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How the Supreme Court's Affordable Care Act ruling hits the HIT world

The Supreme Court surprised the nation by upholding the Affordable Care Act. What's next for HIT? The short answer: quality reporting infrastructure.

The U.S. Supreme Court's recent upholding of the Affordable Care Act (ACA) will have some far-ranging health IT implications -- from building an intricate health care quality reporting infrastructure to patient outreach with technology and telemedicine -- according to two members of the legal task force of the Health Information Management Systems Society, or HIMSS, speaking in a recent webinar.

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That impact begins with quality measurement and benchmarking among public and commercial insurers. The thorny data collection and interoperability issues those activities pose will fall into the laps of HIT leaders.

The Supreme Court vote was surprising, considering the "historic" amount of time judges spent listening to arguments and the tenor of their questions, which seemed to imply they might overturn part or all of ACA, said Nandan Kenkeremath, vice president at Marwood Group LLC.

His co-presenter, James Wieland, principal at Ober, Kaler, Grimes & Shriver, quoted chapter and verse from the parts of ACA where he thinks HIT will be most affected. Some of the highlights:

  • Section 2401 provides medical assistance for home and community-based services for qualified individuals. These services not only help patients accomplish daily life activities but also include "backup systems to ensure continuity of care."
  • Section 2703 establishes home medical services for patients with a chronic disease. These services will include -- among many provisions -- care management and use of health IT to combine services.
  • Section 3011 requires the secretary of the U.S. Department of Health and Human Services, or HHS, to create a national strategy to improve health care delivery, which includes integrating quality improvements and measurements for health IT.
  • Section 4103 calls for all Medicare patients to have an annual wellness visit. At these visits, patients will be encouraged to self-manage their medical problems (and will be trained in self-management), as well as to adhere to caregiver recommendations, through the use of HIT and other personal technology.

ACA had many provisions that are related very closely to the ... optimal use of information technology and management systems for the betterment of health care.

James Wieland,
principal, Ober, Kaler, Grimes & Shriver

  • Section 10410 establishes national centers of excellence for the treatment of depression that will use electronic health records, or EHRs, and telemedicine to extend access to treatment and coordinate it beyond their local patient populations.
  • Section 2717 directs the establishment of quality reporting requirements for group and individual health insurers.
  • Section 3013 mandates -- and funds -- the establishment of new quality measures where they don't already exist, and the expansion of existing quality measures. These will measure improvements to populations' health, health plans, health care service providers and others delivering patient care. Also included on that list: Quality measures that assess the meaningful use of health IT.
  • Section 4302 directs the Office of the National Coordinator for Health IT, or ONC, to develop national standards for data collection, as well as interoperability and security for federally managed or funded data management systems. This will be done so that federal health care programs can collect and report on patient demographic data for quality reporting purposes.
  • Section 6301 directs the Office of Communication and Knowledge Transfer to disseminate the proceeds of government-funded research to a number of groups, including clinical decision-support software vendors, in order to get those results incorporated into clinical practice as quickly and efficiently as possible.

Then there's Section 3022, which establishes accountable care organizations (ACOs). These HIT-intensive entities not only collect a lot of data across whole patient populations, but also crunch it in analytics applications and feed it back to providers in the form of clinical decision support. ACOs also are required to coordinate care through the use of telemedicine and other technologies that extend the reach of physicians beyond their office walls, Wieland said.

"It's a wonderful thing that the Supreme Court did not overrule ACA because, behind all the highly publicized elements, ACA had many provisions that are related very closely to the ... optimal use of information technology and management systems for the betterment of health care," Wieland said. "[It's] very significant and very positive for health information technology."

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