Cassie M. Chew

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	A nationwide interoperability roadmap released by the U.S. 

 (HHS) in January outlines a set of critical actions healthcare players need to take between now and 2024 to get to a fax machine-free future.

	Charged with coordinating health IT across the country, HHS’ 

 (ONC) is asking industry stakeholders to submit comments about its interoperability roadmap by April 3.

	The 166-page draft, “Connecting Health and Care for the Nation,” sets a 10-year course toward interoperability of electronic health records (EHRs) with an initial industry effort to send, receive, find and use a common clinical data set by 2017. Between 2018 and 2020, ONC wants to expand interoperable health IT and users. By 2024, the agency hopes to achieve what it calls a nationwide health learning system.

	The industry needs to do four things to reach those goals:

		Establish processes toward nationwide interoperability;

		Improve technical standards and guidance for sharing and using a common clinical data set;

		Develop incentives for sharing information in common standard formats; and

		Clarify privacy and security standards in support of interoperability.

	“It’s time to free up data so patients can have access to information whenever they need it across the care continuum,” HHS Secretary Sylvia Mathews Burwell told attendees at ONC’s annual conference in February.

	In addition to introducing the draft roadmap, cheerleading and chastising industry efforts, the conference featured presentations from health information exchange players across the country working on interoperability projects.

	Despite their efforts and optimism, these pioneers in health IT say that they need more support.

	“There aren’t a lot of resources to pay for health information exchange,” said Brian Braun, chief financial and strategy officer for the 

Colorado Regional Health Information Organization

, describing results of an ONC-funded project that covered the cost of bringing long-term care providers into the state’s health exchange network. “It will require a commitment from payers and the health system.”

	In its final report on an 18-month project that connected nursing homes with hospitals and pharmacies in Minnesota for improved care transitions for residents, 

	“Upon implementation of the project, the value of health information exchange was realized immediately by the skilled nursing facilities and pharmacy. The value was not immediately realized by hospitals,” the non-profit healthcare quality and innovation organization wrote.

	Meanwhile, some providers who saw the value and the vision and made the switch to electronic record keeping are now back at square one, said Dominic Mack, executive medical director of 

 during his presentation on implementing health data exchange in underserved areas.

	“Sixty percent of companies are switching vendors because they have bought into systems that don’t support interoperability,” Mack said.

	After more than 10 years of trial and error, federal enforcement of patient privacy statutes, “meaningful use” incentives, advances in technology, and anecdotal evidence, the connection between EHR standards, privacy rules and improved healthcare has started to make sense. Getting there will take considerably more time.

Cassie M. Chew is a freelance writer in Washington, D.C.

Articles

A nationwide interoperability roadmap released by the U.S. Department of Health and Human Services in January outlines a set of critical actions healthcare players need to take between now and 2024 to get to a fax machine-free future.

ONC finalizes roadmap for interoperability

Consensus on the best regulatory framework under which providers, payers, pharmaceutical companies and medical device makers can operate has been elusive on Capitol Hill in the last few election cycles. That lack of consensus is expected to continue under the new Republican-controlled Congress, and a prime target will be dumping controversial provisions of the Affordable Care Act (ACA).

	Healthcare stakeholders, who’ve been known to flip their support between parties, gave generously to Republican candidates during the 2014 mid-term election cycle, ultimately boosting the number of conservative lawmakers on the Hill. Most of the activities in the last few sessions of Congress have been House efforts to repeal or reduce funding streams that would pay for ACA provisions, with those bills ultimately stalling out in the Democratic-controlled Senate.

	But for the first time in eight years the GOP, sworn in on a snowy day in January, is setting the agenda in both chambers of Congress, and one of the first healthcare policies they may consider is repeal of the 2.3% tax the ACA imposes on medical device makers. In effect since January 2013, the tax is expected to provide an estimated $29 million over 10 years to offset health insurance subsidies for low-income Americans, as well as fund other ACA provisions.

GOP Senate majority might target ACA device tax

	Medical device manufacturers can deduct the tax as a business expense, lowering it to a net of 1.4%, and eyeglasses, contact lenses and hearing aids are exempt.  Still, some device manufacturers say the tax will kill jobs and stifle innovation, and in October 2013, some lawmakers discussed repealing it as a compromise to end the federal government shutdown.

	In a November 2014 report, the Congressional Research Service (CRS) wrote that the tax won’t kill jobs and increase costs: “The analysis suggests that most of the tax will fall on consumer prices, and not on profits of medical device companies. The effect on the price of healthcare, however will most likely be negligible because of the small size of the tax and small share of healthcare spending attributable to medical devices.”

	Nonetheless, the Advanced Medical Technology Association (Adva.Med), which says it represents 80% of medical technology firms in the U.S., has been actively lobbying for its repeal.

	AdvaMed, along with device makers Boston Scientific, Direct Supply and Medtronic, contributed more than $3.8 million to Republican candidates in the latest election, or 65% of the device industry’s total campaign contributions, according to Federal Election Commission data compiled by the Center for Responsive Politics.

	AdvaMed also disagrees with the CRS’s analysis that the tax will have a negligible impact, calling that conclusion “flawed” because consumers don’t buy medical devices.

	“Rather, the buyers are institutions such as hospitals, clinical labs, and physician practices. In a highly competitive market such as the one for medical devices, such purchasers have the ability to refuse to accept price increases. In addition, they can delay or cancel large capital purchases or substitute less-expensive for more-expensive product alternatives,” AdvaMed argued.

	Medical device makers gave $92,549 to support the re-election of U.S. Rep. Erik Paulsen (R-Minn.) a third-term lawmaker who introduced a bill targeting repeal of the tax in 2012. The bill passed the House but was not brought up for vote in the Senate.

	In January, Paulsen introduced a new bill to repeal the tax, and this time it might succeed. Device makers gave their second highest donation to help re-elect Kentucky Republican and new Senate Majority Leader Mitch McConnell, who on more than one occasion has said that his party will make every effort to repeal the ACA.

Cassie M. Chew is a healthcare journalist based in Washington, D.C.

The new Republican-controlled Congress takes aim at the Affordable Care Act.

Author | Cassie M. Chew

Articles

ONC finalizes roadmap for interoperability

Medical device tax targeted by new GOP Senate