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ONC Releases 2018 HITECH Report

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ONC Releases 2018 HITECH Report

In early January the Office of the National Coordinator for Health Information Technology (ONC) issued its annual report to Congress for 2018 on the adoption of electronic health r ...

In early January the Office of the National Coordinator for Health Information Technology (ONC) issued its annual report to Congress for 2018 on the adoption of electronic health records (EHR) and interoperability. This report is required under the HITECH Act and is further informed by requirements of the later 21st Century Cures Act.

There was actually very little to comment about in this report, and it felt more like ONC was “going through the motions.” There were a few (actually, very few) updated statistics about technology use, a short discussion about the importance of open Application Programming Interfaces (APIs), and a useful but not terribly new list of initiatives and reports issued by ONC over the past year or two. I spotted one or two things in there that I had not recalled seeing before but nothing terribly important.

One thing that I think is notable was a short discussion about barriers to interoperability that we have heard before. The report identifies three types: technical barriers, financial barriers, and trust barriers. Within trust barriers the report mentions legal incentives to keep data from moving (I guess that would have better been phrased as legal disincentives to sharing), but this misses the point: It is the patchwork of inconsistent and incompatible State and local laws and regulations – not intentional information blocking – that presents a bigger challenge and barrier. These can be laws prohibiting movement of certain health data across state lines, incompatible consent requirements, or restrictions on “downstream” use of data that is shared. Until these legal barriers are addressed separate from trust issues interoperability will be hampered.

HHS Releases Landmark Report: Reforming America’s Healthcare System

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HHS Releases Landmark Report: Reforming America’s Healthcare System

On December 3, 2018, the Department of Health and Human Services (HHS) released an extensive, 120-page report on the administration’s proposals to reform the healthcare system. The ...

On December 3, 2018, the Department of Health and Human Services (HHS) released an extensive, 120-page report on the administration’s proposals to reform the healthcare system. The report, titled Reforming America’s Healthcare System Through Choice and Competition, is divided into four major sections. The report  that government policy of the last few years has suppressed competition, increased prices for healthcare, and limited choices for consumers. Though rich in detail as it tries to prove each of these points, the more than fifty recommendations are often broad and aspirational rather than practical.

Since I am not a health economist, I will leave the market issues to others to discuss (many of the ideas in this report have been vetted and discussed by others previously). But there are two sections of the report which make direct mention of Health IT.

CDC Issues National Test Collaborative RFI

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CDC Issues National Test Collaborative RFI

In October the Centers for Disease Control and Prevention (CDC) issued a Request for Information (RFI) for a Natural Test Collaborative (NTC). Through a series of questions, th ...

In October the Centers for Disease Control and Prevention (CDC) issued a Request for Information (RFI) for a Natural Test Collaborative (NTC). Through a series of questions, the RFI seeks opinions and information about “The development of a national testbed (notionally called the National Test Collaborative (NTC)) for real-world testing of health information technology (IT)” and “Approaches for creating a sustainable infrastructure” to achieve it. The scope of the questions is somewhat confusing and quite broad, starting with Clinical Decision Support (CDS) and electronic Clinical Quality Measures (eCQMs) but quickly expanding to Electronic Health Records (EHR) and interoperability (not precisely defined).

ONC EHR Reporting Program RFI: A Public Health Perspective

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ONC EHR Reporting Program RFI: A Public Health Perspective

On August 24, 2018, the Office of the National Coordinator for Health Information Technology (ONC) released a Request for Information (RFI) related to the EHR Reporting Program. Th ...

On August 24, 2018, the Office of the National Coordinator for Health Information Technology (ONC) released a Request for Information (RFI) related to the EHR Reporting Program. This RFI is required by the 21st Century Cures Act and its primary purpose is to gather ideas and suggestions related to how ONC might provide better information about Certified EHR Technology (CEHRT).

Apparently, the initial intention was to create a “star rating” like the type used in Consumer Reports to use to rate EHRs, but that seems to have been abandoned in favor of some kind of measurement system. But it is far from clear exactly how this would be done. There may be something to learn from the Immunization Information System (IIS) community: with guidance from the CDC, the American Immunization Registry Association (AIRA) initiated a process to help assess compliance of IIS with national functional standards through a formal measurement and improvement initiative. “Validation,” rather than “certification” or “compliance,” is the carefully-chosen term to signify a system meeting the designated measures through formal testing. The process is interactive, and the results are only made public with the agreement of the IIS program. Perhaps some of the concepts and processes in this initiative can be useful for the EHR Reporting Program.

Frankly, there is not much of interest in here for public health, which is not in the business of worrying about CEHRT. Of course, the quality and functionality of EHR products does impact their effectiveness in supporting interoperability with public health registries. To that end, the RFI does as some questions towards the end (p. 42918) about additional information that might be useful for prospective purchasers of CEHRT, including “Submitting, editing, and retrieving data from registries, such as clinician-led clinical data registries.”

ONC asks for how they might prioritize including information related to this in EHR Reporting as well as data sources for reporting about this. It may be useful for public health to weigh in on these questions; comments are due no later than 5 p.m. on October 17, 2018 at the Federal eRulemaking Portal.

CMS MIPS PI NPRM: A Public Health Perspective

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CMS MIPS PI NPRM: A Public Health Perspective

See my HIMSS blog and our formal comments on this NPRM! Well, here we go again. The Centers for Medicare and Medicaid Services (CMS) has now released a new Notice o ...

See my HIMSS blog and our formal comments on this NPRM!

Well, here we go again.

The Centers for Medicare and Medicaid Services (CMS) has now released a new Notice of Proposed Rulemaking (NPRM), titled Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability ProgramThe purpose of this NPRM is to address proposed changes for Year 3 of MIPS, the provider (as opposed to hospital) side of the Quality Payment Program. The part that is most relevant to public health is the Medicaid Promoting Interoperability (PI) Program for Eligible Professionals (EP)” (the EHR Incentive Programs have been renamed). A major goal of this NPRM is to synchronize as much as possible the EP program with the hospital-based program that was addressed in a previous NPRM  just a few months ago.