Providers, payers, new entrants draw battle lines over looming interoperability rules

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Crystal Yednak Senior Manager, Health Research Institute, PwC US January 31, 2020


While the health information technology crowd at the annual meeting of the Office of the National Coordinator for Health Information Technology (ONC) anticipated news about proposed interoperability rules, HHS Secretary Alex Azar addressed those defending the status quo. “Patients need and deserve control over their records; interoperability is the single biggest step we can take toward that goal,” Azar said at the ONC meeting. “Scare tactics are not going to stop the reforms we need.”

The proposed rules released in 2019 would move the industry toward one in which patient data is more accessible through application programming interfaces (APIs) and in which data moves with patients as they change health plans or providers.

Under the proposal, healthcare organizations would not be able to hoard patient data within their own organization while providers would have to provide electronic notification to other providers when patients are admitted, transferred or discharged.

HRI impact analysis

Azar shared his own story of trying to unsuccessfully gain access to his health records in what he described as a “balkanized system.” He told of visiting three providers last year that were all part of a health system that was not interoperable and could not properly share his information within its own organization. “And this isn’t just frustrating. Each of these issues is an opportunity for medical error,” he said.

His comments followed a report from Politico indicating that a large electronic health record system may sue over the rules (the company later softened its language and said it would work with HHS on its privacy concerns).

The American Medical Association and the American Hospital Association have also raised concerns that the freer flow of patient data to third-party app developers and tech companies could lead to the improper use of patient data.

But other stakeholders say that the privacy concerns can be addressed and that the industry must move toward a more interoperable system. On Monday, the CARIN Alliance met with the Office of Management and Budget, usually the final reviewer of any rules, to urge it to release the final rules.

The members in attendance included representatives of electronic health records companies, payers, large tech companies, patient advocates and health systems.

With scrutiny from members of Congress as well, it’s unclear how the battle of words and lobbying efforts will affect the rules’ timeline or text. HRI’s recent report “Beyond IT: Why the regulatory push toward interoperability requires whole organizational responses from providers, payers” outlines both the concerns around the proposed rules and the opportunities. In either case, navigating the privacy and technological changes that will be required by interoperability will require significant investments and attention from healthcare organizations. 

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Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Crystal Yednak

Senior Manager, Health Research Institute, PwC US

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