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December 2016

What Lies Ahead?
By Lee DeOrio
For The Record
Vol. 28 No. 12 P. 8

Noting that the health care industry is in flux is hardly jaw-dropping. The nature of the beast says that's pretty much true every year. So instead of sounding alarms about what's in store for 2017, For The Record (FTR) charges several industry leaders with answering unique true/false questions designed to provide insights on a few of the day's more pressing issues.

FTR: True or false, information blocking among EHR vendors is occurring at an unacceptable rate.

Chris Bradley, CEO of Mana Health: Although notoriously fragmented, a handful of EHR vendors still control the vast majority of the market. This allows them to tightly control the flow of health care information. Because of this, access to valuable data stored in their proprietary systems is extremely limited. Only 6% of EHR vendors meet interoperability standards and they often charge prohibitively expensive fees to connect to their technology. This is a massive problem since access to these very data is an essential ingredient to a vast number of data-driven solutions. From personalized medicine and decision support to care coordination and population health, access to data is critical to the basic premise of value-based care.

EHR-driven data access limitations block Health and Human Services' (HHS) agenda to transition providers to value-based care models. Instead, they indirectly support the status quo by slowing the adoption of more sophisticated data-driven solutions. If the United States is to succeed in its desperate effort to improve quality and drastically reduce the costs of health care, EHR vendors will need to make exchanging information much more simple and cost-effective. Fluid data exchange will power the dynamics that will make value based-care organizations such as accountable care organizations and health information exchanges (HIEs) thrive.

Currently, the market is full of claims that Epic, the largest EHR vendor in the United States today, is actively blocking the flow of health care data. A recent Politico article by Darius Tahir cites the American Board of Family Medicine, American Academy of Ophthalmology, American College of Cardiology, and American Urological Association as having all claimed Epic limits their access to data and charges exorbitant fees to gain data access. Epic is not alone in this practice. Many physician groups have also levied claims that Practice Fusion and eClinicalWorks are blocking potentially life-saving information from being obtained.

The HITECH Act provided EHR vendors with billions of dollars in incentives to digitize health care in an effort to make the whole system more efficient, higher quality, and lower cost. These vendors may have lost sight of HHS' noble triple aim. To succeed in bringing health care into the 21st century and beyond we need to start at the beginning: getting data to the right people at the right time and in the right format without actively blocking or excessively charging for it.

FTR: True or false, although most industry experts say the ICD-10 transition was much ado about nothing, there will be a sizable increase in denials in 2017.

AJ Johnson, general manager at TriZetto: False. On October 1, 2016, there were 1,700 new ICD-10 diagnosis codes introduced. New diagnosis codes are included in most sections of the ICD-10 code set. On top of this, the Centers for Medicare & Medicaid Services (CMS) ended the one-year leniency it incorporated and is imposing tighter restrictions on diagnosis coding. Commercial payers, some of whom had issues of their own deploying ICD-10 edits, are expected to follow CMS' plan. Given that providers have had two years to prepare and refine their ICD-10 compliance, one would not expect a significant impact in 2017. However, this is dependent on providers proactively comparing their frequently used diagnosis codes against the changes introduced on October 1, 2016, and making the necessary changes to their billing and coding.

FTR: True or false, the Medicare Access and CHIP Reauthorization Act (MACRA) will begin to noticeably reshape the role of HIM professionals.

Lauren Riplinger, JD, senior director of federal relations at AHIMA: True. One of the underlying tenets of MACRA is the role of quality data in the delivery and coordination of care. As HIM professionals, this is what we do, and we do it well, as evidenced by our work in information governance. As we begin this multiyear journey of MACRA implementation, HIM professionals will play an increasingly important role in ensuring that the data being used to deliver care under MACRA's authority are useful, relevant, and secure. We also believe that MACRA is indicative of the changes we continue to expect under delivery system reform as we shift toward value-driven health care.

FTR: True or false, in light of the recent breach at the New England Healthcare Exchange Network, providers are likely to be leery of sharing data with an HIE.

Matthew Weinstock, director of communications and public relations at the College of Healthcare Information Management Executives: Any breach of a health care organization gives us reason to pause and heightens concerns across the industry, but we can't slow down efforts to improve information sharing across the industry—that includes working with HIEs. What's important is that we lean on each other to share best practices. We also have to do a better job of keeping each other up to date on threats that could impact our organizations. Provider organizations should also be working with their partners—other providers, vendors, and HIEs—to adopt strong risk management and security protocols.

FTR: True or false, value-based care will force providers to make patient engagement more of a priority.

Nancy Ragont, senior manager of customer insights at CDW: It is true that value-based care will motivate providers to make patient engagement a priority. Patient engagement efforts are at a high in today's health care industry, as evidence increasingly shows a strong link between more involved patients and improved patient outcomes. As the US health care system shifts from a fee-for-service to a pay-for-performance model, the need for expanded patient engagement becomes paramount as providers seek to improve outcomes and reduce costs and readmissions. With patient care and the bottom line at stake, providers are increasingly motivated to find new ways to promote effective patient engagement. In a 2016 CDW study, "Patient Engagement Perspectives," 60% of providers said that improving patient engagement is a top priority at their organization and 58% said they improved their engagement with patients in the past two years. Many providers (70%) said that the top motivating factor to improving patient engagement is that it is an important part of improving overall care, followed by technology advancements and meaningful use requirements.

To improve engagement with their patients, many providers are preparing for action. The CDW report found that 67% of providers are working on a way to make personal health care records easier to access, and 28% said they either already provide or plan to provide patients with the ability to merge information stored on their mobile devices or wearable devices with the provider's online patient portal. These signs are encouraging as we move into an era where patients are more active participants in their own health care and providers will increasingly need to focus on improving experiences with their patients. We are seeing that patients want to be more engaged, and providers now have more resources than ever to help them do so successfully, ultimately helping to improve care outcomes and reduce the cost of care.

— Lee DeOrio is editor of For The Record.