Health IT Report to Congress: A Summary

Health IT Report to Congress Cliffs Notes

In its 2018 Report to Congress, the Office of the National Coordinator (ONC) for Health Information Technology provided a progress report on how U.S. healthcare data-sharing is going with its “Annual Update on the Adoption of a Nationwide System for the Electronic Use and Exchange of Health Information.” If the title doesn’t entice you to read it (nevermind that it’s 22 pages), no need to worry. We’ve read the whole thing so you don’t have to.

What You Need to Know:

This 2017-2018 report marked the first report since 2016 but still incorporated 2015 figures: 96 percent of non-federal acute care hospitals and 78 percent of office-based physicians have adopted “certified health IT.” These figures were roughly the same as the year prior, 2014, so it may be safe to say we have hit a proverbial “wall” with adoption rates, at least as far as reporting access is concerned. The hurdles, as before, still exist around data’s secure access, and ease in sharing data among case team members (spoiler alert: only around half of office-based physicians are exchanging info outside of their organization).

  • Three major roadblocks exist with our “current state:
    1. Patients are not empowered to truly manage their health because they can’t access their own information.
    2. Providers are often missing patient data at the “point of care” (multiple providers maintain different pieces of data, own different systems and/or those systems are designed by different developers).
    3. Payers lack access to clinical data for groups of their covered individuals (they can’t assess value).
  • The overarching “theme” we need to re-write is regarding how data is “accessed:” via multiple portals/logins, none of which are talking to one another, and via one-off informational grabs. In essence, when only one record can be viewed at a time, this lacks the “computational visibility” to determine which providers offer the highest care at the lowest cost.
  • Until multiple records can be accessed at a time, enabling more “outcomes” information, current solutions such as “machine learning and AI” which are transforming other industries, cannot be applied to healthcare.

The main suggested solutions to improve our “future state” include the provisions initially set forth with the 21st Century Cures Act:

  • Development and use of upgraded health IT capabilities

  • Expand on transparent expectations for data sharing, including through open APIs

  • Improve health IT end-user experience, reducing the administrative burden


Diagram showing need for interoperable access for patients, providers, and payers

The ONC’s visualization of Cures Act expansions will ideally yield improvements across the board, streamlining processes for patients, providers, and payers alike.

Credit: 2018 HITECH Report to Congress

Of the proposed solutions, “open APIs” seem to hold the most potential with patient-facing solutions, including smartphones and mobile apps. According to the data used for this report, “Less than five percent of individuals transmitted their health record data to a service or app.”

Surely, we can do better.

The Centers for Medicare & Medicaid Services (CMS) and ONC both agree and have since made two important follow-up announcements to kick-start more interoperability goals in 2019, made in conjunction with the HIMSS annual conference.

Report ‘Recommendations’ Kick-Started with New Policies

CMS has set a 2020 goal for 125 million patients (those participating in Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans, and health plans in the federal Affordable Care Act exchanges) to be provided with “free electronic access” to their personal health data, including all medical claims. As for any antagonists that continue “information blocking,” or those providers who have yet to add digital contact information to their National Provider Identifier (NPI) entries, CMS’s hope is that “public reporting” will motivate better behavior — this being akin to having your name written “on the board” in grammar school.

And specifically dealing with open APIs, the ONC in concert with these objectives released a “Notice of Proposed Rulemaking.” Unless one of seven “reasonable and necessary” exceptions exist for why an organization is blocking information, they could be subject to a $1 million penalty per violation.

Both CMS and the ONC have called for feedback to learn how more private sector innovation could find its way into public sector processes and standards. One example of this: CMS is seeking Requests for Information (RFIs) on how to improve patient matching, absent a Unique Patient Identifier (UPI), which HHS has not been granted funding to enact due to various HIPAA and other security concerns.

Expect to hear more buzz in health IT circles about whether these latest measures will improve health information exchange (HIE) rates outside of organizations and solve some of the other 2019 goals toward much-needed transparency — on both the provider/payer value assessment front, and with patient-facing solutions.

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