Jared Kushner, the senior White House advisor and President Trump’s son-in-law, has been in the headlines a lot in recent months and not always for the right reasons.
The ongoing controversy about his possible meetings with shady characters and the downgrading of his ‘Top Secret’ security clearance has obscured most of the other parts of his ambitious portfolio—not least of which is his role as the director of the White House Office of Innovation.
Created in March of last year, the Office’s mandate is to reduce Federal bureaucracy, which is Conservative Washington speak for deregulating and turn over to private industry as much government work as you possibly can. Aside from recruiting an impressive group of high-level tech industry Poobahs as advisors, the Office hasn’t been heard from much since.
Maybe, that’s about to change. Last week, Kushner made a rare surprise public appearance at the 2018 Healthcare Information and Management Systems Society (HIMSS) conference in Las Vegas where he introduced Centers for Medicare and Medicaid (CMS) Administrator Seema Verma and spoke mainly on the need for Americans to have better access to patient data and the continuing problems of interoperability. Said Kushner:
The time is now to align every facet of the federal government and private sector to share information Interoperability is about saving lives. Up to 400,000 people die each year because doctors don’t have access to their complete medical histories. This is an issue that impacts every hospital, care provider and patient in our country. Now that electronic health records have become digitized over the past decade, complete interoperability is the logical next step.
Interoperability became the hot-button focus of government transformation IT efforts last December when the Veterans Administration announced that it was scrapping its 15-year, nearly $2 billion down the rathole effort to link up the homegrown and integration resistant, VistA platform that it has relied on to manage health records for its 9 million beneficiaries since the 1980s and start all over again, this time with a single vendor contract to Cerner, a large provider of health information technology solutions, headquartered in North Kansas City, MO. (See our previous article here.)
Customer decision making
Kushner added that over the past six months the administration has gathered information from more than 100 stakeholders–including healthcare providers, health IT companies and patient advocacy groups—to develop an interagency plan that would enhance patient access to and sharing of health records.
This is the essence of our administration’s goals for healthcare. More decision-making in the hands of the customer. Medical data belongs to the patients. Our vision will apply a whole of government approach that we hope will unleash private sector innovation. Together, we hope to lead a whole of country approach.
Kushner’s speech came the same day the CMS launched a new initiative, called MyHealthEData, aimed at increasing Medicare beneficiaries access to their own health records. As part of the effort, CMS is requiring providers update their systems to ensure data sharing, and it intends to require a patient’s data to follow them after they are discharged from the hospital. Seema Verma said:
At a time when health-care data is being generated from so many sources, too often that data runs into the hard walls of closed systems that hold patients, and their information, hostage. Our doctors run scans and other tests on us, but the results often sit dormant in distant databases where sometimes we can’t even access the records without overcoming multiple barriers. What we’re looking for a healthcare ecosystem where data flows freely.
MyHealthEData aims to allow patients to receive copies of their entire EHRs, share their personal health data with anyone they choose and put themselves at the center of the healthcare system. That, in theory, allows patients to find providers and healthcare services that best meet their needs, improve their understanding of their overall health, and make more informed decisions about their personal care.
Verma also announced plans to overhaul the EHR Incentive Programs to emphasize enabling interoperability improvements and reducing the administrative burden associated with meeting federal reporting requirements.
Stick and carrot
She also threw in a stick by warning that CMS has implemented new laws about information blocking in an effort to ensure patients have access to their own health data.
How will the process work? Details are still a bit vague but Verma is betting on the development of open APIs that will link clinical data with payment data. CMS will act, in effect, as a convener for APIs across the digital system that also connects to patients’ claims data with the aim that beneficiaries will have complete control to how and when their data is used.
For Kushner, achieving interoperability and ensuring access to health data will not only empower patients and reduce waste, fraud and abuse, it will more interoperability to use AI, machine learning and big data to drive greater improvements in how we identify new diseases and treatments. Said Kushner:
Unleashing data will unleash innovation, this is the essence of the Administration’s goals: more decision making in hands of customers, medical data belongs to the patients, a whole-of-government approach that leads to private innovation. We are on the cusp of a technological healthcare revolution centered on patients and the targeted delivery of care.
This is not the first time the government has tried to get health-care providers to switch from paper records to electronic software. A law enacted in 2009 as part of an economic-stimulus package provided billions of dollars in subsidies for health-care providers to transition to EHRs.
What government buyers envisioned was sophisticated networks that could relay patient data seamlessly from a family doctor to a hospital surgeon to a physical therapist instantly wherever the records were needed. That notion didn’t happen on a major scale. What really happened is that vendors came up with competing data formats and incentives to lock customers into proprietary systems. “Interoperability,” predictably, was a casualty of competition.
While millions of health-care records have been digitized in the past decade, hospitals and doctors haven’t yet realized broad productivity gains from the transformation because digital records are often limited to one health-care provider’s system, and competing systems don’t communicate with each other
Will the administration’s new plan to try coax medical software providers down the “interoperability” path through a combination of incentives and tougher rules work? From here, the answer looks like a resounding ‘probably not.’
Image credit - via Healthcare IT