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New administration may mean new approach to HIT


Experts discuss how the federal government will approach technology during Trump presidency

With a new look to the U.S. Department of Health and Human Services (HHS), experts hope that Secretary Tom Price, MD, and his team will tackle a number of issues facing physicians. From streamlining regulatory requirements to improving the usability and interoperability of electronic health records (EHRs), this is no small task. 


Further reading: Why are doctors still waiting for interoperability?


Eric Fader, JD, a healthcare attorney with Day Pitney in New York, says Price faces “a balancing act” between reducing physicians’ regulatory burden and promoting EHRs as tools to improve care coordination and reduce costs.

The department will have opportunities to work toward those goals as it implements the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the 21st Century Cures Act, which includes numerous provisions related to health information technology (HIT).  


Jeffrey Smith, MPP, vice president of public policy at the American Medical Informatics Association, expects the new administration to take both a short- and long-term approach to MACRA.  

In the short term, Smith thinks CMS officials may extend the reporting requirements for 2017 into 2018 with few, if any, changes. If HHS officials pursue this strategy, they would give themselves time to think about how they want to implement the program over the long term, Smith adds.  

Robert Tennant, MA, director of health information technology policy at the Medical Group Management Association says his organization hopes CMS will allow physicians to comply with MACRA’s reporting requirements in 2018 using EHRs certified to 2014 standards. Current regulations require physicians to upgrade by 2018 to technology that meets 2015 certification requirements.

Tennant points out that few of the 4,000 products with 2014 certification have been recertified under the 2015 standards, making it difficult for physicians to upgrade their EHR systems. 


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HHS officials have “quite a bit of leeway” in how they approach reporting requirements for clinicians under MACRA’s Merit-based Incentive Payment System (MIPS), which is designed for physicians practicing medicine primarily in a fee-for-service model.

Under MIPS, clinicians report on four broad categories of performance-quality, clinical practice improvement, cost and “advancing care information” through EHR use. However, HHS officials could implement those performance categories with fewer measures and shorter reporting periods than was envisioned by the Obama administration, Smith says. 

Next: Dissecting the 21st Century Cures Act


They could also allow physicians to apply a performance measure to more than one category. For example, if physicians send secure electronic messages to communicate with their patients with diabetes, the physicians could get credit for both a clinical practice improvement activity and an advancing care information activity, he says.   


21st Century Cures Act

The 21st Century Cures Act includes numerous provisions intended to streamline regulatory reporting and administrative requirements and improve the interoperability and usability of EHRs. Donald W. Rucker, MD, MS, MBA, the national coordinator for health information technology, likely will have an important role in implementing these provisions. Given his professional background, “the appointment of Dr. Rucker sends a strong signal that HHS will be focused on health IT issues,” Smith says.    


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For example, the law directs HHS to develop a strategy and recommendations to reduce providers’ regulatory and administrative burden, including documentation and reporting requirements related to EHR use. The law also “gives a lot of discretion to the secretary to begin adding some different units of measure within the (HIT) certification process, like user-centric design and interoperability,” Tennant says. 

Rucker has experience with certification, dating back to his time on the board of the Certification Commission for Health Information Technology, a nonprofit organization that developed an early EHR certification program. Before the organization closed its doors in late 2014, it had developed initial measures to assess usability as part of the certification process, Tennant says. 

The Cures Act also gives the HHS Office of the Inspector General the authority to investigate and penalize organizations found to be engaging in health information blocking-a term the Office of the National Coordinator uses to describe purposeful actions by vendors or providers to interfere with the exchange of electronic health information. 

While the Cures Act provides avenues for HHS officials to improve the interoperability and usability of EHRs and to reduce providers’ reporting and administrative burden, those goals won’t be achieved fully unless HHS officials allocate the time and resources necessary to implement the law, Smith says. Depending on future Congressional efforts to repeal and replace the Affordable Care Act, “HHS could continue to be really focused on insurance reform” and, therefore, less able to focus on EHR issues, Smith adds. 

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