Ups and downs in health IT

It doesn’t seem that the federal government took off much time for the 4^th of July holiday—at least when it comes to health IT. From cybersecurity to a health IT safety plan, there is plenty to consider.

“We’ve seen a rapid rise in adoption of health IT,” said Jodi G. Daniel, JD, MPH, director of the Office of the National Coordinator for Health IT’s (ONC's) Office of Policy Planning, speaking about the Health IT Patient Safety Action and Surveillance Plan. The plan’s “goal is to advance patient safety in an increasingly health IT-enabled healthcare system. There are benefits and risks to any new technology,” Daniel said, and healthcare needs to be prepared for both.

The plan focuses on three strategies—learn, improve and lead, said Jacob Reider, MD, ONC’s chief medical officer. “We want to increase the quantity and quality of data and knowledge about health IT safety. The Institute Of Medicine report was very explicit about how there isn’t sufficient knowledge of what’s happening in health IT safety. There are opportunities to improve and better understand exactly what’s happening in the domain of safety of the systems themselves—both in their creation and how they’re implemented.”

Meanwhile, as part of its efforts to develop a voluntary framework to improve cybersecurity in the nation's critical infrastructure, the National Institute of Standards and Technology (NIST) has posted a draft outline of the document to invite public review and gather comments.

The outline proposes a core structure for the framework and includes a user's guide and an executive overview that describes the purpose, need and application of the framework in business. Reflecting received comments that emphasized the importance of executive involvement in managing cyber risks, the framework is designed to help business leaders evaluate how prepared their organizations are to deal with cyber threats and their impacts.

On the less positive side, up to nine of the 32 Pioneer accountable care organizations (ACOs) may drop out and shift over to the less risky Medicare Shared Savings Program (MSSP) ACO, confirmed the Centers for Medicare & Medicaid Services (CMS). What does this say about the effort to shift from volume to value? Time will tell.

“We’re encouraged that these systems want to continue in these programs that promote better care at lower costs. We fully anticipated that as these programs get up and running, some groups would shift between models,” according to a statement provided by Kathryn Ceja, CMS spokeswoman.

And, although participation in health information exchange (HIE) is on the upswing, with 30 percent of hospitals and 10 percent of ambulatory practices now linked to one of 119 U.S. operational HIEs, the future remains uncertain as 74 percent of HIEs report struggles with developing a sustainable business model.

In a Health Affairs study, researchers surveyed 172 organizations (out of 221 attempted) that exchange clinical data between independent entities between August and November 2012 and compared the results with planning and operational efforts reported from surveys they conducted in 2009 and 2010.

Of the 172 respondents, 119 were actively exchanging clinical data, compared to 75 identified in a 2010 survey. The majority of operational efforts were not for profit and had been exchanging data actively for less than two years, according to the report.

Hospitals and ambulatory practices most commonly participated in HIEs, and they were the most likely to pay for it, the researchers found. However, HIE participation was significantly lower among payers, independent pharmacies and other groups.

While HIE adoption grows geographically and among providers, sustainability issues loom as many rely heavily on government grant funding. “Taken as a whole, these findings are good news for current federal policy efforts but raise real concerns about the future,” the authors wrote.