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Washington Debrief: Carolyn Clancy Leaving AHRQ, Exploring the Barriers to HIE

February 5, 2013
by Jeff Smith, Assistant Director of Advocacy at CHIME
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Jeff Smith, Assistant Director of Advocacy at CHIME

AHRQ to Focus on Workflow, Health IT Challenges The Agency for Healthcare Research and Quality (AHRQ) is looking to pull back the curtain on health IT and ambulatory workflow challenges.  In a notice published in the Federal Register this week, ARHQ said it intended to conduct interviews and focus groups with six small and medium-sized ambulatory care practices that are implementing patient-centered medical homes (PCMHs) to characterize the relationship between health IT implementation and health care workflow.

AHRQ said the practices “will be in the process of implementing a new health IT system during the course of the study, but some may have an existing, baseline system such as an electronic health record system.”  The specific goals of this study are to identify the relationship between health IT implementation and ambulatory care workflow; the behavioral and organizational factors and the role they play in mitigating or augmenting the impact of health IT on workflow; and how the impacts of health IT are magnified through disruptive events such as interruptions and exceptions.

In a related note, AHRQ Director Carolyn Clancy announced that she will be leaving the Agency after ten years on the job.  HHS Secretary Kathleen Sebelius said she will continue to serve in this role for the next few months while a search is underway for a new Director.

Barriers to Health Information Exchange Discussed During Day-Long Hearing in Washington Several healthcare IT practitioners, academics and policymakers met in Washington this week during a joint meeting of the Health IT Policy Committee and Health IT Standards Committee.  The hearing was meant to give the federal advisory committees and federal government officials a sense of what policy levers could be used to help facilitate exchange; and whether regulation, guidance or the bully pulpit was needed to overcome barriers.  The hearing began with a presentation by Micky Tripathi, Chair of the Information Exchange Workgroup and President and CEO of the Massachusetts eHealth Collaborative, where he summarized the current state of HIE and spoke about “HIE version 1.0” and “hie 2.0.”  HIE 1.0 is characterized by a focus on “the noun,” that is trying to address perceived market failures by solving a wide variety of rich use cases through comprehensive interoperability.  By contrast, HIE 2.0 focuses on the verb that is trying to meet market needs most pressing to participating providers; HIE 2.0 has fewer legal challenges because it is trying to tackle less complex use cases and in many instances has the ability to marshal financial, technical and organizational resources. Tripathi also pointed out that HIE 2.0 comes in many shapes and sizes including point-to-patient; point-to-point; vendor-specific; transaction-specific national level; enterprise-level HIE organizations; State-level and regional collaborative HIE organizations and National level collaborative HIE organizations. 

After getting a sense of the changing landscape for health information exchange, the hearing shifted to understand current barriers to exchange.  Sharp Healthcare CIO and member of CHIME’s Policy Steering Committee Bill Spooner spoke with others on this subject, noting that some barriers to HIE relate to incomplete and unspecific interoperability standards and the cost of interfacing the EHR with the HIE.  “The lack of mature, agreed standards around interfaces, patient consent and patient identification are significant barriers to success,” he said in his testimony.  But Spooner also sounded a note of optimism, saying that payment reform initiatives, like ACOs, PCMHs and population health management will push interoperability.  “The health reform carrot may well be more effective than the regulatory stick in furthering HIE adoption,” Spooner concluded.

Former CMS Administrators Signal Dangers Stemming from Sequestration If sequestration is allowed to come to fruition in March, CMS stands to take major budgetary hits.  Programs spanning health insurance exchanges to accountable care organizations and patient-centered medical homes will be put in jeopardy, according to two former CMS administrators.  Mark McClellan, administrator under President George W. Bush, noted that the sequestration cuts could be devastating for the agency’s administrative budget, which is responsible for a growing number of tasks.  The CMS administrative staff “is already stretched,” he said, with the implementation of the Affordable Care Act.  Bruce Vladeck, who served under President Clinton, also spoke during a press briefing in Washington this week.  He agreed that investments needed to ensure real-time data is given to providers working on ACOs, PCMHs and other similar projects could be squeezed if the potential 8 percent reduction called for under sequestration goes into effect.  There is the added problem that many state governments are opting to run federally-facilitated health information exchanges, rather than run the new marketplaces themselves.  Standing up the technical infrastructure, as well as developing the educational programs to get people enrolled will require a tremendous amount of work, the two noted.