State, federal policies driving info exchange, interoperability

There are many opportunities to support information exchange across healthcare settings as well as existing provisions that “provide huge opportunity,” said Kelly Cronin, health reform coordinator at the Office of the National Coordinator for Health IT (ONC), speaking at the 2014 State Healthcare IT Connect Summit.

While healthcare is seeing “some movement of data, we’re not where we need to be to really connect the system.” The key, she said, is to advance connectivity across the system to get to systemwide interoperability and connectivity.

One evolving change is what is expected of hospitals when they do discharge planning as well as expectations of patients. Several policy levers can help make sure caregivers, patients, visiting nurses at home and more have “access to a longitudinal care plan and the standards are there to support that,” she said.

While there’s been a lot of progress with labs’ structured reporting, at least 40 percent of labs need to get to better reporting, Cronin said. “We can do that under the expectations of CLIA [Clinical Laboratory Improvement Amendments]” and incentives could help. And, while imaging is not directly touched by Meaningful Use, accreditation can make electronic access of images available so there’s less redundant imaging. “Radiologists are getting a lot of orders and don’t always consult with the physicians doing the ordering.” Policies can help make the communication routine practice and infrastructure needs to support it as well. Technologies are evolving in the market, “but we need to make sure policies and standards are being adopted.”

The Medicare Shared Savings Program already is driving a lot of change in the market, Cronin said, and the 360 Medicare accountable care organizations now in existence have “real traction and offer the impetus for stakeholders to want to share information and think about specific ways in which people coming into the program can lay out a path for health IT infrastructure.” She said there are other models beyond the ACO portfolio, such as bundled care and accountable care communities.

A request for information is out now on how the Centers for Medicare & Medicaid Services (CMS) could be doing large-scale practice transformation. “There are several questions around the roles of states and the role of health IT, how we look at EHRs, population health tools and clinical decision support and how we should we all be working together to scale this.”

Those policies are all tied to Medicare but there are Medicaid levers as well, Cronin said. State Medicaid contracts have quality strategies and external quality review with a federal match. Waivers can be tied to use, adoption and exchange and the use of certified technology to make sure it is standards based.

“The goal is to move to a much more automated system,” Cronin said. “There’s an opportunity to think about how to use your state infrastructure and how to potentially support Medicaid to scale reporting of electronic quality measures.” As has already been stated by ONC staff members, the goal is to streamline reporting to make it easier for providers.

“There is a need to dig down on quality measures and improve complexity because it’s so important to value-based purchasing,” she said. “There are a lot of applications and architecture that’s very disparate.”

Regulators are looking to integrate data from disparate data silos and streamline it to get to multipayer reform. “We’re going from a system that doesn’t allow for a longitudinal view of patients that has lags in data,” she said. “There are a lot of quality issues. As it stands right now, Meaningful Use Stage 1 measures were not perfect—far from it. It’s taking a lot of work to make those measures better when they do become electronic.”

Cronin’s office is looking at ways to integrate behavioral health and long-term and post-acute care providers. They drive a lot of costs and don’t have a lot of IT adoption, she said. Her office is looking into “finalizing recommendations on how to expand voluntary certification to get to these settings.” There are federal funds to support interoperability with these providers, she said. There is a “comprehensive effort to figure out how to have incentives that give a reason for these other types of providers to adopt tools to exchange and manage data beyond their setting.”

Top priorities, Cronin said, are creating a network of networks, developing a multiyear interoperability strategy and scaling claims and clinical data infrastructure for value-based purchasing.

The Department of Health & Human Services “is committed to realizing a patient-centered, value-driven healthcare system supported by the secure exchange of information across all providers of care,” she said. “ONC is ensuring HHS-led delivery and payment reform will drive interoperability and exchange. It’s complicated and will take time. We want to get it right together.”