The ball will drop in Times Square this week, marking the end of 2014 and the calendar flip to 2015. The New Year is the perfect time to let go of old habits and start anew. What are your New Year’s resolutions? I plan to take yoga classes and install a stand-up desk, since a friend of mine declares that sitting is equivalent to smoking as a health hazard for this generation. Needless to say, I’ll be standing around a lot more in 2015.
2 resolutions to note
This December two familiar groups have published New Year’s resolutions: The Office of the National Coordinator for Health IT (ONCHIT) posted the Federal Health IT Strategic Plan 2015-2020 and eHealth Initiative (eHI) circulated the eHI 2020 Roadmap. Together these documents highlight Health IT (HIT) initiatives and requirements that are likely to impact you in some way. These HIT initiatives may lead to physician opportunities in the form of incentives or work to avoid penalties. Let’s look at these New Year’s resolutions that are not yours, but may impact you all the same.
Federal Health IT Strategic Plan
The June 2nd Acumen blog post summarized remarks from the new National Coordinator for HIT Karen DeSalvo, speaking at the eHI National Forum on Data and Analytics. Key eHI Forum themes from Dr. DeSalvo, including patient access to and control of personal health data and health data system interoperability, are now fundamental initiatives in the Federal Health IT Strategic Plan 2015-2020.
With oversight from ONCHIT, Medicare and Medicaid HIT incentive programs have prompted 75% of Eligible Providers (EPs) and 92% of Eligible Hospitals (EHs) to digitize patient records. The new ONCHIT strategic plan signals that the government will shift focus from EHR features and functionality to timely, secure and efficient data sharing. Federal programs will drive hospitals and providers toward an “interoperable environment” to achieve quality health care goals and reduce health care costs. This government quality-plus-lower-cost goal should sound familiar from Acumen blog posts on the value-based payment modifier (VM), the new Medicare incentive program that will reward or penalize practices based on achieving quality outcomes while controlling costs based on benchmarks.
In addition to fostering interoperability and patient-centered data, the federal government also intends to broaden the scope of HIT. In the past year there has been tremendous growth in personal health mobile devices and the capacity for pervasive health sensing. The government plans to recognize mobile technology, telehealth, cloud-based services, remote monitoring devices, sensors and assistive devices as HIT products and services. This should result in incentives and reimbursement for utilizing these devices and services.
The Federal Strategic Plan 5 for 5 (5 goals in 5 years) list includes:
- Goal 1: Expand adoption of HIT
- Goal 2: Advance secure and interoperable health information
- Goal 3: Strengthen Health Care Delivery
- Goal 4: Advance the health and well-being of individuals and communities
- Goal 5: Advance research, scientific knowledge and innovation
Goal 4—advancing the health and well-being of individuals—specifically involves increasing patient access to electronic health record information. More than providing a patient portal as a functional EHR component, this goal is about creating opportunity for patients to authorize the use of their health data, contribute data to their record and engage with providers about their health data. The initiative also includes strategies that incorporate self-generated or self-reported data such as home glucose, home BP, diet or fitness data into a personal health record.
eHealth Initiative 2020 Roadmap
Like ONCHIT’s Federal HIT Strategic Plan, the eHI 2020 Roadmap outlines HIT strategies. You may recall from previous blog discussions that eHI is a national organization of HIT stakeholders with membership including consumers, providers, payers, public health agencies and technology companies. This group represents the private sector community interested in the use of HIT to improve health care quality and efficiency and to close the gap between non-health care and health care use of technology.
The eHI 2020 Roadmap provides key recommendations in 3 focus areas:
- Business and clinical motivators
- Interoperability
- Data access and use
From a business and clinical standpoint, engaging patients with patient-centric and interactive health records is necessary to enhance patient engagement in improving health outcomes. Providers, patients and payers must be aligned in achieving clinical quality outcomes, which will be good for the business of health care. The eHI group urges the government to decrease the complexity of feature-focused incentive programs like Meaningful Use (MU) and the Physician Quality Reporting System (PQRS) and to follow through with ICD 10 implementation in October 2015. From a business aspect, data privacy and security will be important as data exchange becomes more common.
HIT systems interoperability is just beginning and will be complex and expensive to fully implement. In addition, interoperability will happen quickly in HIT local areas with health care organizations that are more advanced and will be implemented more slowly in areas with greater HIT challenges. eHI encourages the government to support interoperability standards development and to make affordable software solutions available. eHI recommends that federal incentives and penalties account for highly variable adoption of interoperability capability in the next few years. In addition the government will need to assist with harmonizing the current state-to-state variability in HIT privacy and security regulations to foster interstate HIT data sharing.
Data access and use is part of an ongoing national dialogue over balancing individual privacy rights with public health needs. National rules and policies create a framework for data sharing and aggregation. Patients may have the option to control how and if certain HIT data is shared, but some data critical to public health may be shared automatically.
2014 has been a HITECH year and 2015 is coming in with an HIT bang. The Federal Health IT Strategic Plan was published as an old-fashioned PDF document, not as a talking Karen DeSalvo hologram (which would have been ultra-cool), but the strategic plan contents are transformative all the same. We are being pushed along by these federal strategies, and the eHI Roadmap provides visibility of the HIT future. At midnight on December 31st raise your glass to closing the HIT technology gap and make a resolution to get on board.
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.
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