August 07, 2019
ONC Takes Aim at Data Sharing and Interoperability
By: Matthew Michela
Full interoperability and the unimpeded flow of non-proprietary clinical data are essential to innovation and advances in patient care. Still, despite a variety of efforts over the decades, the otherwise technologically advanced U.S. healthcare system has made only sporadic and partial advances toward that goal. Systems remain isolated and data is blocked.
The interoperability and data sharing provisions of the 21st Century Cures Act were intended to finally change this situation.
The Cures Act and health IT
While the 21st Century Cures Act, passed at the end of 2016, is mostly devoted to funding various medical research, it also contains provisions intended to finally achieve interoperability and prevent data blocking in healthcare.
While Congress passed the Cures Act, specific rulemaking is being done by The Office of the National Coordinator (ONC), a staff agency within Health and Human Services (HHS). The ONC coordinates between the vast number of healthcare stakeholders, advancing and publicizing standards through communications and public meetings.
The two issues of interoperability and data sharing somewhat overlap, with interoperability mostly referring to technical capabilities of software and systems to exchange and use data, while data sharing refers more to procedural or bureaucratic barriers to secure data exchange. This spectrum of barriers currently makes exchanging healthcare data extraordinarily difficult. Even with full intent to collaborate, organizations have to overcome the technical barriers — and in many cases, that collaborative intent is missing as hospital systems regard their own clinical data as an asset of some value, and put up arbitrary and unnecessary barriers to access.
Interoperability and innovation
Other areas of the economy, from transportation to manufacturing to going out for the evening, have been transformed by the free flow of data available through application programming interfaces (APIs). Despite a lack of market forces, the Cures Act intends to create the same kind of informational exchange through a range of incentives and fines for noncompliance.
For interoperability, the ONC is creating an environment that supports the development of an entire ecology of APIs. Innovative companies know that they cannot create a new environment of machine learning-based decision support enabled by APIs without appropriate access to de-identified clinical data to train those models. The ONC rules are based on deep analysis of the challenges for data and interoperability from clinical EMRs into health systems with their key applications. It is explicit about the gaps or challenges innovators face in unlocking and operationalizing this data for the benefit of patients.
The key directive in the Cures Act is that clinical data should be shareable “without special effort.” These three words are essential for enabling the free exchange of healthcare data. The ONC believes this means the use of modern, industry-specific standards by all players. There are already many APIs, but their vendor specificity slows their uptake. It often takes many hours of customization for a user to get even a trickle of data, and smaller vendors do not have the resources to achieve even that.
The ONC also has specific programs to interconnect health information exchanges (HIEs) and health information networks (HINs) under the standards established by the Trusted Exchange Framework and Common Agreement (TEFCA).
Data sharing and HIPAA
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides a workable foundation for data sharing. In contrast to the complex and incomprehensible End User License Agreements (EULAs) that consumers face whenever acquiring a new piece of software, HIPAA has enumerated uses for treatment, payment and operations, which provides operational clarity for secondary uses of data while still insuring privacy.
But HIPAA has often been perversely interpreted over the years, typically to justify a refusal to share data. The Cures Act takes specific aim at data blocking, which is explicitly illegal. Rules are being created to define allowable exceptions, but the goal is to make these exceptions explicit and limited.
Most importantly, the Cures Act aims to eliminate the barriers patients currently face accessing their own medical records. Institutions often raise procedural and financial hurdles for patients, who end up suffering the most from the deficiencies in the current system of information exchange. Ultimately, it must be patients who control their own data, not clinicians or vendors.
Sharing or consequences
While specifics are still being worked out, there will be clear consequences for failing to comply with the requirements for data sharing. Electronic medical record (EMR) providers, HIEs and HINs are the entities subject to civil and monetary penalties of up to $1 million “per event” enforced by the Office of the Inspector General.
Perverse incentives, status quo bias and entrenched competitiveness have all contributed to a suboptimal system, where information is too often inaccessible. The problems are both technical and procedural. The change will be difficult and expensive, and no market participant will change unless there are clear positive and negative incentives, and coordination so that everyone moves forward together.
With these incentives in place and a clear path forward, eager healthcare innovators will gain access to the data needed to create the next generation of healthcare technology.
About the author: Matthew Michela is the president and CEO at Life Image.
Matthew A. Michela
President and CEO