CMS Administrator had powerful messages to share related to new HHS interoperability proposal.
ORLANDO, Fla.—For the thousands of people attending the 2019 HIMSS conference this week, there is no escaping the buzz about the proposed new interoperability rules issued by the U.S. Department of Health and Human Services (HHS) on Monday.
Centers for Medicare & Medicaid Services Administrator Seema Verma is the ubiquitous face of the news at the event, participating with a panel of representatives at the opening keynote session yesterday morning, and closing out the day with presentation about the latest news, along with a videotaped message from HHS Secretary Alex Azar. Verma also conducted a press conference yesterday for members of the media.
Following are key takeaways from these combined events, with a focus on highlights that are relevant to health systems, providers, and innovation.
1. The health system failed, so the government has stepped in. Although the current administration is in a deregulatory mode, CMS is proposing stricter rules because the healthcare system has failed to do the job of putting patients' needs first.
"It's requiring the government to step in," Verma said. "Over the past year and a half, we've talked to a variety of stakeholders, and I've been surprised." She said that CEOs of large insurance companies and health systems have pulled her aside and said, "We need the government to force us to tell us to do this."
2. Data belongs to patients. Period. "Some hospitals have to ask permission from EHR vendors to use their own data," said the CMS Administrator "So let me be clear. The idea that patient data belongs to providers or vendors is an epic misunderstanding. Patient data belongs to patients."
3. Doomsday has arrived for information blockers. With further clarity now available this week through the Office of the National Coordinator for Health Information Technology about what constitutes information blocking, "there's no more room for excuses," said Verma. "We won't tolerate it anymore, and those of you that continue down this road will see less opportunities to engage in this practice in the future. Information blocking is a thing of the past."
4. The blame game must end. "As we unpack the issues related to sharing health data," said Verma, "we realize that each participating party blames someone else. The game of pointing fingers at feigning innocence has to end. We are all part of what makes the healthcare system work, and similarly, we all—insurers, providers, and the government—are culpable for the lack of data sharing."
5. Payers are the missing link. Payers are the primary focus of Monday's proposal because incorporating claims data into the patient record can help improve care and outcomes. Claims data also offers providers the opportunity to make better decisions, enhance safety, and avoiding duplication.
"Just by looking at the claims history," said Verma, "you can see the rapid decline in someone's health, and you can even predict future healthcare events."
6. Healthcare systems need to have data sharing and notification capabilities. To enhance transitions in patient care, the new proposal aims to improve the patient and provider experience though data sharing and electronic notification abilities. Hospitals must electronically notify providers and the patient's care team when a patient is admitted, discharged, or transferred. This will be enforced as a condition of Medicare participation.
"This is a small step in improving the discharge process for patients and their care teams," said Verma, "but it's a significant first phase of the policies that we are proposing. We want to see a future where it's more than the notification and discharge, instead, the entire record set will follow the patient."
7. Patient record matching is a new target. Verma mentioned that patient identity and record matching is a "critical issue that has plagued data-sharing efforts for years, and we must find a solution." She vowed to put the "weight of CMS" behind it.
8. Combined data delivers new possibilities for healthcare. Verma explained that the agenda behind the proposal is to connect the underlying databases that power the health system using APIs and other technologies to create a single patient record. She suggested that in the near future, data won't be limited to a predefined set of parameters but will include the entire HIPAA-designated record set.
"When all of this data available," said Verma, "physicians and health systems will use tools like artificial intelligence and machine learning to help interpret the information to provide high quality, evidence-based, cost-effective care, and the tools that are used at a point of care will be user-friendly for clinicians … giving access to the right data for the right person when they need it. The American healthcare system will be and must be powered by technology, not burdened by it."
9. Sharing data will occur across the spectrum of the delivery system. "We are promoting scalable data sharing," said Verma, "not just an individual patient record from hospital-to-hospital, but a model that supports the flow of information across the entire healthcare system. We encourage industry to align in this direction because this is the future. "
10. A data revolution is underway. Verma characterized the infusion of claims data into patient records as the "beginning of the digital data revolution." She added, "Now that we have all this complete data in an era of artificial intelligence, imagine what we can do with all that data in terms of research and in terms of developing new cures and treatments.”
11. There is more to come. Liberating claims data for providers, patients, and innovators is just the beginning Verma predicted. "Freeing data from locked silos will spur innovation at a pace we've never seen before, supporting future advancements in healthcare through new medications, devices, and more personalized healthcare."
Mandy Roth is the innovations editor at HealthLeaders.
Photo credit: Oscar & Associates for HIMSS19
Patient data belongs to patients only.
Information blocking is a 'thing of the past.'
Health systems must have data sharing and notification capabilities.
Patient record matching is next.