Health IT ‘chasm’ prevents shift to value-based care, AMIA contends

The transition in care models will be slowed because data is locked up in EHRs, says Julia Adler-Milstein.

Despite the widespread adoption of electronic health record systems by providers, the existing healthcare information technology infrastructure is not designed to support the industry’s transition to value-based care from fee-for-service.

That’s the message the American Medical Informatics Association delivered this week to lawmakers and their congressional staffs in Washington.

In an April 5 briefing on Capitol Hill, AMIA unveiled its policy prescriptions for “liberating” data for patients, improving interoperability for clinicians, and enhancing the capacity for research and innovation—all in an effort to enable value-based care.

Specifically, the group offered 17 policy recommendations detailed in a just-published paper in the Journal of the American Medical Informatics Association and presented in their briefing to legislators.

“Provider organizations pursuing new models of healthcare delivery and payment are finding that their electronic systems lack the capabilities needed to succeed,” states the new paper. “The result is a chasm between the current health IT ecosystem and the health IT ecosystem that is desperately needed. Both the technologies themselves and the application of those technologies and the data they contain urgently need improvement to support the transition to value-based care.”

Also See: Providers experience challenges in transitioning to value-based care

Nonetheless, making the transition to the point where the industry’s HIT infrastructure can support quality care—instead of quantity—does not require a major overhaul, contends Julia Adler-Milstein, lead author of the paper and associate professor at the University of Michigan’s School of Information.

“There’s a set of near-term achievable actions or policies that we think could really advance where we are today to where we need to be, to meet the needs of the multiple stakeholder groups that health IT is supposed to be serving—patients, providers, researchers and innovators,” she says. “The core focus underlying the recommendations is really data access and accessibility. That is the key to solving so many of the problems.”

Adler-Milstein adds that “as long as the data is locked up in each individual EHR, it just makes it very hard to make progress.”

In particular, AMIA’s policy recommendations are designed to:
  • Enable patients to have better access to their data in a computable format
  • Improve interoperability through application programming interfaces (APIs)
  • Simplify clinical documentation for reimbursement and quality measurement
  • Do a better job of engaging patients in research
  • Promote an ecosystem of safe, effective and secure health applications
“If we can get the data out in computable format, there’s so much we can do with it, and it would be better for patients, providers, researchers and innovators,” according to Adler-Milstein. “The data is not acceptable and when it is being accessed, it’s just very time- and resource-intensive to get to it and to make sense of it. That’s particularly true for researchers.”

To improve patient access to clinical data, AMIA recommended that the Office of the National Coordinator for Health Information Technology develop EHR certification requirements alongside provider attestation that patient data is transmittable in a manner that preserves computability. “One potential approach is to amend certification, which prohibits the use of the ‘unstructured document’ template as part of the CCDA, and require vendors to develop an import/export functionality for all data maintained electronically, making computable records access easier for patients and less burdensome for providers,” states the paper.

The group also called for clarifying a patient’s HIPAA “right to access” to include a right to all data maintained by a covered entity’s designated record set, or to a digital copy of their legal medical record through guidance by the Office for Civil Rights.

While AMIA sees great potential for patient access to data through APIs, the paper makes the case that they are “nascent, and uncertainties remain about how their technical specifications and governance will inhibit or facilitate patient data access.” Adler-Milstein has concerns that APIs can be designed and implemented in ways that either facilitates or complicates access to data.

“They are not a silver bullet,” she says. “We need to design open, standardized APIs because we don’t want to end up in a situation where a provider or vendor can offer an API, but when you actually go and try to use it, it gives you access to a very limited set of data. We are wary of the fact that some of the strategic interests that have led to the data not being acceptable today could lead to APIs being designed and implemented in ways that don’t really achieve broader data accessibility.”

When it comes to providers, AMIA’s paper warns that a “lack of standardized APIs limits clinician access to external data and knowledge, advanced analytics, and other tools to provide patient-specific cognitive assistance integrated into the clinical workflow.”

To address these shortfalls, the group recommends that federal officials work to ensure that APIs are standards-based and published in the public domain as a component of the federal Health IT Certification Program. AMIA also encouraged continued adoption of 2015 Edition Certified Health IT so that standards-based APIs, published in the public domain, become a standard feature and can continue to be deployed by providers.

In addition, it advises that APIs include core data elements that have received community endorsement resulting from collaborations between specialty societies, informatics experts, standards developers, and health IT vendors.

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