The Health Information and Management Systems Society (HIMSS) annual conference ended Friday with an optimistic portrait of the future of healthcare data from Don Rucker, MD, the national coordinator for health information technology.
In a conversational closing keynote session with HIMSS President/CEO Hal Wolf, Rucker—a former emergency room doc—imagined a future where every American can immediately access their entire health record on that most ubiquitous of technology, their smart phone. ONC’s mission, he said, is to identify the missing steps and do all it can to bring that capability to the public.
Joining personal health records with fitness and wellness apps creates a great tool to “understand what’s inside of ourselves and what we can do better,” Rucker said.
The interoperability requirements behind these efforts are part of the 21st Century Cures Act passed in 2016, which also prohibited information blocking—a major communications point from the federal contingent at HIMSS. Under Section 4004 of the act, blocking can lead to fines of up to $1 million per violation.
The law also had provisions to increase the availability of psychiatric hospital beds and authorized $1 billion in grants to fight the opioid epidemic.
Acknowledging it’s hard to predict the future, Rucker nonetheless said he expected an impact yielding some new business models. He drew a parallel of depositing checks: At one time you could only go to a branch of your home bank during certain hours. Then you could use an ATM anytime. Now you can deposit checks through your phone. Think broadly of advances like price-comparison sites, ride-sharing services, and the kinds of APIs (advanced programming interfaces) that can be linked in the future.
Until recently, Rucker observed, few apps dealt with clinical data, though many dealt with other kinds of medical data—and the historical divide limited both sets of apps. “The whole world’s about data mashups,” he said. “Tell me that’s not going to happen in healthcare!”
Wolf agreed, noting we’re not yet fully reorganized around these opportunities and all the new information coming in will force redesign and redevelopment.
Some of the challenges remaining center around documentation—our system is a funny mixture where billing and documentation are “made into a soup,” Rucker said—and things like prior authorization and price transparency. Having a third-party payment system requires a proxy for what the patient wants, he noted, the answer to which has been quality measures. Issues to consider moving forward include maintaining privacy and security without information blocking and that for patients information access must be free—all costs must be rolled into services.
As an ER doc Rucker was frustrated by time spent on the phone rather than with patients. They were mostly short calls, he said, looking for discrete bits of information—hardly value-added work. For the professional as well as the patient, he said, that’s what coming connections will reduce.