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AAFP Opposes Direction Of Federal Patient Data Access Efforts

Posted on April 4, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Not long ago, a group of federal agencies announced the kickoff of the MyHealthEData initiative, an effort designed to give patients control of their data and the ability to take it with them from provider to provider. Participants in the initiative include virtually every agency with skin in the game, including HHS, ONC, NIH and the VA. CMS has also announced that it will be launching Medicare’s Blue Button 2.0, which will allow Medicare beneficiaries to access and share their health information.

Generally speaking, these programs sound okay, but the devil is always in the details. And according to the American Academy of Family Physicians, some of the assumptions behind these initiatives put too much responsibility on medical practices, according to a letter the group sent recently to CMS administrator Seema Verma.

The AAFP’s primary objection to these efforts is that they place responsibility for the adoption of interoperable health IT systems on physicians. The letter argues that instead, CMS should pressure EHR vendors to meet interoperability standards.

Not only that, it’s critical to prevent the vendors from charging high prices for relevant software upgrades and maintenance, the AAFP argues. “To realize meaningful patient access to their data, we strongly urge CMS to require EHR vendors to provide any new government-required updates such systems without additional cost to the medical practice,” the group writes.

Other requests from the AAFP include that CMS:

  • Drop all HIT utilization measures now that MIPS has offered more effective measures of quality, cost and practice improvement
  • Implement the core measure sets developed by the Core Quality Measures Collaborative
  • Penalize healthcare organizations that don’t share health information appropriately
  • Focus on improving HIT usability first, and then shift its attention to interoperability
  • Work to make sure that admission, discharge and transfer data are interoperable

Though the letter calls CMS to task to some degree, my sense is that the AAFP shares many of the agency’s goals. The physician group and CMS certainly have reason to agree that if patients share data, everybody wins.  The AAFP also suggests measures which foster administrative simplification, such as reducing duplicative lab tests, which CMS must appreciate.

Still, if the group of federal organizations thinks that doctors can be forced to make interoperability work, they’ve got another thing coming. It’s hard to argue the matter how willing they are to do so, most practices have nowhere near the resources needed to take a leading role in fostering health data interoperability.

Yes, CMS, ONC and other agencies involved with HIT must be very frustrated with vendors. There don’t seem to be enough sanctions available to prevent them from slow-walking through every step of the interoperability process. But that doesn’t mean you can simply throw up your hands and say “Let’s have the doctors do it!”

Before Investing In Health IT, Fix Your Processes

Posted on August 2, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Recently, my colleague John Lynn conducted a video interview with healthcare consultant and “recovering CIO” Drex DeFord (@drexdeford) on patient engagement and care coordination. During the interview, DeFord made a very interesting observation: “When you finally have a process leaned out to the point where [tech] can make fewer mistakes than a human, that’s the time to make big technology investments.”

This makes a lot of sense. If a process is refined enough, even a robot may be able to maintain it, but if it remains fuzzy or arbitrary that’s far less likely. And by extension, we shouldn’t automate processes until they’re clearly defined and efficient.

Honestly, as I see it this is just common sense. If the way things are done doesn’t work well, who wants to embed them in their IT infrastructure? Doing so is arguably worse than keeping a manual process in place. It may be simpler — though not easy — to change how people work than to rewrite complicated enterprise software then shift human routines.

Meanwhile, if you do rush ahead without refining your processes, you could be building dangerously flawed care into the system. Patients could suffer needless harm or even die. In fact, I can envision a situation in which a provider gets sued because their technology rollout perpetuated existing care management problems.

Unfortunately, CIOs have powerful incentives to roll ahead with their technology implementation plans whether they’ve optimized care processes or not.

Sometimes, they’re trying to satisfy CEOs pushing to get systems in gear no matter what. They can’t afford to alienate someone who could refuse to greenlight their plans for future investments, so they cross their fingers and plunge ahead. Other times, they might not be aware of serious care delivery problems and see no reason to let their implementation deadlines slip. Or perhaps they believe that they will be able to fix workflow problems during after the rollout. But if they thought they could act first and deal with workflow later, they may get a nasty surprise later.

Of course, the ultimate solution is for providers to invest in more flexible enterprise systems which support process improvements (including across mobile devices). To date, however, few big health IT platforms have strayed much from decades-old computing models that make change expensive and time-consuming. Such systems may be durable, but updating them to meet user needs is no picnic.

Eventually, you’ll be able to adjust health IT workflows without dispatching an army of developers. In the meantime, though, providers should anything they can to perfect processes, especially those related to care delivery, before they’re fixed in place by technology rollouts. Doing so may be a bit disruptive, but it’s the kind of disruption that helps rather than hurts.