Verma: Public Sector Must 'Step Up' to Advance Interoperability

Keith L. Martin

February 12, 2019

ORLANDO — In the public-private partnership to reduce the cost of US healthcare and create true interoperability of patient data, the federal government believes it is taking a significant step forward. And it would like to see the private sector take that step along with it.

This message comes one day after the Centers for Medicare & Medicaid Services (CMS) and the National Coordinator for Health Information Technology (ONC) unveiled proposed rules to improve interoperability and increase patient access to digital health data. The complementary rules were released on the heels of the Healthcare Information and Management Systems Society (HIMSS) 2019 Conference here in Orlando.

Included in the rules is the proposal that anyone treating Medicare and Medicaid beneficiaries be able to provide that patient's data in the application of the patient's choice, and at no cost. By 2020, hospitals would also be required to provide electronic notification to physicians when their patients are admitted, discharged, or transferred.

Furthermore, the rules set penalties for any "information blocking" preventing patients from accessing their data.

CMS Administrator Seema Verma

Speaking to Medscape Medical News at HIMSS, CMS Administrator Seema Verma said that greater interoperability of healthcare data has been a request of physicians dating back to the beginning of her tenure in 2017. And, through its "Patients Over Paperwork" initiative that evaluates and streamlines regulations to reduce physician burden, this is another step by her agency to empower doctors and patients.

"It works well for the physician that when the patient presents, they have the entire medical history," Verma said. "This way, [physicians] know the care they are providing is safe and it gives them better opportunities to provide high-quality care with better results and outcomes."

Verma added that when doctors have the complete record for a patient, they are less likely to duplicate tests, hence saving money, and can truly engage with the patient by having the total picture of his or her health history.

"[This rule] will unleash innovation in a way we've never seen before," she said. "I call it the digital data revolution."

Call to Action to Vendors, Private Payers

While the proposed rule would only affect those receiving care via public programs, Verma said the hope is that the private market will follow. In building a health IT infrastructure for 125 million patients, she said, the agency in turn hopes to create patient demand from those under commercial health plans.

"We hope to create patient demand, where, say the patient says, 'When I was in Medicare, I could access this data,' and now they will ask their private insurer [for that data]," she said. "I hope that's where the market goes."

And it is not just private insurers whom Verma hopes follows CMS' lead. While health IT vendors who support CMS patient plans would be required to follow the proposed rule, she hopes other vendors of electronic health records (EHRs) also answer the call to provide greater interoperability and patient data exchange.

"[This rule is] about unleashing the data," Verma told Medscape Medical News. "It's about putting patients in the center of the healthcare system and empowering them with the information they need. Also, from a larger standpoint, we are all in this together. We all have to work together and try and bend the cost-growing curve and make our healthcare system sustainable for the future of our country."

A "Call to Action" for the Private Sector

That call for better collaboration between the private and public sector was repeated in the keynote of the HIMSS conference from current federal administrators like Verma, as well as former Health and Human Services Secretary Mike Leavitt (2005-2009) and former ONC Coordinator Karen DeSalvo, MD (2013-2016), who also served as acting secretary at HHS afterward.

Leavitt, the founder of consultancy Leavitt Partners, noted that healthcare needs to advance to a larger picture of the patient's world, including social determinants of health. That requires greater access to data, he noted, and new data to look at community-related issues.

This is a moment for us, as an industry, to step up. We need to see this rule as a call to action for the private sector. Former HHS Secretary Mike Leavitt

"There is a lot of collaboration already in health IT…but there's also a lot of work to do," he said. "And we won't be able to do it by CMS simply developing a rule. We're going to have to get involved as an industry. This is a moment for us, as an industry, to step up. We need to see this rule as a call to action for the private sector…We need to step up and we need to move forward."

Verma added that the private sector needs to "step up" with creative apps for patients to use on their smartphones to understand the data that CMS is opening access to.

DeSalvo, a physician who now works as a professor of medicine and population health at the University of Texas at Austin, noted the "sense of urgency" of the CMS initiative and the call for greater interoperability and patient access.

"It was fine to go at a slower pace when we were working on flip phones and BlackBerrys…but the world has dramatically changed, which means we not only have to keep up as it is a good business idea, but it is the right thing to do," she said. "If we have tools and technology at our disposal to improve the health of the people we serve, we ought to [have] a sense of urgency like this."

In closing her keynote speech, Verma noted that while the proposed rule is the start, CMS and ONC both want input from the private sector on their proposals and how to move forward through various healthcare scenarios.

"The federal government has already spent $36 billion dollars on interoperability, so it might be best for the private industry to take the next step," she said.

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