After considering more than 200 comments to a March 2013 request for information on ways to accelerate health information exchange, the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services have identified a set of principles to guide new strategies.

The principles in three categories--Accelerating HIE, Advancing Standards and Interoperability and Consumer/Patient Engagement--work toward three core goals: To improve the patient experience, improve population health management and reduce the total cost of care, all facilitated by supporting new models of payment. The next step is to develop policies and programs so that information flows to where it needs to be and supports care coordination, said Farzad Mostashari, M.D., national HIT coordinator, during a Web presentation on August 7.

The policies will encourage providers to routinely share information across care organizations. ONC heard from stakeholders that payment models which explicitly encourage HIE will help build a strong business case for data exchange. Consequently, the industry can expect to see new initiatives that could include expanding grants to long-term care, post-acute care, behavioral health and home health to support HIT investments, exploring additional reimbursement codes for telehealth, e-visits and other initiatives to improve care coordination, and extending services of regional extension centers to support HIE adoption, Mostashari said.

Long-term care, post-acute care, behavioral health and home health also could benefit from voluntary certification programs for their information systems. To move HIE to where it becomes a standard business practice, ONC and other units of the Department of Health and Human Services will work to align new regulations and guidance with existing policies to enable patient information to follow the patient. This includes aligning quality measurements across Medicare and Medicaid.

Patrick Conway, M.D., chief medical officer at the Centers for Medicare and Medicaid Services, said the agency is proposing in the upcoming new physician fee structure a “complex care management fee” conditioned on electronic exchange of a summary of care.

New Medicaid initiatives also are envisioned to incorporate HIE into payment policies and to financially support infrastructure costs. The government also wants open source tools that facilitate HIE, Mostashari said. For example, an Admissions/Discharge/Transfer tool could notify a physician that a patient showed up in a different emergency room a week after being discharged from the hospital.

The forthcoming mandate to use the HIPAA electronic attachments transaction standard in 2016 is another way to demonstrate how other regulations can support HIE. For instance, submitting a summary of care record could be a way to comply with an attachments request from an insurer. “We are committed to an incremental but comprehensive and strategic approach to information exchange,” Mostashari said.

A new ONC white paper on principles and strategies for accelerating HIE, informed through stakeholder comments to the March RFI, is available here.

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