To say that 2017 was a busy one for organizations and outlets covering healthcare would be an understatement. And so far, there’s no indication to suggest that 2018 will be any different. As of press time, the Affordable Care Act has survived dozens of attempts to repeal it, though rule-making efforts by the Department of Health and Human Services (HHS) can still chip away at it, and recent tax reform bills have placed the individual mandate on the chopping block. Additionally, 2018 is the year that late certain provisions of Obama-era healthcare legislation, such as the 21st Century Cures Act and the Medicare Access and CHIP Reauthorization Act (MACRA), are slated to go into effect. If 2017 taught us anything, it was to expect the unexpected.
HIM in Washington
AHIMA’s Senior Director of Federal Relations, Lauren Riplinger, JD, has her eyes on a number of heath information management (HIM) and health IT issues happening in Congress and the Department of Health and Human Services. There are a number of reports due to be published in 2018 concerning privacy and patient matching that Riplinger will also be tracking closely in coming months.
The Government Accountability Office (GAO) is expected to release a report on patient matching, as well as a report on barriers to patient access to their healthcare information. The GAO had 18 months to prepare these reports and Riplinger expects to see them early this summer.
“What we won’t see implemented next year [at least as of right now if ONC’s budget is cut] is the adoption of the electronic health record (EHR) reporting system by ONC (Section 4002 of the Cures Act),” Riplinger noted. “Cures requires the Secretary of HHS to convene stakeholders to develop a reporting system that collects information that would help providers select appropriate EHR products. The reporting criteria would include the evaluation of certain functionalities of EHR systems including: security, usability and user-centered design, interoperability, conformance to certification testing, and other factors necessary to measure the performance of EHR technology.”
Riplinger also anticipates that ONC will provide further definitions on information blocking.
James Cannatti, senior counselor for the Health Information Technology for the HHS OIG, outlined some of his office’s goals for 2018 regarding information blocking in testimony before the Senate HELP committee in October.
The Cures Act gives OIG “new authorities that will allow us to address the issue of information blocking more directly—beyond those limited circumstances in which the conduct is a part of a larger kickback scheme,” Cannatti told the committee.
HIM professionals are usually on the receiving end of a lot of criticisms from physicians about their documentation burden and their dissatisfaction with EHRs. That’s another topic that’s addressed by the 21st Century Cures Act.
“ONC is statutorily required to address documentation burden under Cures. The bill requires HHS to establish a goal and develop a strategy to reduce regulatory or administrative burdens related to the use of EHRs. ONC was a little unclear on the details in terms of how they will address it but I think right now they are really in the stage of engaging with stakeholders. CMS is also involved in these discussions as well particularly as they relate to meaningful use and MACRA,” Riplinger says.
Informatics on the Rise
It’s no secret that in 2017 AHIMA has begun to put more focus on the field of informatics as an area of great opportunity for HIM professionals. Informatics can address physician EHR burnout faster—and perhaps better—than federal health officials in Washington can.
“This can be helped by understanding the physician workflow and the EHR and working with the physician to streamline the healthcare data collection process,” Patty Buttner, RHIA, CDIP, CHDA, CPHI, CCS, director of HIM practice excellence at AHIMA, says. “This may be accomplished by incorporating templates, adding drop down boxes, natural language processing so the physician can update progress notes, and other documents with voice recognition techniques.”
Informatics also plays a role in several HIM hot topics for 2018: MACRA and value-based purchasing (VBP). While the Trump Administration is taking a hands off approach—or even scaling back some VBP programs, informatics can still help.
“Informatics could very well play a role in setting up the capture of healthcare data for MACRA. With the transition to VBP and all the initiatives and innovations that are currently in place or planned for the future, informatics plays a significant role in ensuring all required data is collected in the most efficient and effective way,” Buttner says. “Another area where informatics plays a role is in the long-term and post-acute care settings. These areas have not adopted EHRs at the same rate as acute care hospitals. Cost has been a prohibitive factor.”
HIEs and Interoperability
Without a doubt, interoperability is subject #1 for the ONC, health IT vendors, healthcare standards developers, and even patients. Although they may not know the word “interoperability” they share in the frustration of redundant tests, and in not having their records follow them from provider to provider.
Health information exchanges (HIEs), depending on where they’re located and how big they are, have become an effective way to exchange patient data regardless of the EHR systems their members use. For example, when a ransomware attack hit Erie County Medical Center in Buffalo, NY, last spring, officials from the New York HIE, HEALTHeLINK, brought computers on site while the hospital’s IT systems were down. According to Healthcare IT News, Erie County had been exchanging data such as labs, radiology, and transcribed reports with the exchange for ten years.
“Work your HIE into your business continuity plans,” Daniel Porreca, executive director of HEALTHeLINK,” told Healthcare IT News. “Think through how you might provide computers and Internet access to your staff in the event of such a crisis. Get as much of your data to the HIE—it will not only support better treatment for your patients throughout your community, but you just might need access to your own data in a time of crisis.”
Diana Warner, MS, RHIA, CHPS, FAHIMA, director, informatics, information governance, and standards, says HIE will be a big area of focus for AHIMA in 2018. AHIMA will be publishing Journal articles, blog posts, and a Practice Brief. The HIE Practice Council also will be busy with projects such as a blockchain primer, which will help explain how blockchain technology improves interoperability and how providers can use it. Additionally, they will work on projects tied to information blocking; a primer on APIs and FHIR; data exchange versus document exchange; an overview of information blocking; and HIM’s role in all of these topics.