- Healthcare organizations are making progress towards a more interoperable data ecosystem, but patients, providers, and payers are still facing data access, integration, and analytics challenges that are holding back the promise of patient-centered care, says HHS.
In its annual report to Congress on the state of the health IT environment, HHS stressed the central importance of data for informing decision-making across the care continuum and highlighted several key pain points that will need to be addressed before the industry can overcome some of its fundamental challenges.
“Access to data” is HHS’s new watchword, the report explained, due to the critical role digital information now plays in the modern healthcare environment.
By 2015, certified health IT tools were present in 96 percent of non-federal acute care hospitals and 78 percent of physician offices, HHS notes, meaning that most patients have an electronic record in one form or another.
“However, this information is inaccessible across systems and appropriate end users in the market in ways that can generate value,” the report pointed out, emphasizing the need for better access to these data sets.
“Patients often do not have electronic access to their health information, which hinders their ability to manage their health and shop for medical care at lower prices,” HHS continued.
“Health care providers often do not have electronic access to patient data at the point-of-care, particularly longitudinal data maintained in different health IT systems. Payers often do not have electronic access to clinical data on groups of covered individuals to assess the value of services provided to their beneficiaries.”
Under the 21st Century Cures Act of 2016, HHS was granted the authority to enhance innovation and continue to promote data interoperability throughout the healthcare industry.
Since that time, HHS, CMS, and the ONC have made it a priority to foster the adoption of interoperability-friendly technologies, such as open APIs, FHIR, and 2015 Edition CEHRT with standardized data exchange features baked in.
CMS Administrator Seema Verma has also taken a hard line against organizations that do not meet emerging patient data access standards, and has repeatedly warned stakeholders that failing to embrace patient-centered, value-based, and data-driven care will be problematic for them in the future.
While the industry is still waiting for the ONC’s pending definitions of data blocking – and the associated penalties for being guilty thereof – CMS has been busy using its regulatory authority and role as an industry convener to take significant steps towards revamping the way organizations create, share, and analyze data.
The Patients Over Paperwork and MyHealthEData initiatives launched in 2018, as did Blue Button 2.0 and the Trusted Exchange Framework and Common Agreement (TEFCA) offering voluntary standards for industry to follow.
Providers received some relief from documentation burdens; the Da Vinci Project launched to help payers leverage FHIR more effectively; and the deadline for adopting 2015 Edition CEHRT came into effect on January 1, 2019.
But despite the positive impact of these actions, which represent the culmination of many years’ work, the industry still has room to grow.
A rapidly advancing consumer technology environment has raised demand for more mobile data access and a retail-style engagement with providers and payers. Despite their relative novelty, patient portals may already be outdated as far as consumers are concerned, HHS indicated.
“Currently, patients electronically access their health information through patient portals that prevent them from easily pulling from multiple sources or health care providers,” HHS said.
“Fully using modern computing tools is critical to advancing health care. Patients should be able to easily and securely access their medical data through their smartphones.”
Providers and payers also have work to do on the technical foundations of data access and exchange.
Moving from single-record access to bulk record exchange will be critical for population health management and the growth of advanced analytics, including artificial intelligence tools.
“For health care providers and payers, interoperable access and exchange of health records is focused on accessing one record at a time. Payers cannot effectively represent their members if they lack computational visibility into which health care providers offer the highest quality care at the lowest cost.”
“Without the capability to access multiple records across a population of patients, health care providers and payers will not benefit from the value of using modern computing solutions—such as machine learning and artificial intelligence—to inform care decisions and identify trends.”
The report emphasized the need to integrate payers more closely into the big data ecosystem to advance population health management, improve the quality of care, and reduce wasteful or unnecessary spending.
“Often, health care providers and payers negotiate contracts based on the health care provider’s reputation rather than on the quality of care that health care provider offers to patients,” HHS stated.
“Health care providers should instead compete based on the entire scope of the quality and value of care they provide, not on how exclusively they can craft their networks. Outcome data will allow payers to apply machine learning and artificial intelligence to have better insight into the value of the care they purchase.”
The future state of healthcare must be seamlessly interoperable in order to support sophisticated data analytics and patient access to personal data, the report concluded.
“Interoperable access underpins HHS’s efforts to pursue a health care system where data are available when and where needed,” the agency said. “Patients, health care providers, and payers with appropriate access to health information can use modern computing solutions to generate value from the data.”
“Improved interoperability can strengthen market competition, result in greater quality, safety, and value for the healthcare system, and enable patients, health care providers, and payers to experience the benefits of health IT.”