By Seth Katz, MPA, RHIA, FAHIMA
Our lives and businesses run smoothly because the world around us is connected by devices and software built on standard protocols followed by every developer in the tech industry.
These standards are why I can send message from my Gmail account to an Outlook address with no problem. It’s why my friends and colleagues with Androids can send texts to my iPhone—and vice-versa. Standards are why a bank in Indiana can transfer funds to an institution in India in a manner of seconds.
This level of seamless convenience is so ubiquitous that it’s practically hard-wired into our brains as a base expectation of any consumer-centric service.
While two banks 8,100 miles apart can share information in near real-time, two hospitals across the street from each other cannot (and in some cases will not).
This is the problem the information blocking provisions of the Cures Act is set to tackle head-on.
Realizing Healthcare’s Patient-Centered Vision
The information blocking provisions are the sword intended to split the Gordian Knot that has bedeviled every attempt to access, share, and use electronic health information (EHI)—from the HITECH Act’s “meaningful use” EHR Incentive Program (now called Promoting Interoperability) to hub-based health information exchanges (HIE).
While meaningful use spurred investment in electronic health records, the proprietary elements of competing information systems created significant—and intentional—barriers to interoperability.
The promise of an HIE was that if a patient went to six different doctors, all records would be transmitted a central hub for easy access by any of the patient’s providers. This idea has not worked out as planned for a variety of reasons. Some hospitals refused to participate, while others choose to only send the bare minimum data necessary to meet federal requirements.
Additionally, dueling HIEs on both the state and federal level refuse to connect to each other because of political or financial reasons. This has led to some hospitals having to join (e.g., pay) multiple HIEs to cover all the places their patients could go.
The Cures Act may be our industry’s best chance for finally fulfilling the long-promised vision of one record tethered to the patient.
The Cures Act explicitly prohibits practices that prevent or inhibit the access, exchange, and use of EHI. There are exceptions, of course, and the privacy rules governed by HIPAA remain in place. But what separates the Cures Act from previous attempts to shatter data silos is the focus on the patient rather than the technology.
Hospitals and health IT vendors will be required to share vital information—with patients and each other. I believe that this ability alone will open many new and exciting opportunities to help reshape our healthcare system, including:
HIEs for patients. If a patient goes to six different organizations for care, there is a good chance they have six different patient portals. Even if some of those hospitals are on the same EMR, the behavior of those portals is unique to the set-up for each institution. This creates a heavy burden on patients to try to keep track of their care across all these different platforms.
However, by leveraging application programming interfaces (APIs)—see this article for a primer on the subject—patients may finally be able to collate all of their health data in one place and take ownership of their care.
The health app economy. The app store on your phone has no shortage of healthcare related programs; finding one that can connect to your provider’s EHR is another story.
For the most part, EHR vendors have tightly controlled access to data. This means that the only apps able to connect back an EHR are ones built—and controlled—by the EHR vendor.
Information blocking will open the market to new and innovative players in the app space, leading to products and services designed to help patients manage their conditions and hospitals exchange data securely. This is a massive opportunity in the telehealth and remote patient monitoring sectors that will only grow in the wake of the COVID19 pandemic.
Cutting red tape. Like the hospital price transparency rule, which gives consumers a greater window into the negotiated costs and rates of health services, the provisions of the information blocking rule will have a similar effect on consumers’ relationship with their own health data.
For too long, providers and insurance companies did not want the public to know their rates, and in some cases said it was illegal to disclose them. The same is true with some of the big health IT players who said they could not—and would not—work with other entities. With information blocking, they cannot hide behind vague data-use agreements or random “gag clauses” meant to stifle the valid sharing of health information.
Minimum is no longer enough. Like my example of organizations not fully participating in HIEs or providers who refuse to post a patient’s entire record to their portal, providers can no longer just “check a box” by doing the minimum necessary and getting credit for it. Organizations are going to have to fully participate and share information to the best of their abilities or face the consequences.
None of this comes without some level of risk, but the benefits that will come from this rule easily outweigh any concerns.
Every healthcare stakeholder should embrace this opportunity and develop new, patient-centric ways to better our system.
If organizations choose to hide behind one of the eight exemptions to the rule, then nothing will change and the goal of interoperability and better patient empowerment will continue to be a dream.
Seth Jeremy Katz is the vice president of HIM and revenue cycle at Truman Medical Centers.
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