Does the CMS push on data sharing mean the private sector failed on interoperability?

Health IT professionals and vendors saw few negatives in the new My HealthE Data initiative announced by CMS at the HIMSS18 conference in Las Vegas, even though CMS Administrator Seema Verma, MPH, warned that the agency would crack down on information blocking by vendors or providers.

The easy exchange of patient data has been a much talked about goal which simultaneously remained elusive for much of the healthcare system and its electronic health record (EHR) vendors. An October 2017 study in Health Affairs found less than 30 percent of hospitals had achieved interoperability and were able to find, send, receive and integrate patient information from outside systems.

HealthExec asked several major health IT leaders at HIMSS18 if this CMS push was an acknowledgment by the federal government that the private sector won’t achieve interoperability on its own. Two HIMSS officials—Tom Leary, vice president of government affairs and Jeff Coughlin, senior director of state and federal affairs—said they didn’t interpret that way. Coughlin did say vendors and providers want to hear more details about the proposal, particularly how it will address the “business case” for sharing data.

“It’s often not a technical issue in terms of exchanging data, but the business models don’t necessarily lend themselves to sharing data,” Coughlin said. “So I think more information how that transpires, that’ll be the interesting piece that I think we really need more detail on.”

Don Rucker, MD, chief of the Office for National Coordinator for Health IT (ONC), made the argument “there’s almost nothing that’s in the true private sector in healthcare” in the first place. Interoperability, in his opinion, has been narrow, largely connecting amongst high-priced providers and not true competitors, but he doesn’t think the CMS initiative is at all an indictment of private sector efforts.

“The fact that the Bentley and the Rolls Royce dealer have connected is nice,” Rucker said to HealthExec, “but if I’m somebody that’s at risk of losing my entire savings, about to go bankrupt and can’t find out what the cost of surgery is and can’t shop for that care … that economic competition, somehow, often is not interoperating.”

Among vendors themselves, the reaction remained mostly positive. Kyle Ambrester, chief product officer at athenahealth, praised “the freeing of CMS data for patients” and well as the promises to reduce regulations around documentation. He did add a small sour note to his take on the announcement, however.

“While we wish CMS would also take this opportunity to recognize and work with ONC on the burden that the EHR certification program places on users of those products, we recognize CMS’s objective as being well-meaning,” Ambrester said in a statement to HealthExec. “No one entity can free healthcare from its many burdens and deep-rooted friction—it will take all players to wick away the non-essentials associated with workflows, information access, and technology if we’re going to enter into a more value- and innovation-oriented healthcare.”

Besides the mention about some relief on documentation guidelines, the CMS push for giving patients more control over and access to their complete health record also came with the promise of the agency using whatever means it can to get health insurers to give members electronic access to their claims. America’s Health Insurance Plans (AHIP) president and CEO Marilyn Tavenner said in a statement the lobbying group supports the My HealthE Data initiative as a whole, saying it “will work to bring together data from seniors, doctors, and health insurance providers for a better patient experience.”

Almost on cue, private insurance companies announced they would require greater interoperability. In-network providers aligned with Blue Shield of California will have to participate in nonprofit health information network Manifest MedEx, which the insurer said “facilitates the secure exchange of 11 million patient claims records and 5 million patient clinical records for over 200 participating partners.”

Humana president and CEO Bruce Broussard said it already provides claims data to its Medicare Advantage members, but praised the initiative as a key component to drive consumerism and the transition to value-based care across the industry, particularly on its plans to expand the Medicare Blue Button project.

“These efforts have been hampered as a result of inconsistent data sharing and lack of standards,” Broussard told reporters. “The announcement will stimulate greater transparency of medical information to Medicare beneficiaries and effectiveness of clinical interventions through healthcare stakeholders sharing data through a common standard.