EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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ONC Should Decertify Products that Block EHR Interoperability | EHRintelligence.com

ONC Should Decertify Products that Block EHR Interoperability | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
Congress attempts to further EHR interoperability by asking the ONC to decertify EHRs that don’t meet data sharing standards.

Congress has instructed the ONC to “take steps” to decertify EHR products that actively block the sharing of information or the interoperability of health IT systems in the 2015 omnibus appropriations bill.  The $1.1 trillion spending bill, which has a number of health IT implications, asks the Office of the National Coordinator to ensure the integrity and value of the Certified EHR Technology (CEHRT) program to healthcare providers and to the taxpayers whose dollars are invested in the EHR Incentive Programs.

The language in the bill firmly directs the ONC to meet Congressional expectations about the future of interoperability in the healthcare industry.

“The Office of the National Coordinator for Information Technology (ONC) is urged to use its certification program judiciously in order to ensure certified electronic health record technology provides value to eligible hospitals, eligible providers and taxpayers,” Congress says.

“ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange. ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in CEHRT, and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use.”

This is not the first time that questions have arisen about the seeming laxity of some provisions of the EHR certification requirements.  Earlier this summer, the Health IT Now Coalition posed the same query to the ONC: if federal and industry roadmaps focus so sharply on the need for widely-adopted data standards, health information exchange, and the fluid transfer of data across the healthcare continuum, why are providers still being encouraged to purchase EHR software that doesn’t allow them to achieve these goals?

“Taxpayers have paid $24 billion over three years to subsidize systems that block health information in a program Congress created to share health information,” said Joel White, Executive Director of Health IT Now, at the time.  “We call on HHS and Congress to use their authority to investigate business practices that inhibit or prohibit data sharing in federal incentive programs. We also call on HHS to work to decertify systems that require additional modules, expenses, and customization to share data.”

While the omnibus bill may have done little to satisfy critics on either side of the aisle, the Congressional injunction to speed interoperability by withdrawing certifications from EHRs based on closed, proprietary technologies may go a long way towards cheering up health IT pundits over the holiday season – even if it brings no small amount of anxiety to the healthcare providers who have already invested heavily in EHR technology that may come on the certification chopping block.

If a number of products are decertified, will the ONC provide any type of compensation for healthcare organizations that will be required to purchase new technologies in order to continue to meet meaningful use criteria?  Will those organizations be eligible for extensions or exemptions as they try to adopt new software and reengineer their processes accordingly?  How will significant changes to the certification process affect the timelines for Stage 3 of the EHR Incentive Programs?

Congress has asked the ONC to produce a report on the interoperability landscape, the challenges to industry-wide data exchange, and its plans to retool the certification process, in which some of those answers may be revealed.  “The report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee,” the omnibus says, and must be delivered no later than 12 months from now.



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Effects of Interoperability on Health Data Privacy Policies | EHRintelligence.com

Effects of Interoperability on Health Data Privacy Policies | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

Interoperability enables healthcare providers to make the most well-informed decisions for individual patients, but it introduces the potential for sensitive patient health data to become compromised if the technologies exchanging information or the pipeline between these systems are unsecured.

“In terms of what I think some of those challenges are, it’s no big secret; we’re working on interoperability,” Lucia Savage, the new Chief Privacy Officer for the Office of the National Coordinator for Health Information Technology, recently told HealthITSecurity.com.

“Of course there are the topics that have been well-discussed in the press, like data lock and all that stuff that have to with people’s proprietary systems,” she continued. “But what’s really more essential in the privacy and security realm is making sure people understand how are current legal and regulatory environment actually help support interoperability — right now, at this very moment in time.”

New models for care delivery (e.g., accountable care organizations) emphasize the need for interoperable EHR and health IT systems, added Savage. Interoperability, however, is limited to certain geographies and contexts. In short, there is tremendous room for improvement.

“For example, insurance companies contract with large systems to the ACOs. For that to succeed, just like the Medicare ACOs, data has to flow between the two parties,” Savage explained. “That data is flowing right now in some ways, and in some ways it could flow better and could make better use of the delivery system was built with the meaningful use incentive.”

According to the ONC’s Chief Privacy Officer, a lack of health information exchange (HIE) as a result of limited interoperability comes as a surprise to patients who “thought their doctors were doing this already.” And what is essential is that the healthcare organizations and providers, both private and public, make use of new forms of exchanging information while adhering to the privacy and security rules laid out by HIPAA.

“The HIPAA environment we have is perfectly designed for that. It’s media-neutral, meaning 20 years ago when faxes were new, that’s how the information started to move. Now the information is moving through other media but the rule hasn’t changed. We’re going to capitalize on that,” she maintained.

The next step involves the building of trust among providers and patients, which will come with time and use:

When we introduce a pretty significant technological innovation it takes optimally to breed trust. If through interoperability it facilitates physicians engaging their patients through electronic health record systems and the portal, and giving patients access, giving dialogue with patients about their data that they collect and share about themselves, then patients confidence in the system will grow because they’re using it too.

For the ONC, the path forward requires the federal agency to gather information and listen carefully to the insights of subject-matter experts so that the “potential benefits and the possible risks” of a fully interoperable, HIE-enabled healthcare environment are understood and incorporated into emerging and evolving regulation and oversight.

“Most of the people in the know understand well how HIPAA works for these big data analytics, but there’s new sources of data, whether its wearables or patient generated data or the way people want to take a healthcare transactional data and add data from public records systems to it for analytics purposes,” Savage said.

Not only is interoperability a challenge from the technology side of healthcare, but it also presents new challenges to health IT security and privacy.



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