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Stakeholders from across the health care industry are providing feedback on proposed changes to rules addressing the 21st Century Cures Act (Cures Act) that will impact interoperability and data blocking in health care. Here’s some insight into what’s happening and where Cerner stands on these important issues.
What’s the Cures Act, and what does it mean for health care?
Former President Barack Obama signed the Cures Act into law on Dec. 13, 2016, to accelerate medical innovations and improve the health care experience for patients. Part of the legislation focuses on advancing interoperability and addressing data blocking. The Cures Act’s definition of interoperability calls for “all electronically accessible health information” to be accessed, exchanged and used “without special effort on the part of the user.”
During the past few years, the rulemaking to implement the Cures Act has evolved to better meet the needs of the health care industry. Earlier this year, the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare and Medicaid Services (CMS) released several proposed rules to improve data sharing among disparate systems and prevent information blocking.
ONC’s proposed rule outlines updates for the 2015 Edition Health IT Certification Criteria and proposes exceptions to the information blocking definition created by the Cures Act. In addition, ONC published a second draft of the Trusted Exchange Framework and Common Agreement to support nationwide exchange of electronic health information across disparate health information networks. At the same time, CMS proposed a rule to advance interoperability and increase patient access to medical records from certain health care payers.
How has the Cures Act impacted interoperability in health care, and how’s the industry responding?
Since the introduction of the Cures Act, and the proposed rules and frameworks from ONC and CMS, the industry as a whole has made progress on key initiatives that started in 2014 to connect networks at the national level. In late 2018, this culminated in the first Carequality implementers starting to connect with providers using CommonWell Health Alliance®, while eHealth Exchange is starting to make progress to connect its participants through Carequality to other networks. Between these networks ─ and the use of Direct (a secure email system that connects providers, patients and other stakeholders) ─ a robust clinical document exchange infrastructure has emerged with millions of clinical documents being accessed and shared on a monthly basis to get pertinent patient information into clinicians’ hands more quickly.
Now the industry has shifted its focus to enhancing the quality of clinical documents exchanged. This means adjusting the type and amount of data sent to clinicians to what is most relevant for a complete and succinct view of the patient’s care visit. We need to share a balance of both standard clinical conditions, results and impressions that are coded as well as clinicians’ narrative summaries that describe their care encounter with the patient.
At the same time, we must push forward to empower networks to use HL7® FHIR®-based APIs to increase the speed and scale of data exchange. Going beyond clinical document-style exchanges will create a richer, nationally scalable toolkit based on established interoperability standards. It will ensure we put the best and most useful information in front of clinicians when and where they need it, while making major strides in giving consumers scalable access to their data across providers.
What’s Cerner’s position, and what’s next?
This is an exciting time to be part of the rapid progress toward national interoperability. We’re moving toward balancing public and private initiatives and requirements, and we’re watching the developments unfold overtime. As we move the needle forward, it’s important to recognize the industry successes, particularly the establishment of national trust frameworks, and build on them. As an industry, we need the continued support of government agencies to adjust incentives (such as the shift from fee-for-service to value-based care payments) that can align health care business models around making all data available to those who need it and have the authority to access the information.
Cerner continues to strongly support allowing full access to a patient’s record by patients and others who are authorized to see it, regardless of where the data is maintained. There’s still a lot of work to be done to achieve widely adopted interoperability on a national level, but Cerner, and the industry, are making meaningful strides.
To address the remaining challenges, we must build on the headway we’ve made so far and identify the most appropriate principles and approaches based on lessons learned. The discussion we’re having now as an industry will drive the next three to five years of interoperability progress and get us closer to our goal of providing the right data for the right patient at the right time to the right user. Through the progression of the industry on its own and through requirements set by the Cures Act, Cerner developed and published a position paper — our vision of the roadmap to achieve the industry’s goals. We look forward to continuing the conversation and the movement toward true health care interoperability.
Now is the time for national discussion and active participation to ensure that we, as an industry, are on the right path to achieve nationwide interoperability. Cerner’s position paper, “The Building Blocks of Nationwide Interoperability: 2nd edition,” assesses the latest proposed rules from ONC and CMS and provides recommendations based on practical principles and a strategic approach. Learn more here.
