Year in Review: The federal government's 2015 HIT output

The federal government has been busy this year with multiple initiatives, rules and reports impacting the entire health IT landscape.

Meaningful Use: The development with the most widespread impact is probably the final rule for Meaningful Use (MU) Stage 3. The Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) released the final rule they say "adds new flexibilities for providers to make electronic health information available when and where it matters most and for healthcare providers and consumers to be able to readily, safely and securely exchange that information."

The agencies responded to widespread criticism of the MU program in the rule, easing the reporting burden for providers by allowing providers to choose the measures of progress that are most meaningful to their practice and giving them more time to implement changes to program requirements. Providers are encouraged to apply for hardship exceptions if they need to switch or have other technology difficulties with their EHR vendor, according to the announcement of the rule. Additionally, the new rules give developers more time to create user-friendly technologies that give individuals easier access to their information so they can be engaged and empowered in their care.

The agencies also released the final rule for 2015 Edition Health IT Certification Criteria (2015 Edition) which aims to increase interoperability and improve transparency and competition in the health IT marketplace.

The final rule as well as the MU program overall has been the subject of much criticism ever since the rules’ release. Beth Israel Deaconess CIO John D. Halamka, MD, writing in his blog, Life as Healthcare CIO, questioned whether regulation is the “best approach to accelerate the move to consumer-facing mobile apps and APIs for downloading EHR data and uploading patient-generated data.”

He reiterated his opinion that it may be time to move beyond MU. Merit-based payment might be the better option “because, at this point, it is more effective and efficient for [providers] to focus on achieving better outcomes for value-based care than being told exactly how they should get there.”

Medical associations also continued their fight against MU throughout the year. Citing the poor rate of success with Stage 2, the American Medical Association, a coalition of 111 medical societies sent letters for congressional leaders urging them to intervene and refocus MU Stage 3.

The coalition asked Congress to refocus MU to achieve a "truly interoperable system of EHRs that will support, rather than hinder, the delivery of high quality care."

Quality: HHS announced measurable goals and an aggressive timeline to move the Medicare program toward a system based on paying providers based on the quality, rather than quantity, of care they provide.

HHS established a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as accountable care organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.  HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs.

To make these goals scalable beyond Medicare, HHS Secretary Sylvia M. Burwell also announced the creation of a Health Care Payment Learning and Action Network. Through the Learning and Action Network, HHS will work with private payers, employers, consumers, providers, states and state Medicaid programs and other partners to expand alternative payment models into their programs.

Health IT Strategy: ONC released the final Federal Health IT Strategic Plan 2015-2020 which reflected input from more than 400 public comments, collaboration between federal contributors and recommendations from the Health IT Policy Committee.

“Health IT only achieves its full potential when it seamlessly supports individuals as they strive to take control of their own health,” said National Coordinator for Health IT Karen B. DeSalvo, MD, MPH, MSc. “Implementing the Federal Health IT Strategic Plan over the next five years drives toward a public-private partnership to achieve interoperability and will help the nation achieve important health outcomes, while remaining flexible to the evolving nature of healthcare and technology.”

HHS announced plans to award $685 million to 39 national and regional healthcare networks and supporting organizations to help equip clinicians with the tools and support needed to improve quality of care, increase patients’ access to information and reduce costs. The Transforming Clinical Practice Initiative is one of the largest federal investments designed to support doctors and other clinicians in all 50 states through collaborative and peer-based learning networks.

Linked to the strategic plan is the final interoperability roadmap. The final version “lays out the milestones, calls to action and commitments that public and private stakeholders should focus on achieving,” according to a blog post authored by DeSalvo and Erica Galvez, ONC’s Interoperability and Exchange Portfolio Manager.

Precision Medicine: President Obama announced a $215 million Precision Medicine Initiative during his State of the Union Address. The initiative seeks to revolutionize healthcare delivery and the treatment of diseases and entails a model of patient-powered research to accelerate biomedical discoveries and provide clinicians with new tools, knowledge and therapies to select which treatments will work best for which patients. The objectives of the initiative include: more and better treatments for cancer; creation of a voluntary national research cohort; commitment to protecting privacy; regulatory modernization; and public-private partnerships.