal with this issue? Well, six years in, the report calls for addressing gaps in current knowledge, programs and authorities. Specifically:
- Limited evidence and knowledge of information blocking.
- Limitations of certification for addressing information blocking by developers.
- Limitations of program oversight for addressing information blocking by providers.
- Inadequate legal protections and enforcement mechanisms for information blocking.
- Lack of transparency and information about health IT products and services.
- Need for an effective governance mechanism for nationwide health information interoperability.
Addressing these gaps would be a noble, laudable undertaking. A day late and a dollar short, as they say, but noble nonetheless. Meanwhile, the ultimate goal of the entire program, interoperability, in service of the Triple Aim, remains at risk.
If I were Congress, I might be thinking about asking for my money back.
David Harlow
The Harlow Group LLC
Health Care Law and Consulting
Photo credit: Flickr CC Holly Victoria Norval
Congress may (ask for their money back), but there won’t be any refunds – and I don’t think they were naive or stupid in understanding this risk long before asking ONC for “evidence” (which ONC also avoided giving them).
Congress could have easily mandated interop as a function of MU1. They can just as easily assess penalties for failure to interop. The question is – will they. Given the history (and lobbying) I think this dance is endless.
Well, Congress can’t easily do much of anything these days…. I agree that the dance is potentially endless, though. For me, the question is whether taking it to the next level (i.e., lower-case meaningful use of health IT) will be a public sector or private sector initiative. All indications seem to be pointing to the private sector. The most productive thing for Congress to do at this point might be to butt out and move along. The enormous cash infusion under the Recovery Act was perhaps not directed with as much precision as one might have hoped, but the fact of the matter is that many more providers are wired (or wireless) than were before. The legal infrastructure for requiring folks to share information appropriately with patients is already present, and sharing with other providers (as well as with patients) now becomes driven more by market forces.
Actually, having used e-medical records for 11 years now, silo of data was prevalent and intentional. It’s taken $28 billion to highlight it as a PROBLEM, not just “what happens.” Interoperability also has to be pushed by those of us in the trenches, the foot soldiers of HIT, and I run into very many who are older and don’t trust computers — they trust paper where they can see it. The other side of the spectrum is young invincibles who believe ONLY technology is worthwhile.
In short, a cohesive journey forward needs to blend these two groups, so that older can hand off to younger. Otherwise, the eggs (patients) being juggled smash on the ground — we saw that with Ebola in Texas. I’m surprised it doesn’t happen more often.