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How Will Interoperability Fare in the Trump Era?


Although the future of the initiative is unwritten, healthcare organizations can prepare for policies to come.

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According to the West Health Institute, improving interoperability between health systems could save the United States an estimated $30 billion per year in healthcare costs. With the current administration citing interoperability as one of its 2 top healthcare priorities, along with the implementation of the 21st Century Cures Act, the promise of interoperability should be a foregone conclusion. But legislative priorities can be a funny thing. What happens when an administration’s own policies are not necessarily aligned with their priorities?

Trump Administration Priorities That Support Interoperability

In late 2016, President Barack Obama signed the 21st Century Cures Act. Part of that law directly encourages interoperability, defining the term and outlining monetary penalties for organizations who fail to ensure data sharing. Vendors and providers caught hoarding data could face stiff penalties.

Given President Donald Trump’s promise to roll back the Affordable Care Act, or Obamacare, worries quickly arose about the future of the Cures Act when he was elected. But unlike Obamacare, the 21st Century Cures Act garnered bipartisan support when it passed, and the administration’s early actions seemed to indicate a commitment to the bill. Although parts of the Cures Act have yet to be realized, the plan remains in place and the law will receive additional funding in 2018. Framework development is still in the comment phase, according to regulations.gov, but it appears interoperability will remain a focus.

The appointment of Seema Verma as administrator for the Centers for Medicare and Medicaid Services, can also be put in the win column for interoperability. Although tasked with upholding the principles of Obamacare, a program she fought hard to dismantle, Verma remains committed to innovation that connects even the poorest segments of the population with their health data. According to Mattie Quinn of Governing.com, Verma wants to loosen bureaucratic restrictions on innovation while “emphasizing that recipients take personal responsibility for their health.” Verma would be “focused on interoperability and patient empowerment,” according to her recent comments at the Office of the National Coordinator for Health Information Technology’s (ONC) annual meeting.

In mid-December, Jared Kushner, the president’s senior adviser and son-in-law, held an electronic medical records (EMR) and interoperability meetup at the White House. The meeting, co-chaired by Verma and acting Department of Health and Human Services (HHS) Secretary Eric Hargan, indicated the administration’s commitment to interoperability initiatives. Whether the breakout sessions yielded anything tangible remains unknown, but the administration seems to be keeping its promise to encourage better sharing of information.

Trump Administration Policies That Challenge Interoperability

Although interoperability remains a Trump administration priority, financial resources to support that priority seem to fall short. The ONC, which develops and enforces key health information technology (IT) strategies, could see its capabilities reduced. In March 2017, the ONC announced a 37% reduction in financial resources. In practical terms, it will have to make due with a budget of just under $40 million and a task list that has not changed.

The ONC’s 2018 appropriations estimate states that “interoperability is crucial to ensure information is available when and where it is needed.” It also lists several support offices that will cease to exist: The Office of Care Coordination, the Office of the Chief Privacy Officer, and the Office of Clinical Quality and Safety will all be eliminated, which could make interoperability standards harder to develop and enforce. Health IT adoption programs may also be shut down. The program helps rectify EMR issues arising from implementation, a vital component of interoperability.

Brace Yourselves—This Could Hurt

With resources greatly reduced, innovation may take a hit. The American Medical Informatics Association’s vice president of public policy issued a statement last March claiming that Trump’s proposed cuts to public health budgets would greatly hinder “our national capacity to advance and deploy better cures for patients faster.”

The greatest impact is likely in the area of adoption support. In place of direct assistance, this could result in greater focus on education, monitoring, and removal data blocking practices that block the flow of data. Hundreds of billions of dollars would be cut from all agencies under the HHS umbrella over the next decade. Although the ONC states that resources from the closed offices will be reallocated into other departments to make the agency leaner, it would be naïve to suggest that interoperability initiatives would not be negatively affected.

Where 2 Roads Meet

The Interoperability Standards Advisory (ISA) was formed to coordinate the assessment, identification, and public awareness of interoperability standards. Last year, its scope was expanded to include consideration for research and public health interoperability, and for 2018 it has been updated to include recommendations made by the public during the comment period. ONC said it will continue to support the creation of the recommendations, and vendors and providers would be well-advised to pay attention to updates from the group. It might help them make more informed choices with their interoperability goals and to understand the limitations of those choices.

Until the actual framework for interoperability standards has been completed, it will be hard to measure actual impact of these meetings and policies. But both related agencies and the healthcare industry continue to recognize the importance of interoperability. Even with a considerable reduction and redistribution of resources, healthcare entities could still find a way forward by hiring the right talent for their IT initiatives. They will also have to be smarter about how they map out adoption of interoperability standards.

It’s widely accepted that wasted resources are a major problem that drives healthcare costs. Adopting workflow solutions and comprehensive data aggregation strategies and understanding how consumerism affects interoperability may help organizations meet interoperability goals. Institutions should also adopt their own ongoing training standards as fundamental policy. Investing in resources to become more efficient can be a way to lessen the negative impact of any new administration’s policies.

Shereese Maynard, MS, MBA, is a healthcare strategist and policy expert who has worked with hundreds of providers across the country. For the past 5 years, she has served as the managing director of EnvisionCare and speaks nationally on health IT and blockchain uses in healthcare.

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