The HHS proposed interoperability rules have engendered controversy in the health IT space.
Released by CMS and ONC last year, the proposed rule would require the health IT industry to adopt application programming interfaces for patients to more easily access their health data and make the flow of information easier. In January, Epic came out strongly against the proposed rule, citing privacy concerns related to third-party use of patient data and former HHS Secretary Tommy Thompson argued it would hurt Epic because the company would have to share its intellectual property.
Epic CEO Judy Faulkner emailed hospital and health system CEOs to oppose the rule, and 60 signed a letter opposing the rule, including NYU Langone, Madison, Wis.-based UW Health and King of Prussia, Pa.-based United Health Services. But others, including Cerner and Microsoft, support the rule as an opportunity to enhance communication between medical professionals and provide better patient care.
What do CIOs think? It's complicated.
"The devil is in the details," said Lee Milligan, MD, senior vice president, CIO and CMIO of Asante Health System. "I am fully supportive of increased patient access and large data set aggregation, which can lead to patient empowerment and tremendous research discoveries. However, there are privacy concerns that are not fully addressed in the current proposal, so I can understand the hand wringing by some. The potential negative consequences of unaccountable and automated access to PHI are real and need to be fully defined."
Stephanie Reel, CIO of Baltimore-based Johns Hopkins University and Health System, is also a member of the ONC's Health IT Policy Committee's Information Exchange Workgroup. In her role, she is committed to focus on interoperability and privacy as well as confidentiality of patient information and other information assets. However, the potential threat of stifling innovation with the new rule is a real point of contention.
"The angst that I feel about the recent interoperability conversation is around the risk to innovation," she said. "I think we need to find a balance that allows us to protect each individual patient, wisely leverage our data assets, while being equally cautious about the protection of intellectual property. I worry a bit about too much control or reluctance to expand our thinking in an innovative way…I don't want us to err on the side of being too careful and too controlling because I think there is some risk that we will not make the next big discovery or cure that dreadful form of cancer."
At the same time, rural healthcare organizations may take a different view due to the size and scope of their operations. "Epic's opposition is a huge frustration," said Shelton Monger, vice president of information services, CIO and corporate compliance officer at Wayne HealthCare in Greenville, Ohio. He finds the proposed rules more appropriate than the meaningful use regulations to achieve interoperability without being punitive. "Smaller, rural sites such as Wayne HealthCare cannot afford Epic nor are they disposed to discussing options with us. Being able to easily share information with tertiary care facilities in our area, and the providers they support, is of paramount importance if we are to stay relevant."
"It’s time to open up the entrepreneurial energy we are all amazed at in the Apple app world and unleash it on healthcare," said Randy Davis, CIO of CGH Medical Center in Sterling, Ill. "Does it make Cerner and Epic a little less relevant? Yes. That of course is the point. I can say with reasonable confidence no matter how far the feds go in requiring interoperability, they won’t go far enough. Attempts to derail it in the name of patient confidentiality or any other excuse is a thinly veiled attempt to keep the gravy train running to only a couple of stops."
HHS is set to release the new rules later this month, with comments from many stakeholders including the American Medical Association and the American Hospital Association. But addressing concerns from across the industry isn't easy, and the agency will likely try to avoid the problems it ran into when mandating EHR, which resulted in technology incompatibility issues, privacy and security deficiencies and physician burnout.
"There is no question that CMS and ONC's purpose of increasing innovation and competition, reducing burden and advancing interoperability, and promoting patient access is laudable," said Bruce Metz, PhD, vice president and CIO of the Accreditation Council for Graduate Medical Education. "My concern is whether the purpose can be met without addressing the vast majority of recommendations put forth, particularly at a time when health systems, providers and patients are still finding their way in a post-EHR world."
Vice President and CIO of University of California System in Oakland Tom Andriola supports the proposed rule to connect healthcare providers and payers with information. "Every patient should have the right to control their own health data, and I feel the government's efforts are in the right direction," he said.
Jeffrey Sturman, senior vice president and CIO of Memorial Healthcare System in Hollywood, Fla., agreed in principle with the goal. "However, this is much more complicated, and we need to enhance care while also balancing privacy. Interoperability rules should be rooted in standards and therefore make this process much more streamlined for all," he said. "The way things are currently proposed, I think will create burden on provider organizations and ultimately would be a very onerous process."
As the lines are drawn between organizations and systems that support the new rules with those that oppose it, both aim to put the patient first. "While interested parties including companies like Microsoft and Epic have differing views about the proposed new rules, there appears to be strong support by all stakeholders for the intent underlying the rules, namely to advance an interconnected healthcare system," said Dr. Metz.
Dr. Milligan agrees, understanding why some have opposed the rule while others support it. "[There are] companies that stand to gain from this rule, so their position is in line with their model," he said. "We can get this right, but it will take balancing access with accountability, no matter where the data ultimately flows."