HIMSS Review: Technology Priorities and Realities

Another HIMSS conference is history. The technology cart, however, may be getting ahead of the horse. Everywhere I turned, vendors touted their technology solutions to transform existing healthcare providers into ACOs. Many of these solutions tackle the worthy challenge of correlating claims data coming from payers with clinical data coming from providers, in an effort to create longitudinal records of care for any patient who walks through the provider's doors. In this way, providers will catch comorbidities they are missing today, eliminate duplicative tests, reduce readmissions, and increase patient satisfaction, all in one fell swoop.

At least, that's the theory. But wait—if the brave new technology future is at hand, why are the Pioneer ACOs petitioning CMS to ease up on demanding early results?

I think I now understand why the pioneers are freaking out.

The ACO concept only works if health information exchange between providers is mature enough to handle what the ACOs require. And I'm here to report that health information exchange still has a long way to go.

That's why, in the midst of a HIMSS packed with innovations that I will describe in future columns, the National Coordinator for Health Information Technology, Farzad Mostashari, sees the maturation of HIE as the biggest challenge of 2013. (Mostashari views the HIE acronym as a verb and a desired state of being, rather than as only a description of HIE/HIO organizations.)

"There are technical challenges," Mostashari told a packed HIE town hall on the final day of HIMSS. "There are governance and trust challenges to information being exchanged. And there are business practices and a business case for information exchange, all of which need to be addressed in order for information to move. We intend to act on all of them this year to create a context where we get to the goal and the 'why' of all this, which is that information follows the patient wherever they need it to go, across organizational boundaries, across vendor boundaries, across geographic boundaries."

Security and identity

During Q&A, a doctor from a large practice in New York City strode to the microphone to warn about the litigious atmosphere that HIE may enable. Attorneys able to openly access electronic medical records will have a field day with that longitudinal patient data, he warned, accelerating the pace of malpractice suits in the U.S.

Mostashari ranged from smiling to brow-furrowing in answering this issue. "The patient owns the data!" he exhorted at one point, stepping away from the microphone to plead his case. More soberly, he characterized the legal worries as "problems we didn't imagine happening before."

Meanwhile, away from the microphones, ONC's health IT policy committee labored in January to assure that patient consent travels with that data from provider to provider. Toward that end, ONC has tested new eConsent processes, starting in western New York state, with results to be published later this year.

Fruits of this effort can't arrive soon enough. Without clear consent, some patients will freak out when they see their healthcare data following them around. What providers see as their ticket to ACO nirvana may appear to some patients as a kind of Big Brother, if they haven't been fully educated about all the consent forms they normally sign without reading.

Then there's what I consider the elephant in the room: what the technologists, including Mostashari, describe as a lack of digital key distribution that continues to prevent easy verification of patient identity as patients travel from provider to provider.

The federal government is prohibited by law from being the provider of digital keys that would establish a national patient identification system in the U.S.

This puts us at odds with practically every other industrialized nation on the planet, and hampers our efforts to implement not only ACOs but all manner of population health and public health innovations, not to mention to greatly reduce fraud and waste.

The distant goal of interoperability

Private industry is starting to step up, but slowly. Mostashari pointed out that one such effort is the CommonWell Health Alliance, announced at HIMSS last week.

What he didn't say, but I will, is that the CommonWell announcement was mostly marketing spin and very little substance at this point.

In the words of two of its vendor founders, CommonWell "plans to build, certify, and deploy a national infrastructure which will create an ecosystem for universal connectivity providing patient record linking, along with standardized consent and authorization services, so that providers can gain access to needed patient data, regardless of their electronic health record [EHR] supplier or the setting of care."

Cynics pointed out that CommonWell looked a lot like the health IT industry minus one glaring exception: Epic. The market share leader in EHR software in the larger-than-200-bed market wasapparently not invited to join CommonWell. I've seen these kinds of theatrics in IT before, and question how sincerely Epic's competitors were pursuing a détente with the 800-pound IT gorilla.

But around the show floor, some hospital and health system executives confided that Epic will quietly implement some interoperability with other EHR systems, particularly for large customers, although that's apparently not something Epic wants to be highly publicized, and probably is aimed at continuing to assimilate that data into Epic somewhere down the line.

So it may be that Mostashari's exhortations and CommonWell's developmental goal won't be enough. Providers are the ones who can and must demand that health data exchange become ubiquitous. Those providers who fear the legal ramifications have to try to work within our existing litigious system to provide a level of comfort with letting go of data that is, after all, the patient's data.

And with the ongoing sequestration of funds from government programs hampering the ONC itself, vendors who until now have been prospering from government HIT incentives must turn to the hard work of getting that tech cart behind the horse, and keeping it there, by cooperating in ways they never imagined.