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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Genomic Data Sharing Policies Must Protect Patient Privacy, Minimize Risk

By Michael Saito (Epic), Chair & Nam Nguyen, (Allscripts) Vice Chair, EHRA Privacy & Security Workgroup

The National Institutes of Health’s (NIH) ongoing objective of sharing research data sets to facilitate additional study is something EHRA member companies wholly support – as long as it protects patient privacy, ensures patients can provide informed and meaningful consent for use of their data, and minimizes the risk that patients’ genomic and other health data can be re-identified or misused. 

To that end, we took advantage of the NIH’s recent Request for Information (RFI) on the proposed updates to and long-term considerations for its Genomic Data Sharing (GDS) Policy to provide feedback in the key areas of de-identification, potentially identifiable information, and data linkages.

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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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Privacy and Security, and Building Patient Trust

Earlier this year, ONC published an updated “Guide to Privacy and Security of Electronic Health Information” to help healthcare providers and ambulatory practices understand existing federal law on protected health information (PHI).  It provides guidance on how providers can use certified electronic medical record technology (CEHRT) to provide secure communications with their patients and, via secure and interoperable health IT, share patient data with other care providers.

There is a great deal of practical information provided in this guide that helps explain who is and who is not a business associate (BA), per the HIPAA regulations.   It also provides clear guidance as to when it is permissible to disclose PHI, when patient authorizations are required, and how to provide patient access to their health information.  In addition, there is a useful section on general cybersecurity explaining the threat of cyber-attacks, the use of mobile devices, and email and texting among providers and their patients.

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EHRA Responds to ONC’s Interoperability Roadmap

After many conference calls, and lots of “on the job training” using Google Docs to manage the edits of many contributors, we were pleased to submit our response to ONC’s Interoperability Roadmap. . . just in time to start working on the interoperability aspects of the proposed rule for Stage 3 of the EHR Incentive Program . . .and to get ready for HIMSS15!

Overall, we’re positive about the framework the draft Roadmap is starting to put in place, its identified principles, and the pragmatic review of well-established and emerging interoperability standards and technologies. We did express some concern that ONC seems to view the many active, and increasingly successful, interoperability initiatives as a problem to be solved rather than work to inform go-forward strategies with valuable experiences to be built upon. In doing so, we provided some positive suggestions on how to approach interoperability governance in ways that rely on and leverage private sector efforts in the context of an effective public/private partnership.

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