IT Building

Top HIE/EHR Issues Facing Developers and Providers in 2016

December 17 2015 by Gary Hamilton

As 2015 draws to a close many healthcare news organizations are reporting on this year’s accomplishments and/or failures relating to the adoption of electronic health record (EHR) systems, the government’s meaningful use EHR incentive program (MU), the development of health information management exchange (HIE) platforms, and healthcare consumers’ acceptance and enthusiasm for using health information technology (HIT) and remote/mobile health devices to manage and monitor their own healthcare.

Instead, let’s look forward at what’s coming down the pike in 2016 that healthcare providers and HIT/HIE developers will have to contend with.


“Although ICD10 and Meaningful Use work may be diminished in 2016, security work is likely to increase,” wrote John D. Halamka, MD, CIO of Beth Israel Deaconess Medical Center (BIDMC). Halamka is also Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a Full Professor at Harvard Medical School, and a practicing Emergency Physician.

For providers large and small, preventing theft of your patient’s data will become increasingly critical in 2016 as healthcare organization begin exchanging protected health information (PHI) with other providers and with payer organizations.

In his ongoing blog “Life as a Healthcare CIO,” however, Halamka wrote that the number #1 risk to healthcare security is people. “We spend millions on new technology, countless hours on policy writing, and engage all stakeholders to enhance their awareness. Yet, we’re as vulnerable as our most gullible employee.”

Nevertheless, Halamka writes, that he is “incredibly optimistic” about challenges facing healthcare in 2016. “[BIDMC’s] agenda is filled with new ideas and it feels as if the weights around our ankles (ICD10, Meaningful Use) are finally coming off.”

Patient Privacy

Big Data promises to fuel the next big revolution in personalized patient care. However, an article published in the Journal of American Physicians and Surgeons states that patient and practice privacy is an “illusion,” and that the federal Department of Health and Human Services (HHS) is using medical homes, Medicare and Medicaid, and meaningful use and payment reform programs to install a “de facto single-payer system.”

According to Susan Israel, MD, a psychiatrist and patient privacy advocate in Connecticut and the article’s author, “Patient and physician behavior will be tracked, scrutinized, studied, and used for research, using the electronic medical record and insurance claims data. This effectively will eliminate the privacy of medical practice and remove it from the rest of the U.S. free-enterprise economic system.

“Lack of competition and choice in the medical system will degrade it. Physician initiative will decline, and patients will have no recourse but to accept the treatments mandated for them by the monolithic, government-controlled system.” Israel concluded.

Israel’s ominous predictions somewhat blunt Halamka’s optimism. If accurate, however, developers of EHR systems, HIE platforms, and proponents of health information networks could find patient/practice privacy at the top of their priority lists in 2016 as well.

“We need to foster a public debate over citizens’ right to medical privacy vs. government seizure of private information without consent, because any loss of privacy rights undermines our society, and threatens our freedoms and our way of life,” wrote Israel.

Meaningful Use Stage 3

The meaningful use (MU) stage 3 final rule went into affect this month. As written, stage 3 focuses MU’s efforts on the privacy and security of health data, on interoperability between disparate EHRs, and on HIE between providers, health systems, and healthcare consumers. The government now predicts that the reduction in healthcare costs through the adoption of EHRs and HIE falls somewhere between “$48,534,332 at the lowest and $63,359,464 at the highest for an EHR reporting period on an annual basis for 2015 through 2017.”

Not an insignificant sum. However, the stage 3 final rule also states that the highest gains will go to “large provider systems and groups” and that “office-based physicians may not realize similar benefits from purchasing health IT products.

“At this time, there is limited data regarding the efficacy of health IT for smaller practices and groups, and the CBO report notes that this is a potential area of research and analysis that remains unexamined. The benefits resulting specifically from this final rule with comment period are even harder to quantify because they represent, in many cases, adding functionality to existing systems and reaping the network externalities created by larger numbers of providers participating in information exchange. In many cases, they represent the reduction in the time spent per each individual respondent to attest to the EHR Incentive Program objectives and measures,” the final rule states.

In simpler terms, the biggest gain could simply be in the reduction in time it takes for providers of large-scale health systems to attest to meaningful use. According to the Congressional Budge Office (CBO), such gains could amount to millions in reduced costs per provider organization.

A Working National Heath Information Network Within a Year

Finally, on a positive note, 2016 promises to be a boon for nationwide interoperability and HIE. That is if Karen DeSalvo, MD, Director the Office of the National Coordinator for Health Information Technology (ONC), accomplishes her goals.

At a meeting in Washington, DeSalvo likened the existing HIE “infrastructure” to highways that, in some areas, are already communicating across state lines. “Our goal is to connect that highway, including the health information exchanges [and] the private sector exchanges, in the entire country within a year,” DeSalvo said.

It’s a bold vision that some in the government think could be unrealistic. Nevertheless, DeSalvo also discussed the government’s role in promoting and assisting in the development of application programming interfaces (APIs), which are supported in MU stage 3’s final rule as an option for providers to meet their attestation goals, and which could be key to accomplishing what portals began—giving patients a way to engage with their providers in their own healthcare decision-making.

“We are about to reach a tipping point where everyone can have access to their data,” DeSalvo stated. “The future is closer than we all think due to changes at not only the technology level, but also at the policy and systems level.”

If the healthcare industry continues along its current path, there’s every reason to be optimistic about HIE’s expanding role in patient care. Securing those exchanges, however, will require determination and vigilance.

See you in 2016!

Gary Hamilton – CEO, InteliChart