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D.C. Report: CHIME Asks ONC to Rethink NwHIN

July 5, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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CHIME Urges ONC to Rethink Nationwide Exchange Governance Plans CHIME submitted commentsthis week to the Office of the National Coordinator for Health IT, responding to the agency’s vision for nationwide health information exchange.  ONC officials in May released a Request for Information (RFI) that sought feedback on how to establish a governance mechanism for the nationwide health information network (NwHIN).  The RFI asked over sixty questions, across a range of issues, on the creation of a voluntary program under which entities that facilitate electronic health information exchange could be validated with respect to their conformance to certain ONC-established “conditions for trusted exchange,” or CTEs.  Although CHIME acknowledged the complexity of establishing a nationwide governance model, the organization said it had several outstanding concerns that need to be addressed before moving forward with the regulatory process.  In over-arching comments, submitted with responses to most of the 66 individual questions, CHIME said, “NwHIN governance is being unduly rushed,” and that ONC should “consider other mechanisms for facilitating a dialogue regarding these matters, such as a ‘Town Hall’ meeting.”  CHIME also urged ONC to “devote more time and resources to identifying and publicizing best practices among existing health information exchanges (HIEs),” and that interoperability, patient data-matching, the lack of consistent patient consent practices at the national level and HIE sustainability represent greater challenges than “trust,” as the RFI suggests.  CHIME concluded its over-arching commentsby saying, “As a matter of policy, it may make more sense to undertake pilot projects to fully assess the impact of various approaches, or take advantage of HIE experience to date in various parts of the country to determine what is most effective and efficient, rather than attempt to roll out a large number of national “rules of the road.”

In Surprise Move, Supreme Court Upholds ACA For the next few months leading up to the election, publications, politicians and the general public will be debating what the affects of the Supreme Court ruling on Affordable Care Act will be on the US healthcare system and the economy.  While many of the bill’s writers attempted to make sure the individual mandate in the ACA was not considered a tax, the Supreme Court ruled that the mandate was constitutional as a tax in a surprise 5-4 vote where Chief Justice Roberts provided the swing vote.  “The breadth of Congress’s power to tax is greater than its power to regulate commerce,” the majority said.

 “Yesterday’s decision bolsters HITECH and the over $19 billion available to the nation’s doctors and hospitals for adoption and use of EHRs.  By upholding the ACA, the Supreme Court’s decision will, without question, help strengthen these and future investments in health IT,” CHIME senior director of advocacy Sharon Canner said.  “CHIME members have long been at the forefront of healthcare innovation.  And they will continue to lead, build, and transform the nation’s healthcare system through the use of information technology.”

Many aspects of health IT remain unaffected by the ACA ruling because they fall under the HITECH Act from the American Recovery and Reinvestment Act passed in 2009.  However, delivery reform and payment reforms such as Accountable Care Organizations (ACOs), Bundled Payments and Patient Centered Medical Homes (PCMHs) established under ACA are the future of healthcare.  The ACA enables the Centers for Medicare and Medicaid Services to serve as a platform to scale such innovations to hundreds of millions of beneficiaries, and the lessons learned through hundreds of demonstration projects will help the nation achieve the kinds of healthcare transformation needed to achieve better outcomes, better population health and lower costs.

OCR Releases Official HIPAA Audit Protocols This week, the HHS Office for Civil Rights (OCR) released its official protocolused to conduct HIPAA Privacy & Security audits required by the HITECH Act.

The audit protocol covers Privacy Rule requirements for:

(1)  Notice of privacy practices for PHI,

(2)  Rights to request privacy protection for PHI,

(3)  Access of individuals to PHI,

(4)  Administrative requirements,

(5)  Uses and disclosures of PHI,

(6)  Amendment of PHI, and

(7)  Accounting of disclosures.

The protocol also covers Security Rule requirements for administrative, physical, and technical safeguardsas well as requirements for the Breach Notification Rule.  Although OCR has made headway in this effort, the health IT policy world is still awaiting a final omnibus HIPAA rule governing the privacy, security, breach notification and enforcement rules, and the Genetic Information Non-Discrimination Act.  According to ONC’s Farzad Mostashari, the multi-part HIPAA update should be out by the end of summer.