National Coordinator for Health IT Farzad Mostashari, M.D., has talked in recent months about how the ONC plans to facilitate health information exchange (HIE) standards without necessarily crafting new regulations to mandate data transfer. At the April 3 meeting of the Health IT Policy Committee, officials provided some insight into how federal agencies might accomplish this.
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Last year, the ONC issued a request for information regarding possible regulations for the Nationwide Health Information Exchange. The health industry responded overwhelmingly by saying it is too soon to start regulating information exchange. It's still trying to figure out what works in this area, and new regulations might stifle innovation. Since then, the ONC has taken a lighter approach to regulation while still seeking ways to encourage information exchange.
At the Health IT Policy Committee Meeting, Micky Tripathi, chair of the committee's Information Exchange Workgroup and president and CEO of the Massachusetts eHealth Collaborative, presented a report outlining some possible policy levers that federal agencies could pull to facilitate and encourage information exchange. Possible areas of focus fall into four categories: payment policy, providers ineligible for meaningful use incentives, state-federal policy variations and leveraging existing federal infrastructure.
For payment policy, Tripathi said some efforts are already under way. The Affordable Care Act's penalties for high hospital readmission rates could lead hospitals to work more collaboratively with primary care physicians. Using interoperable networks will be important in these situations.
But the Centers for Medicare and Medicaid Services (CMS) could do more, Tripathi said. One option would be to harmonize more of the requirements between the various advanced payment programs and collaborate with private payers that are working toward payment reform. This could help eliminate variations in documentation requirements.
Creating policies that encourage HIE adoption among providers who are not eligible for meaningful use incentives is another key opportunity, Tripathi said. The stage 2 meaningful use rules push standardization to some degree, but he added that different providers cannot receive incentives under that HITECH Act program. The ineligibility of long-term care facilities, post-acute care providers, pharmacists and commercial laboratories will leave considerable gaps in any kind of interoperable network that comes out of the meaningful use requirements.
To remedy this, Tripathi said, CMS could harmonize the work these providers already have to do for quality reporting or Medicare and Medicaid claims with meaningful use requirements. Asking providers who are ineligible for meaningful use incentives to collect most of the same information and report it in the same formats as those participating in the incentive program could create de facto interoperability.
Federal-state variations in privacy and liability policy continue to make it difficult for IT vendors to offer products that are interoperable across the entire healthcare spectrum, Tripathi said. But some of these state-level variations are in programs that the federal government has some control over, like Medicaid. Additionally, CMS could publish "model language" that state programs could adopt.
Making more federal data public also could spur interoperability, Tripathi said. For example, CMS could make physician attestation and patient immunization databases public. Private companies creating products for accessing this data would necessarily build in a certain level of standardization.
Work continues on stage 3 meaningful use rules
Federal officials have made it clear that the industry won't see any official policy proposals for stage 3 meaningful use this year, but the Health IT Policy Committee continues to whittle away at what the eventual proposal may look like.
In the April meeting, members of the committee's Meaningful Use Workgroup presented a report on their latest ideas. Most notably, workgroup member Christine Bechtel, vice president of the National Partnership for Women and Families, signaled a desire to consolidate into a smaller number of measures many of the meaningful use measures that had been discussed previously.
For example, she talked about how the workgroup had considered measures that would have required physicians to separately record patient preferences for receiving educational materials, appointment reminders and clinical summaries. However, she said it would be much easier to include a provision in the updated EHR certification criteria that would allow doctors to record patient preferences once, then use this for all services. One new certification criteria could eliminate three meaningful use objectives.
Workgroup chair Paul Tang, M.D., vice president and chief innovation and technology officer at Palo Alto Medical Foundation, suggested stage 3 could include an "alternative pathway" to meeting the meaningful use objectives. Since stage 3 will likely focus more on meaningful use of data and less on specific technology adoption, it will be less important to make sure providers follow a protocol for EHR implementation and data capture. Instead, it may be possible for regulators to look at specific outcomes for disease treatment and prevention, as well as performance in the earlier meaningful use stages, and assume the provider is using an EHR system as intended.
The full policy committee will consider these reports and decide whether to pass any further recommendations along to the ONC.