Putting Policy Before Standards Can Create Serious ePA Roadblocks

By Leigh Burchell (Altera Digital Health), EHRA Public Policy Leadership Workgroup Chair

This is part three in a four-part series examining the need for ePA, the barriers presented by the current environment, necessary capabilities and functionality for progress, and the EHR Association’s policy recommendations. Read part two here

There is a strong use case for electronic prior authorization (ePA), given the frustration providers have with the burdensome current processes, and health IT developers recognize the potential that exists for our technologies to assist with making our clients’ lives easier in this area. However, the road to success with ePA will be rocky if it is not broadly rolled out at a pace and with a legal/regulatory cadence that aligns with the ability of stakeholders to deploy and use solutions that follow consistent standards. Therefore, the EHR Association supports the promulgation of ePA requirements only when undertaken in a way that avoids prior policy mistakes of pushing faster than standards development can keep up. 

Rolling out ePrior Authorization will be complex, even moreso than similar efforts at digitization we’ve already accomplished. This complexity stems from the need for change – and adoption of agreed-upon standards – by multiple stakeholders with varying levels of readiness.  For example, it is important to work closely with payers to ensure their readiness for the required bidirectional information flow using standards and to ensure functionality can be sufficiently tested. This also helps avoid a scenario in which payers roll out individual requirements to which EHR developers and providers will have to respond, which would be highly inefficient. 

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Standards will Make or Break Efforts Toward ePA

By Janet Campbell (Epic), EHRA Public Policy Leadership Workgroup Vice Chair

This is part two in a four-part series examining the need for ePA, the barriers presented by the current environment, necessary capabilities, and functionality, and the EHR Association’s policy recommendations. Part one can be read here.

Streamlining the electronic prior authorization (ePA) process will require significant coordination and standardization across multiple domains within individual healthcare organizations, across dozens of health plans covering their patients, and across the health IT tools in use by every participant in the process.

Progress is being made by various stakeholders in terms of standards development. Notably, the Coverage Requirements Determination (CRD), Documentation Templates and Rules (DTR), and the Prior Authorization Support (PAS) implementation guides – all a part of the Da Vinci Project’s efforts to understand functional requirements, build consensus on a technical approach, pilot, and iterate – have resulted in significant progress toward the enablement of highly automated prior authorization workflows.

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Standards, Certification, and ePA: Proceed with Caution

By Hans Buitendijk (Oracle Cerner), EHRA Chair

This is part one in a four-part series examining the need for electronic prior authorization (ePA), the barriers presented by the current environment, necessary capabilities and functionality, and the EHR Association’s policy recommendations.

The prior authorization process required by health plans and payers frustrates patients and providers alike because of inconsistent requirements and associated delays, and it isn’t going away. 

It is clear that there is an opportunity to apply health information technology (IT) toward the goal of improving efficiency in this area, but doing so will be a challenge that requires significant cross-stakeholder coordination and standardization of related data. The need for a collaborative focus is further exacerbated by the widely varying approaches to the adoption and deployment of health IT systems among providers. Further, the process itself touches many different points and players in administrative, clinical, and financial workflows. 

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