A decidedly mixed picture of the evolving federal healthcare IT policy landscape emerged during a panel discussion on Thursday morning at the Health IT Summit in Boston, being held at the Revere Hotel in downtown Boston, and sponsored by Healthcare Informatics. A wide-ranging discussion looked at what is known, what is not known, what is probable, and what is improbable, going forward, in the policy arena, and how it might affect healthcare IT leaders’ planning for the near future.
The panel, entitled “Policy Update: What the 21st Century Cures Act and Other Key Policy Changes Mean for Your Organization,” was moderated by John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center in Boston. He was joined by Dan Tsai, assistant secretary of health in the Executive Office of Health and Human Services for the Commonwealth of Massachusetts (also Boston), Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative (also Boston), Jeff Couglin, senior director, federal and state affairs, at the Chicago-based HIMSS (Healthcare Information and Management Systems Society), Dave Levin, M.D., the chief medical officer at the Minneapolis-based Sansoro Health, and the former CMIO at the Cleveland Clinic integrated health system, and David Szabo, co-chair in the Healthcare Practice Group at Locke Lord LLP, a Boston-based law firm.
“Let’s start off with 21st-Century Cures Act,” Dr. Halamka said, opening the panel discussion. What is it we’ll have to do over the next couple of years? 21st-Century Cures has some controversial elements to it—information-blocking is prohibited, and APIs must be open. Should we be scared?”
“It’s mostly a life sciences/biotechnology bill,” HIMSS’ Coughlin noted, “but it gives you an indication that Congress wants us to move forward on interoperability and information-blocking. And in terms of information-blocking, the question from Congress is, we put a lot of money into HIT, with the HITECH Act [the Health Information Technology for Economic and Clinical Health Act of 2009], and how is that money being spent? They want to understand, why can’t EHRs [electronic health records] talk to each other? And why is the data you’re supposed to share not being shared, etc.? And if you just say, “Well, Congressman, it’s complicated,” that’s not going to be very satisfying. So the ban on information-blocking, and increased access for patients to their own information—if they ask you to be able to transfer a patient’s data tomorrow from one provider to another, and you say, “Well, it will take 90 days,” that won’t work, either. So Congress is looking at interoperability now; it’s no longer just a feature, it’s an obligation. It’s not just a good thing to do now; it’s an obligation. It’s the law.
Referencing a brief comment he had made earlier, Halamka said, “Let me qualify what I meant when I said information-blocking doesn’t exist. What I haven’t seen is volitional blocking of information where the technological capability exists.”
“What I have seen is agreements saying, we will share data with you, but limiting it,” Coughlin said. “I think it will be problematic to restrict data-sharing.”
Panelists (l. to r.): Szabo, Levin, Coughlin, Tripathi,
Tsai, and Halamka, at the Health IT Summit in Boston
Locke Lord’s Szabo noted that “We’re in the process of waiting for rules to come from the National Coordinator” that will establish a concrete definition of data-blocking to help guide healthcare providers forward. “The actual language is three paragraphs in a 1,000-page bill,” he added. “But it’s defined as a practice that’s likely to interfere with, or prevent access to information. And there are two tests within that about whether information blocking is actually occurring. The first test is focused on vendors, developers, and exchanges, etc. –whether they know or should know that this is occurring. Providers have a second test—whether they know that the exchange of information is being inhibited. We’re waiting for the National Coordinator to provide rules around that, for clarity.”
“The biggest concern I have with 21st-Century Cures and its approach to interoperability,” Tripathi said, “is that it takes a regulatory approach to something that shouldn’t require a regulatory approach. There are CMS and private-insurer contracts that are pushing people into interoperability and data exchange. For example, there are 18 ACOs [accountable care organizations] participating in the Massachusetts Health ACO, and we work with a number of them, and I can attest to the fact that that’s really energizing a lot of them, and it’s happening from the bottom up. My concern is that 21st-Century Cures’ language will actually slow the process of interoperability and possibly be used by vendors to attack each other.”
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