- A key HHS advisory committee unanimously passed a slate of recommendations Wednesday for the Office of the National Coordinator for Health IT, including a model linking the inclusion of data elements in a national health dataset to milestones and not a timeline as previously proposed, and ranking interoperability standards priorities.
- The Health IT Advisory Committee also outlined 2020 priorities and the myriad problems still to be addressed in the industry, including privacy and security, secondary uses of data, additional work to clarify HHS' two interoperability rules and price transparency.
- Despite industry opposition, HITAC telegraphed interest in creating a separate task force to look specifically at price transparency, with committee member Denise Webb calling it "an area where we can go really deep and wide, and an area of high interest, especially for consumers."
ONC head Don Rucker has envisioned a future where consumers get health data by smartphone and shop for medical services and where new business models benefiting patients and providers crop up through the use of application programming interfaces connecting disparate software systems.
The health IT agency is currently polishing up its final rule covering secure, standards-based APIs and hopes to publish it within the year, pending a review from the Office of Management and Budget. ONC is also working on finalizing the Trusted Exchange Framework and Common Agreement, a nationwide "on-ramp" to connectivity. In September, ONC awarded well-known nonprofit interoperability advocacy group Sequoia Project the role of Recognized Coordinating Entity, which oversees TEFCA's implementation.
But there's much more work to do, HITAC agreed Wednesday. The advisory panel debated tackling several problem areas, including prior authorization, ONC final rule and TEFCA implementation guidance, artificial intelligence, public health emergency standards and secondary uses of health information.
Of the list, however, protecting data, price transparency and payer-to-provider exchange seemed to take precedence.
Fraudulent behavior, mishandling and other misuses of health data are perennial concerns in the sector, especially as the government adopts initiatives that will make the sharing of that data more commonplace.
"I recently heard from a number of high-profile public and private leaders about their concerns, and a lot of industry noise, around potential misuse of data," Aaron Miri, HITAC member and CIO of the University of Texas at Austin Medical School, said. "I think it would help for us to clear this up."
In its proposed rule, HHS hinted it may include prices under the definition of electronic health information in the future, which would mandate disclosure of proprietary pricing. However, the agency withdrew the language following swift industry backlash.
Creating standards around the exchange of health information between payers and providers has particular bearing around the CMS interoperability rule, which would require plans in Medicaid, the Children's Health Insurance Plan, Medicare Advantage and the Affordable Care Act exchanges to provide beneficiaries with free electronic access to their personal health data by next year.
"There's persistent anxiety on the part of payers and providers, with the data being used for specific purposes in the realm of healthcare and perhaps not for others," Sutter Health CIO Steven Lane said. Committee member Sheryl Turney, a data director at Anthem Blue Cross Blue Shield, agreed HITAC should try to "put some guardrails around this scenario."
ONC previously proposed data elements work their way up into the U.S. Core Data for Interoperability, a standardized set of health data that would be required to be interoperable nationwide, in vetting cycles, with each lasting roughly a year. Instead of that time-based model, HITAC voted to improve a USCDI task force idea requiring the data elements meet milestones increasing in severity, with no estimated timeline.
The HITAC-approved model keeps the bar in place for technical specification and testing while creating more clear requirements for promotion, the task force argued.
However, some HITAC members aired concerns about the model. Eliminating a timeline entirely could lead to bureaucratic stagnancy if ONC is flooded with data elements to review, and stakeholders worried a lack of automation could put too much of a burden on providers in terms of inputting data and on ONC for approval.
"This should be a relatively straightforward process," Deputy National Coordinator Steve Posnack said, noting ONC will need to implement a cut-off every year with each data element it has been able to classify up to that point for the next iteration of the USCDI. "I just want to make sure there aren't misaligned expectations," he said.
HITAC also voted unanimously to recommend the USCDI workgroup's proposals that ONC annually review the USCDI process, create a users' guide for data element submission and advancement and run a pilot use case to test the novel USCDI promotion model using a social determinants of health or other specified data class.
The Interoperability Standards Priorities Task Force spent the past year digging into the current state of health IT standards, matching them to the most pressing clinical issues and identifying gaps in guidelines and implementation. HITAC voted in support of the task force's tiered ranking of 39 highest priority recommendations around lab orders and results, closed loop referrals and care coordination, and medication and pharmacy data.
For example, under the latter category, greater adoption of real-time prescription benefit checking was one of the most important concerns identified by the task force. Though the advisory group voted unanimously to approve the recommendations, members said the work needed to go on, whether overseen by HITAC, ONC or another body.
"It's part of the fabric and has to continue," Webb concluded. "There is such a broad landscape of areas we haven't even touched on yet."
The committee meets again Nov. 13.