AS HITECH funding wanes and health information technology innovations flourish, National Coordinator for Health Information Technology Micky Tripathi’s keynote from the SHIEC 2021 Conference highlighted the groundbreaking work being done in the health information technology (health IT) space.
The keynote highlighted the nexus of technology, business, and policy and the role of health IT in pandemic and public health responses. Tripathi identified opportunities for health IT, states, and federal government to meet current information gaps including addressing health equity and the fragmented public health system.
Information Sharing, Not Information Blocking
When discussing the 21st Century Cures Act, Tripathi revealed that he has a rule of saying information sharing instead of information blocking to focus on the opportunities the rule can bring. Information blocking is defined as a practice by a health IT developer of certified products, health information network (HIN) or exchange (HIE), or provider that prevents or materially discourages the access, exchange, or use of electronic health information.
Tripathi noted that the negative framing around information sharing assumes that every actor is a presumed information blocker until proven innocent. However, information blocking has been a priority in the industry, and the Office of National Coordinator for Health IT (ONC) is seeking to fill in gaps in enforcement of information sharing in collaboration with the Office of Inspector General (OIG).
He emphasized that education is a key part of achieving interoperability and preventing information blocking. Any rulemaking must also be accompanied by materials and outreach that improves general understanding of the issues. To assist stakeholders in understanding information blocking ONC has development education materials and FAQs to address topics such as, what is electronic health information (EHI), the practical ways of making EHI available, and the process, technology, and policy questions for the entities and providers involved.
While technology may be in place or a certain network is available, there is a need to work with ONC’s partners to help identify a process for utilizing available connections and move towards a more interoperable, connected healthcare industry. ONC is working with OIG to codify the enforcement rules for health IT developers of products and health information networks with an expected final rule in September.
Health Information Exchanges as Incubators for Innovation
HIEs allow healthcare professionals and patients to access and securely share patient medical information electronically. Beginning in 2009, HITECH funding drove investments into HIEs to improve the quality, safety, and efficiency of health care delivery. Often regional or state-wide, HIEs helped to satisfy Meaningful Use requirements and facilitate value-based payment approaches by enabling better care coordination across the health care continuum. While Medicaid HITECH funding is expiring this year, Tripathi also said that HIEs can use other Medicaid funding to continue data modernization and interoperability.
As HIEs continue to grow and evolve, Tripathi noted that they have been “tremendously valuable as incubators of leading dynamic business models at the intersection of policy, technology, and process, connecting local environments with value-added services and furthering interoperability network.” As a partner to HIEs across the country, Audacious has seen the impact that improved health information exchange can have on patient outcomes, quality, cost savings, and innovative business models.
Achieving true interoperability, however, can be difficult without common data standards and trust. In 2022, the Trusted Exchange Framework and Common Agreement (TEFCA) will be live, which Tripathi hopes will help to create a uniform standard for data and interoperability and trust that allows for the ubiquitous availability of baseline information. TEFCA is a provision of the 21st Century Cures Act, calling on ONC to “develop or support a trusted exchange framework, including a common agreement among health information networks nationally.”
In a July Health IT Buzz blog, Tripathi underscored how the COVID-19 pandemic illustrated that clinical and public health systems are siloed in different “interoperability universes.” Current nationwide networks support exchange providers for treatment purposes, but neglect other use cases like public health, individual patient access, care management, population health, supply chain awareness, and emergency response. TEFCA seeks to expand the set of purposes for which data must be exchanged across networks and address other gaps that ONC perceives in the current data exchange ecosystem.
During the SHIEC session, Tripathi further outlined his desire to build upon certified health IT technology and health IT capabilities to allow for easier connections with nationwide networks, and siloed sectors like public health and social services, that currently experience difficulties in establishing connection points.
The Intersection of HIEs and Public Health
Tripathi commented that ONC is currently working with the CDC to improve public health data, including connecting public health agencies to HIEs. Out of ONC’s seven priority areas, two are focused on public health including developing a USCDI extension model and including public health as a first-year participant in TEFCA. While there are multiple levers to establishing better public health data through public and private partnerships, several panelists throughout the conference noted the importance of HIEs in filling these critical gaps through partnerships with public health at a local level.
In addition to being a key theme in Tripathi’s speech, HIEs as a public health utility was a common topic at the SHIEC conference. David Horrocks, President and CEO of CRISP, noted in the Public Health Data Utility Model for HIE session that completeness of data is essential for HIEs to be a public utility. Yet vital statistics, length of stay, and chronic condition flags exist in most HIE capabilities. Combined with COVID-19 data, there is no need to create a completely new public health infrastructure to reinvent data that is already in HIEs.
Panelists in the Public Health Data Utility Model for HIE session outlined that to fully bypass siloed public health data, there is a need to have incentives from strong state partners, federal support and regulatory guidance.
The consensus from Tripathi and stakeholders at the SHIEC conference is that, while there is more work to be done to fully utilize HIEs as a public health utility, there is both a strong need and interest in using health IT to address public health challenges.
Health Equity and the Role of Health IT
The COVID-19 pandemic has also led to a renewed focus on health equity as a priority for the federal government. Lisa Bari, Interim CEO of SHIEC, asked Tripathi about ONC’s plan to address health equity and operationalize and implement insights from ONC’s recent Social Determinants of Health (SDOH) and Interoperability Workshop.
Before responding, Tripathi cautioned that it is important to note that ONC is only one piece of the puzzle when it comes to health equity. However, one of the key areas ONC has jurisdiction over is data, and Tripathi noted, addressing health equity starts with data. Variation in implementation and adoption has led to issues in the collection and uniformity of health equity data. For example, ONC requires race, ethnicity, and language as part of its health equity data requirements, in addition to a CDC data set with over 900 categories to capture race, ethnicity and language data.
While these requirements are in place, the variability of adoption presents a great challenge in collecting data on health equity, which leads to gaps and inability to stratify data. At the beginning of the pandemic, it was clear that there was no robust data surrounding health disparities, making it difficult to improve health equity without understanding the totality of the problem.
Health equity is an urgent priority for the federal government, but as Tripathi noted, HIEs can play a critical role in ensuring that race, language, and ethnicity are included in patient records and in identifying where individuals experiencing health disparities can be directed to address gaps and work towards health equity.
Promising Future for HIEs
Tripathi outlined ONC’s role in addressing some of the key issues in healthcare, including the future of interoperability, health equity, and the expanded role of HIEs in healthcare as capabilities expand.
SHIEC 2021 featured a wide range of health information exchanges, vendors, and policy officials highlighting the innovative work that health IT can play in solving some of the major challenges the United States faces across healthcare and public health.
About the Author
Eliana Donner-Klein is Senior Associate for Marketing at Audacious Inquiry, a national industry-shaping health IT company that developed the single most impactful platform for aligning better care across the healthcare continuum. At Audacious, she works to support marketing and business development strategy through market research, case study and content creation, and product marketing. Eliana has been a patient advocate since 2015, working to raise awareness about living with chronic migraine and other invisible illnesses through writing, speaking engagements, consulting, and political advocacy.
Donner-Klein previously worked as an Associate at Sirona Strategies where she focused on a variety of health policy issues including Medicare and Medicaid, value-based care, health information technology and interoperability, telehealth, and the social determinants of health. In addition to her policy and regulatory work, she worked as the communications manager to redesign and run coalition websites, strategic communications campaigns, and thought leadership through events and newsletters.