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The country may be headed for a contentious presidential election, but blistering politics are unlikely to affect healthcare CIOs and their top-line health IT initiatives.
Just as they are today, healthcare CIOs will be focused on interoperability and information blocking, pushing forward on regulations passed this year from the federal Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). The president oversees the U.S. Department of Health and Human Services, the regulatory body that ONC and CMS fall under, but the initiatives and even the terms of regulatory compliance will likely go unchanged, according to experts.
"If you can get past some of the politics around insurance reform, you see that it's actually pretty steady year over year in terms of the policies that have been promoted, even from Obama into the Trump administration," said Jeffery Smith, vice president of public policy at the American Medical Informatics Association. "If you look at what CMS holds on high as some of their marquis achievements, it's directly aligned with what was being promoted in the Obama administration, in many ways. At least in the health IT, value-based pay world."
Major federal health IT initiatives may go unchanged, but the Trump administration could start to place additional focus elsewhere as it prepares for the possibility of losing in November.
New and old initiatives
Indeed, CIOs could see new health IT initiatives coming soon, according to Mari Savickis, vice president of public policy for the College of Healthcare Information Management Executives (CHIME), a professional organization for healthcare CIOs and IT leaders.
Mari SavickisVice president of public policy, CHIME
"Because we're facing an election, what's going to happen is this administration is going to start rapid-fire kicking things free," Savickis said. "They're going to get all their stuff out before if a new administration comes in."
Savickis said changes could come to HIPAA, the long-unchanged healthcare privacy and security act, as well as the Anti-Kickback Statute and Stark Law that prohibits providers from referring patients to organizations that would benefit from performing treatments paid for by the federal government.
Aaron Miri, CIO at UT Health Austin and the Dell Medical School, said if regulatory changes to long-standing laws like HIPAA and Stark occur, healthcare CIOs would be affected and will need to be prepared to act on those changes.
For Miri, however, the most critical health IT initiatives are not tightly tied to the election. He said he's keeping an eye on what Congress does around privacy and security, such as enacting a General Data Protection Regulation-like bill for the U.S., and whether the Trusted Exchange and Framework Common Agreement (TEFCA) will move forward. TEFCA, which has not yet been finalized, is a draft of principles for using a common framework to share electronic health information across healthcare networks.
More immediately, he's focused on what CMS does with telehealth reimbursement, a concern CIOs across the nation are facing. Due to the COVID-19 pandemic, CMS increased telehealth reimbursement to support the healthcare community's massive shift to virtual care. Now, as patients start to return to in-person care, CMS is contemplating whether to make those telehealth reimbursement changes permanent.
Miri said both the current Trump administration transition team and former Vice President Joe Biden's transition team have been listening to CIOs' concerns and are largely on the same page when it comes to continuing major health IT initiatives. Miri also serves as a member of the federal Health Information Technology Advisory Committee (HITAC), which was established by the 21st Century Cures Act to recommend policies and standards for advancing electronic access to health data.
Both teams understand that coming in with sweeping changes to any health IT initiatives already moving forward would create additional stress on CIOs and physicians, Miri said. He added that both teams appear to want to avoid such a situation, particularly as healthcare systems continue to deal with the COVID-19 pandemic.
"It's not anything drastically different, like, 'Oh we're going to completely repeal this,'" Miri said. "No, it's like, 'How do we do this in a way that's not disruptive? … Both parties are listening to us, and they're trying their best so we're not overly burdened and our physicians can focus on being physicians."
Existing federal health IT initiatives
For the most part, CHIME's Savickis said federal health IT initiatives have traditionally been a bipartisan issue. The current administration is, for example, executing on the 21st Century Cures Act passed under the Obama administration. That sweeping piece of legislation focuses on healthcare interoperability and patient-centered care, which ONC and CMS have spent the past four years hammering out.
The 21st Century Cures Act laid the groundwork for the next decade of health IT initiatives, particularly the API requirement in the interoperability rule, Savickis said. APIs enable healthcare organizations to share health data with applications of a patient's choosing.
Yet because of COVID-19, the interoperability rule has been put on the back burner since it was added to the Federal Register in May. Regulatory compliance has also been delayed and won't start until February 2021.
Information blocking, which is a significant part of the interoperability rule and involves withholding patient data from being shared, is the first piece of the legislation to which CIOs will have to adhere. But clarity around how information blocking penalties will be enforced is still murky, as the Office of the Inspector General is currently working on the policy, regardless of who is in office.
The election won't affect the overall regulation, but the timing of it should serve as a signpost for healthcare CIOs that the deadline for compliance to the information blocking provisions is rapidly approaching.
"What that means from a hospital's point of view is the clock starts to tick in November," Smith said. "And what that really means is they need to have policies and programs in place that are cognizant of the information blocking rules, and they need to have compliance teams trying to be familiar with the rules and making sure that when and if the penalty piece of the puzzle comes into play … that they're in a good place to handle that."