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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“No Surprises Act” Regulations Raise Concerns

By Leigh Burchell (Allscripts), Chair, & Janet Campbell (Epic), Vice Chair,
EHRA Public Policy Leadership Workgroup

The growth in high deductible health plans requiring patients to shoulder more of their healthcare costs and the lack of transparency in healthcare pricing has exacerbated the issue of patients left with surprise medical bills that many cannot afford to pay. The urgent need to address these serious issues is why the EHRA supported the No Surprises Act when it was developed and welcomed the regulations published last year as a foundation upon which it can be implemented. 

However, we have several concerns about rulemaking to date as it relates to workability and the unnecessary burden it creates for industry stakeholders. To that end, we reached out proactively to regulatory agencies to provide feedback in four key areas that we believe – based on our member companies’ experiences and our ongoing advocacy for reasonable timelines and requirements – will be informative when it comes to additional regulatory actions expected later this year. 

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TEFCA Signals Progress, With Work To Be Done

By EHRA Public Policy Leadership Workgroup

After a journey more than four years in the making, the Office of the National Coordinator for Health IT (ONC) and The Sequoia Project achieved a major milestone in the advancement of nationwide health information exchange: the publication of the Trusted Exchange Framework and Common Agreement (TEFCA) v1.0. ONC and The Sequoia Project have demonstrated their commitment to incorporating input from stakeholders across the industry, which created a process that produced significant improvements with each draft publication. We applaud the significant efforts undertaken by ONC and The Sequoia Project to collaborate with industry interoperability experts and create a framework that incorporates key principles of trusted exchange, like reciprocity, as well as a technical approach that leverages commonly adopted standards. 

For well over a decade, members of the Electronic Health Record Association (EHRA) have invested substantially in advancing the data sharing capabilities of the health IT systems used by healthcare organizations across the country with the belief that doing so will improve the quality and efficiency of health care. It is our sincere hope that TEFCA will continue to build on those investments for the benefit of patients.  

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SDOH and Health Equity: Summarizing the EHRA Congressional Briefing – Part 2

Ambulatory and Health System Perspectives

By EHRA Public Policy Leadership Workgroup

Part one of this two-part blog series summarized insights around SDOH and health equity from the developer and community perspectives, which were shared during the recent virtual Congressional Briefing hosted by EHRA’s Public Policy Leadership Workgroup. Part two shares the ambulatory and health system perspectives. The presentation slides and full briefing (passcode: H@R$UZ02) are available in the “Positions and Statements” section of EHRA’s website. 

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