With 2015 rapidly winding down, DirectTrust released a list of six trends it predicts for interoperable electronic exchange of health information during the coming year. DirectTrust is a health care industry alliance created by and for participants in the Direct exchange network used for secure, interoperable exchange of personal health information (PHI) between provider organizations, and between provider and patients, for the purpose of improved coordination of care.
“In the world of electronic health information exchange, we’re on track for another year of momentous forward movement in increased adoption by providers and greater interoperability between Federal and state agencies with private-sector providers. We’ll also see, finally, patient and consumer participation in the use of electronic health information exchange,” said Dr. David Kibbe, MD, MBA, President and CEO of Direct Trust.
Specifically, DirectTrust identified the following trends in 2016:
- Patients and consumers will become participants in the electronic exchange of health data. Patients will have greater access to their clinical records, and they will be able to more freely and easily move those records whenever and to whomever they choose. Health care consumers will take as their right control of their own health information in much greater numbers. The corresponding willingness of provider organizations to permit this patient engagement — and to view it as positive and productive to attaining better health outcomes — will also become more evident across the U.S.
- ‘Freed’ health data will drive yet-to-be imagined enrichments in personal and professional uses. Electronic access to personal health information by patients and consumers will “free” the data from its confines within all kinds of health-related databases, including those in EHRs, health insurance companies, health departments, formal information exchanges (HIEs and HINs), pharmacies, pharmaceutical and e-prescribing systems, research programs, and so on. We’ll see the development of patient-facing applications that enable patients and consumers to take advantage of the ‘big data’ aspects of this new freedom to ‘mash up’ content from multiple locations and services, creating yet-to-be-imagined enrichments in both personal and professional uses. This will not happen linearly; rather it will grow explosively, and then suffer hiccups and setbacks as the privacy and security risks of such systems are first exposed, and then dealt with. But it is going to happen.
- Federal and state agencies will move toward greater interoperability. Those agencies that own and operate care delivery facilities and seek secure, interoperable means of sharing patient data with private sector providers will be on the frontline of greater interoperability. The Veterans Health Administration — which alone operates more than 1,000 outpatient clinics and dozens of large inpatient facilities — along with the Department of Defense, state Health Departments, Indian Health Service, and federally qualified health centers will increasingly replace fax, mail, and paper transport of vital health information with Direct exchange and other secure, vendor-neutral means of electronic exchange. At the same time, federal and state agencies that have administrative needs to move personal health information — including Medicare, the state Medicaid Agencies, the US Postal Service, to name a few — will take advantage of the providers’ capabilities to use electronic data exchange through their EHRs, and replace fax and mail accordingly.
- Meaningful Use faces bumpy road going into Stage 3. Having accomplished the significant goals of greatly expanded EHR adoption and baseline interoperability via Direct, but also having alienated many stakeholders within the health care provider community by expanding its final, Stage 3 version of its regulations, the Meaningful Use programs face a potentially uncertain future in 2016 and 2017. Some have speculated they could be delayed or phased out, although how that would occur is open for discussion. Physician groups are particularly worried because they believe the requirements of Stage 3 MU do not align well with MIPS and MACRA, the new rules under which Medicare will pay for value and performance, rather than for volume of care.
- Security, privacy, and identity will rule. The cost of data breaches in health care is simply too high to be tolerated. As use of electronic health information exchange soars, we will experience a corresponding rise in concern about and actions taken to mitigate the risks of exposure of both data at rest and data in transit. Parties involved in electronic data exchanges will insist on more and more rigorous certification, accreditation, and audit of security and identity controls as a first condition of participating in data sharing. This will include requirements for the placement and routine testing of intrusion detection and protection systems. Two-factor authentication (sign-on) to medical records systems, like EHRs and PHRs, will be routinely offered, and will become required by the end of 2016 in many systems. Awareness of identity in cyberspace risks will become a conscious concern for everyone in health care.
- Reliance on Direct exchange for secure, interoperable transfers of patient health information between and among providers for the purposes of care coordination will continue to grow. The drivers of secure health information exchange include Meaningful Use, but are beginning to expand to other use cases, most notably assuring that geographically-separated members of health care teams have access to clinical patient summaries. Value-based purchasing arrangements will increasingly make fax and mail communications between providers obsolete, because coordination of care must be close to “real time.” In those communities (the majority) where care is delivered in a multi-vendor environment, secure EHR-to-EHR exchanges will be predominantly carried via the Direct Protocol.
This article was originally published on DirectTrust and is republished here with permission.