March was the first time since 2009 that the issue of HIPAA protected health information (PHI) and interoperability have been discussed by the Senate HELP Committee. There was a general consensus among the doctors, scientists, and businesspeople who spoke before the committee that this topic was incredibly important and urgent.
A primary point of focus was the “meaningful use” regulations of the US Department of Health and Human Services.
Meaningful use, in a nutshell
What is meaningful use? According to the HHS Department, it is the use of electronic health record systems to:
- Provide better healthcare, safer environments, streamlined operations, and stronger consistency between various health records.
- Get patients and their loved ones more involved.
- Enhance the interaction between various elements of the healthcare industry to deliver treatments more seamlessly and achieve better health throughout our society.
- Safeguard PHI at all times.
Healthcare providers that want to be eligible for the tax incentive must meet the requirements of the code, as organized within three stages: information collection and sharing (2011-2012); application of technology to improvement of clinical methods (2014); and demonstration of better patient outcomes (2016).
Interoperability incentives have been insufficient
Medicare and Medicaid have disbursed more than $29 billion in funds to healthcare practices that have confirmed their adherence to its meaningful use program, explains McCann, but the laws have been difficult for doctors who may have little extra time or funds to properly address them.
“The evidence suggests these goals haven’t been reached,” commented Tennessee Republican Sen. Lamar Alexander, who chairs the Senate body.
On the other hand, half of doctor’s offices were using digital records in 2013, a huge increase from the 11% that had implemented them in 2006.
Dr. Robert Wergin, who currently heads the American Academy of Family Physicians, explained that even though most independent doctors have wanted to transition to electronic format and been cooperative, it hasn’t been easy for them to meet the parameters of the second stage of meaningful use. Disappointingly to those who want to further the cause of interoperability, a recent poll of almost 2000 doctors determined that only 45% would be participating in the second stage.
Wergin explained that the resources needed in order to meet its conditions did not make financial sense to the physicians.
Interoperability is a necessity
Many physicians have medical record technology in place, but there isn’t any interaction between machines.
Wergin argued that lawmakers “must step up efforts to require interoperability.”
Specifically, he said that the government should make secure and consistent digitization of patient files mandatory but not reduce payments for meaningful use stipulations until systems have become interoperable. As it is, providers ignoring the second stage will receive 1% less from Medicare, a drop that will gradually step up to 5%.
University of Michigan public health professor Julia Adler-Milstein disagreed with Wergin. She testified that scaling back the penalties would ultimately slow down the transition. Rather than reducing penalties, she believes that it would help to have additional incentives to get healthcare companies to take action.
Health record business associates often problematic
Repeatedly, those giving testimony said that HIPAA business associates, such as cloud computing providers, aren’t prompted by the government to want to intermingle their information with that of other companies to facilitate interoperability.
The technology companies are islands of data, remarked Wergin, so they often stand in the way of efforts to become more interoperable. Wergin said that many software companies think that the data created through their systems should rightfully stay with them, leading to proprietary lock-in, a huge threat to interoperability.
Hospitals often don’t want to exchange their files either, reported Adler-Milstein, because it just doesn’t make sense from an organizational perspective. However, incentivizing covered entities could make a huge difference.
Some price tags unacceptable
Peter DeVault, who specializes in interoperability at Epic, said he was irritated by the cost and contractual requirements of CommonWell. From his perspective, “the only reasons to have [an] NDA are if they’re going to tell you something that otherwise they wouldn’t want people to know.”
Epic’s interoperability program now includes 100,000 doctors, versus the five companies and 1000 doctors on CommonWell Health Alliance, according to DeVault.
Louisiana Republican Sen. Bill Cassidy said that since affordability was a key consideration, Epic was front and center since it now controls half of the market.
He even asked for specific pricing information.
Getting interoperable with ClearDATA
Obviously interoperability is on the minds of stakeholders in the healthcare industry. When you consider the issue, you should know that we have the only healthcare-exclusive cloud in the world.
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