NATE, DirectTrust and EHNAC Agree That Consumer Access to Data is Critical Next Step in the Future of Interoperable Health IT

WASHINGTON, D.C. (April 14, 2016) – On Sunday, April 10, 2016, theNational Association for Trusted Exchange (NATE), DirectTrust and the Electronic Healthcare Network Accreditation Commission (EHNAC) – all organizations with a focus on the success of Direct secure messaging – joined together to talk about interoperability in healthcare.  In a pre-conference workshop affiliated with the 13thAnnual World Health Care Congress, the three organizations presented from three very different perspectives on “The Demand for Secure Interoperable Health Information Exchange: Options and Opportunities 2016,” creating a dynamic that echoed the recurring theme of the complementary nature of the organizations’ work.

Dr. David Kibbe, President and CEO of DirectTrust, led the day with a discussion of the factors and players involved in interoperability in healthcare, including some predictions on the future expansion and contraction of various networks.  Lee Barrett, Executive Director of EHNAC, focused his comments on the potential security risks involved in interoperability and the importance of maintaining a risk management strategy.  Aaron Seib, CEO of NATE, talked about the critical role of the patient in any interoperable exchange of personal health data.  Renee Smith, Global Director of IT Enterprise Planning and Portfolio Management, Walgreens Boots Alliance, ably facilitated the discussion, and Paul Uhrig, EVP, Chief Administrative, Legal & Privacy Officer, Surescripts, provided insightful wrap-up commentary.

By the end of the day, much had been discussed about how to measure interoperability, the degree to which security should be a deciding factor in sharing health data, and the role of providers and others in educating patients about their rights to their own information and the various methods available to them to get that information electronically.  While all three organizations brought very different outlooks and offerings to the discussion, the day signaled a renewed sense of collaboration and understanding that the organizations each have a complementary role to play in the success of Direct as a method of securely transporting confidential information.  Further, it was clear that all three organizations see patient involvement as critical to the path forward.

Some quotes from the day:

Paul Uhrig, EVP, Chief Administrative, Legal & Privacy Officer, Surescripts: “The Federal investment in HIT has certainly been a driver of demand of the technologies that many providers are using, but in the future it is likely we’ll see increased consumer engagement and demand, and that very much will drive different and increased demand for interoperability.”

Lee Barrett, Executive Director, EHNAC: “Today’s patients are much more informed and are a lot smarter on the existing capabilities available for managing their own health. As these consumer tools continue to advance, resolving interoperability challenges across healthcare stakeholders and their products will need to remain a top priority.”

Aaron Seib, CEO, NATE: “Ultimately, the consumer is the only person who is a part of every encounter that they have.  And if they are going to have 100% information awareness to share with their next provider and to participate and actually partner with all their caregivers, not just the ones that are in the HIEs, not just the ones that are using a particular EMR, but every provider that they’re going to get care from , we have to enable them to get data in the app of their choice…”

David Kibbe, MD, MBA, President and CEO, DirectTrust: “I do think there is great potential, and things might happen very fast. This idea of a shared medical record, that is in the control of the individual, that literally drives patients in a different way through the medical system, could emerge almost overnight.”

Renee Smith, Global Director of IT Enterprise Planning and Portfolio Management, Walgreens Boots Alliance: “I look forward to the day, and the day is coming, when the patient or consumer has that empowerment and that technology and the appropriate security… If that’s not why we’re all here, then we’re in the wrong place at the wrong time, because that is what success will look like.”

Aaron Seib: “I think we as a nation have been working on the right priorities, in the right order: make this work for doctors, make the data available to consumers, let the consumers decide how to use that data. I believe that three years from now, we’ll see the portion of the population that is most burdened by disease using tools to better manage their care and better partner with their doctors.  The key to get from here to there is not to wait for the perfect solution that satisfies everyone that may never come.”

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  • While we are waiting for good interoperability infrastructures to be put in place, it would be nice to postpone penalties for not meeting meaningful use. After all, a lot of today’s MU requirements do not help patient care and just take up providers time. That is especially true for some specialties.

    So to that end please sign the following:

    Better still would be to write your congressional representatives. Feel free to use my message as a template:

    Dear Congress Critter;

    I am an information technologist that helps ophthalmology practices implement Electronic Health Record (EHR) systems. I attended a webinar about meaningful use today and that prompted this letter.

    Medical practices are having to implement severely flawed systems costing both money and efficiency. One small study ( showed a 16.9% decline in patients at an eight physician academic clinic over a four year period. None of the eight doctors were able to return to their pre-EHR patient visits after four years. In a typical private practice a 16.9% reduction would be about five patients per doctor per day.

    In my experience flawed meaningful use requirements are a significant reason for the drop in efficiency. For example ordering a common Optical Coherence Tomography (OCT) test went from telling the technician to do the test, about 5 seconds, to having to order the test through the EHR system’s Computerized Physician Order Entry (CPOE) module. If the test is not ordered though CPOE, it is not be counted for meaningful use. I timed ordering an OCT last year at 55 seconds. For a typical visit the 50 extra seconds to order an OCT represents a 7% drop in efficiency. CPOE makes sense in a hospital or a large practice, but not in a small practice where the doctor and the technician are close enough to talk to each other. As for keeping track that the OCT was done, that is easy, as the results of the test must be entered into the EHR for billing. There are many other examples of delays caused by flawed requirements for test and lab results to be documented before and after the tests are done.

    The great promise of EHR systems was that a patient’s records would be accessible from any medical practice, eliminating the need for duplicate tests and data entry. The data could also be used by researcher looking for clusters of cancer, disease outbreaks, prescription drug abuse and even terrorist biological and chemical attacks. The problem is that the infrastructure for sharing the data does not exist. The first two stages of meaningful use just added to the problems of duplicate tests and data entry, because it required doctors to pester patients for data that was not necessary for the patient’s current visit. An example would be having to ask a patient about smoking when there is a stick in the patient’s eye.

    The Center for Medicare & Medicaid Services (CMS) made huge mistakes when they setup meaningful use for EHR systems. The head of CMS, Andy Slavitt seems to know that there are and were problems, but does not know that the meaningful use ship need to be turned around now. One of the small practices I work with is about to decide if the 3% penalty (about $100,000) is a better deal than spending the money, time and frankly the pain in the rear that meeting meaningful use in 2016 would cost.

    Sometimes programs are so messed up that the only way to save them is to start over. Meaningful use is a shining example of a program that needs to die and be reborn. The death of meaningful use has many supporters. Please do what you can to kill the current and near future implementations of meaningful use that CMS has in place and is contemplating. The rebirth of EMR meaningful use should concentrate on sharing data. Until the significant problems of a data sharing infrastructure are solved and implemented, there should not be any penalty for medical facilities not meeting meaningful use requirements.

    Charles Fischer

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