Stakeholders to Senate Leaders: Action Needed on Patient Data Matching, Data Fluidity
Key Takeaway: CHIME was one of many healthcare associations to respond to the Senate Finance Committee’s stakeholder letter dated July 12, 2014, concerning digital health data availability and use.
Why It Matters: The letter signed by Chairman Ron Wyden (D-OR) and Senator Chuck Grassley (R-IA) received a wide range of input from industry groups pertaining to increasing health data fluidity and usability. Many of the health IT-focused associations mentioned the need for a national patient matching strategy before the issue of health information exchange can rectified in addition to the need for comprehensive Medicare payment reform.
On July 12, 2014 the Senate Committee on Finance released a stakeholder letter soliciting feedback on four questions concerning digital health data. The four questions were:
- What data sources should be made more broadly available?
- How, in what form, and for what purposes should this data be conveyed?
- What reforms would help reduce the unnecessary fragmentation of healthcare data? What reforms would improve the accessibility and usability of healthcare data for consumers, payers and providers?
- What barriers stand in the way of stakeholders using existing data sources more effectively, and what reforms should be made to overcome these barriers?
CHIME’s comments, submitted on August 12, called on Congress to support the concept of a longitudinal healthcare record as a way to prioritize policy challenges. CHIME’s comments focused on the need to:
- Further develop data standards and robust testing requirements for certified EHR technology and other components of health IT referenced in federal policies, including HIEs;
- Adopt a national patient matching strategy; and
- Harmonize privacy laws to reduce burdens on providers that want to exchange data.
Other health IT stakeholders also weighed in. For example, the Healthcare Information and Management Systems Society (HIMSS) called for a careful balance to be struck between protecting the patient’s privacy, security and safety; the patient’s ability to control their own data; and the ability of the healthcare system to aggregate de-identified data for the greater good. The HIMSS Electronic Health Records Association (EHRA) insisted that a nationwide patient data matching strategy remains one of the most critical unresolved issues preventing health information exchange, citing that patients often have medical records in multiple locations, including hospitals, physician practices, laboratories, pharmacies and other settings across states. The American Medical Association (AMA) called for the targeted release of health data, including details around specific conditions, procedures and issues to enable physicians and patients to better understand quality and performance. The American Hospital Association (AHA) requested additional data be made available concerning inpatient hospital discharges, Medicare Advantage enrollees, Medicare Part B carriers and Medicare Part D prescription drugs.
It is expected that Senate leaders will use stakeholder feedback to determine and prioritize future legislation, although nothing specific is expected before the end of the current session of Congress.
Implementation Workgroup to Recommend Constrained C-CDA
Key Takeaway: According to the Implementation Workgroup (http://www.healthit.gov/facas/calendar/2014/08/11/standards-implementation-workgroup), the current consolidated-CDA required for Stage 2 certification has too much variation and data does not integrate into EHRs, despite the requirement for physicians to exchange health history for at least 5 percent of patients.
Why It Matters: Members of the Implementation Workgroup are concerned about the usability of data contained within the current release of C-CDAs and worried that providers and hospitals may start to drop out of the Meaningful Use Program if the technical functionality is not improved.
The standards for the Consolidated-Clinical Document Architecture (C-CDA) were created by HL7 and adopted by and the Office for the National Coordinator for Health IT (ONC) for Stage 2. The C-CDA includes things like vitals, orders, prescriptions, lab notes and discharge summaries. Unfortunately, certification for this element was designed around the creation and transport of a C-CDA rather than the reception and integration of the patient data. While this infrastructure was supposed to allow for flexibility to create documents for care coordination, the workgroup believes that physicians cannot digest all the information and health history provided within the document, and patients often cannot interpret the complex information presented.