interoperability

Today, nearly nine out of ten doctors and virtually all hospitals have adopted electronic medical record systems (EMRs). Health care providers have more data than ever before on the health and well-being of their patients. Unfortunately, the vast majority of this data is stored in proprietary systems that make it exceedingly difficult for clinicians and patients to share health information with other providers and payers. In addition, despite extensive efforts by the federal government, patient data continues to be controlled primarily by health care providers and payers rather than individual patients.

At Humana, we fundamentally believe that every patient should be able to access, share, and control their own personal health care data. The health care industry should no longer be allowed to treat patient data as a tightly held, revenue-generating commodity. The current model has spawned a multi-billion dollar industry predicated on restricting access to patient data. We believe that the data belongs to the patient, and neither providers, EMR vendors, nor payers should profit from its sale.

The reasons for this are simple: it limits data transfer, increases patient health care costs, and adversely affects patient care. With the emergence of open application programming interfaces (APIs), we have the technology available today to empower patients to securely access and share their health information as they see fit. The only thing standing in the way is an antiquated devotion to outdated business practices.

Under the leadership of Administrator Seema Verma, CMS is proposing a new way of sharing information that leverages existing standards and technologies to empower patients to take control of their own health information. Building on the success of the Blue Button 2.0 initiative, CMS has proposed that plans be required to implement openly-published Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR)-based APIs that make patient claims, drug formulary, provider directory, clinical laboratory results, and other health information available to patients through third-party applications and developers. This means that a patient can access and manage their health care data via an app on their phone as easily as they manage their travel or personal finances.

This is a much-needed bold action to move the health care industry toward a consumer-mediated data exchange model rather than one controlled by health care providers and EMR vendors. In this model, the patient is easily able to access, share and control their health care data via a secure mobile app or website, similar to how they manage their finances. We strongly believe that the model envisioned by CMS will improve patient care, resulting in better health outcomes and lower costs. To that end, Humana is fully committed to implementing the open APIs proposed by CMS in 2020.

As the health care industry transitions to a consumer-mediated data exchange model, it will be critical to minimize the existing barriers to sharing health information. Under the leadership of Dr. Donald Rucker, the Office of the National Coordinator for Health Information Technology (ONC) is creating and harmonizing the standards that EHR vendors and other stakeholders must use in order to make health care data easier to share between providers and with patients. Furthermore, ONC is establishing standards to ensure that unnecessary tolls are not placed on this new road to interoperability and consumer-mediated data exchange.

As CMS and ONC begin the difficult task of finalizing their proposed regulations, we urge the agencies and the entire health care industry to adopt the following guiding principles:

Patients Should Control Their Own Health Information – All patients should have a fundamental right to access and share their personal health information as they see fit.

Rapid Implementation of Open APIs Should be a National Priority – While the development and implementation of open APIs will prove challenging, the entire health care industry must move forward without delay. To that end, we encourage CMS to adopt the proposed 2020 implementation date for open APIs, and we urge ONC to accelerate the adoption of standardized, open APIs by requiring or incentivizing EMR vendors to operationalize new open APIs before the proposed 2022 deadline.

Information Blocking Prohibitions and Enforcement Are Critical – The federal government should explicitly prohibit all business practices that directly or indirectly prevent patients from sharing their health information, including any fees for implementing open APIs and for facilitating the interoperable exchange of electronic health information. Moving forward, the inclusion of open APIs should be a core feature set of every EMR – not a revenue-generating add-on.

Patient Privacy Must Be Protected –The federal government must develop appropriate patient privacy protections for mobile app developers and other entities that are not currently subject to federal patient privacy regulations. Patients have a right to know, in plain language, how their information will be used and shared so that they can make an informed decision about whether to share their personal health information with a third-party app developer.

All regulations are iterative processes. There will be plenty of time to refine and enhance the CMS and ONC proposals in the future. However, now is the time to be on the right side of history and support implementation of these important steps toward empowering patients to take control of their health information.

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In a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His latest – Let’s seize health care’s great opportunity – is reprinted below. To see all of his blog posts, click here.

Each of us has experienced firsthand the complexity of our health care system, and we know how confusing and complicated it can be just to manage our own health records. We get it. We empathize with you. It needs to change.

I’ve heard from many of you that managing your health records should be as easy as managing your 401(k) account on your phone. Across the world, there is a growing movement to give consumers control over their data. Health data should be no different. Patients need to control their health data, and they need easy access to it.

There’s good news on the horizon. The health care industry is working to give patients, physicians, clinicians and health plans the ability to access and securely share clinical patient information in near real-time. This is the concept known as interoperability, which connects data across the health care system and allows patients to better manage their health and make informed care decisions.

While 86 percent of office-based physicians are using electronic medical records, many health systems cannot share these with each other, resulting in vast, isolated silos of critical patient information. However, if these systems could begin to talk to one another, we could improve care coordination and generate “more than $30 billion in annual health care savings.”

Interoperability gives health care consumers what they rightly deserve – ownership of their health information. Today, physicians, patients and health plans have a hard time sharing patient information. You experience this when you visit the doctor’s office and fill out personal-information forms – again – or urge them to send your information to another physician.

You might not realize this, but some companies that collect patient data are using proprietary systems and charging exorbitant fees to connect to other systems. These outdated business models profit from the sale of patient medical data at the expense of consumers having access to their own health data.

Despite these challenges, I’m optimistic about our industry’s ability to come together and embrace interoperability so we can bring much-needed simplicity to the system, which will improve care and lower costs.

We have a bold call to action to achieve interoperability. The Centers for Medicare and Medicaid Services (CMS) has issued an important call to action that will empower consumers to control, access and share their personal health data while also making it easier for physicians to share data with other physicians treating the same patients.
Dubbed the Interoperability and Patient Access proposed rule, the goal is to “break down barriers to interoperability and health information exchange,” leveraging the progress of the Blue Button initiative.

CMS intends to require health plans like Humana to implement Fast Healthcare Interoperability (FHIR)-based application program interfaces (APIs) to enable patients to share their lab results, health claims, prescriptions and other clinical information with their physicians via the click of a button on a mobile device. These APIs make it easier for patients, clinicians and health plans to access and share critical health information.

Medicare Advantage enrollees can certainly benefit from interoperability. Today, nearly 75 percent of people over the age of 65 are living with multiple chronic conditions, and these conditions account for the majority of what we spend on health care. Interoperability could improve these people’s health.

Physicians treating patients with multiple chronic conditions would have a near real-time, holistic view of all the clinical actions performed by his or her peers. From reducing redundant testing to stopping conflicting prescriptions, these physicians could leverage this holistic patient data to make more-informed decisions.

The CMS proposal puts seniors in control of their own data, enabling them to decide who gets their information and empowering them to better manage their health. Health plans like Humana that administer Medicare Advantage also benefit from interoperability because it augments the holistic approach to care by using data analytics to garner and share insights from the patient’s data. That helps physicians and clinicians improve people’s health and well-being.

The health care industry has a great opportunity to band together to answer CMS’ call to help deliver a new patient experience. The promise of interoperability is inspiring because, if done right, it will be the foundation for transforming the system.

Physicians should have the best information available, and no one should have to spend hours tracking their health records. I empathize with anyone who has had a difficult experience.

The time for change is now. Let’s heed the call.

Let’s seize health care’s great opportunity

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The healthcare industry must change its focus from a supply-side orientation to a consumer-focused emphasis on health outcomes and value-based reimbursement, Humana President and CEO Bruce Broussard said during his keynote address Tuesday morning at the annual convention and trade show of the Healthcare Information Management Systems Society (HIMSS) in Chicago.

“We have to change the focus towards how we improve health for our customers, members and patients,” he said. By giving the consumer a voice and offering more choices, competition is created and innovation is enabled, he added.

“People are not just looking for insurance,” he added. “They are looking for someone to help them with the journey to better health.”

And he emphasized that in order for this industry transformation to happen, everyone involved must take responsibility and begin working as a team, including the company he leads.

“I represent an industry and represent a company that is part of the problem,” said Broussard. “We realize that we have to change.”

“We’re going to have to change business models,” he said, pushing a move toward interoperability, which will create a more efficient and cost-effective healthcare system. In a LinkedIn blog published Tuesday, he discusses the importance of interoperability.

Acknowledging that change can be difficult, he said it can also make people and industries stronger and healthier.

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