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I believe that patient initiated interoperability will be the single biggest driver of innovation. That starts today with the advent of the information blocking rules. 

Innovators that can gather consumers and provide them a valuable service that utilizes their health record will be granted access to that information by the patient. The health systems and payers in the future will have to comply or risk significant fines. 

What will the patient do? What will the innovators come up with? I have no idea, but I do know that the potential is there for exciting innovation.

Are there challenges. You bet. The scope is daunting to the EHR providers and systems. some definitions need some clarity according to some of the participants. But in the end, the patient has just been made the locus for information sharing around their health record. 

Should be fun to watch.


This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

 Today in Health it, the story is Happy Information Blocking Day. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current. And engaged VMware is committed to our mission of providing relevant content to health IT professionals.

Since the start, they recently completed an executive study with MIT on the top, healthcare trends, shaping IT, resilience, covering how the pandemic drove unique transformation in healthcare. This is just one of the many resources they have for healthcare professionals for this, and several other great content pieces.

Check out VMware. . Dot com slash go slash healthcare. All right. I got a little back and forth on a LinkedIn post on Friday. And the post was from Ricky Kaplan. He's the CEO of the HCI group. He's someone who I have great respect for as a person leader and someone who's accomplished a great deal on this industry.

And he put a pretty simple post out there on LinkedIn and it read. Does anyone know who drives our digital health strategy as a country? I. We can do better. At the bottom was a picture, and the picture had a digital vaccination record from India and the paper card we used in the United States. I looked at that and I thought, I know exactly where this is gonna go, and I thought I would post on it.

What I expected to happen is you'd have 200 people saying yes, our government stinks. Our public servants don't get where we're going. Uh, there's been no national leadership on this. Our health system is broken. We can do better. We should be more like India. That's where I thought this was gonna go. So I thought, you know, I'm gonna weigh in here.

My first point was there's been significant leadership in health. It from a national level, from David Brailer to David Blumenthal, to Karen DeSalvo, Donald Rucker, and now Mickey Pathy. We have had a. Series of leaders that have moved the needle pretty significantly. Some of the moves may have lacked vision and caused less progress or some future roadblocks, but all have moved the ball down the field.

I. So the easiest progress to note is the use of a certified EHR technology. You go back to 2008 and you're looking at roughly 10%, maybe even a le little, less than 10% of the health systems across the country were using an electronic health record at all. So we weren't even putting the information into digital.

That's back when we had all the manila folders. Stacked up and shoved into all the, the spaces that we had in the hospital. And today you're looking at 95% have a certified EHR technology. Now, that's not the end all and be all, but it is the foundation and we all agree on that. You, you can't do anything until you at least digitize the, the medical record and digitize some of the processes around that.

And so they laid the foundation and they moved it forward. Now, mu had some flaws, but the greatest of these was probably that the federal government, as it is prone to do, overlooked the sharing of the medical record while it was doling out billions and billions of dollars. It turns out that the medical record was the property of the creator of the record.

And even though health systems talked a great game with regard to the patient owning the record and being the quarterback of their health, our practices did not bear that out. I. The value of the record was great. It was seen by some as a way to protect your business and, and therefore was not shared easily.

It was seen by others as a valuable asset that could be monetized. Many health systems either knowingly or unknowingly, have profited from the sale of patient data. Meanwhile, the patient makes no money. From the sale of the information about them, and they are saddled with an arduous process to collect all of their health records.

Sure, there have been regulations that have been put in place to make it easier for them to get access to their information, but they're all stopgaps. Nothing really solve the problem. We, we don't have a good digital medical record, at least not a complete one. For years, epic has basically said we do interoperability, but on the ground you find that they do it.

Between Epic shops really well and between others not so well. Cerner hasn't done much better. Heck, none of them have really made this a priority. And why would they? There was really no incentive to do this. This also speaks to the pace of innovation. Why don't we have a national vaccination record? Well, it turns out we don't have a national vaccination record because there's no mechanism for it.

The owner of the record is the creator of the record. The creator of the record a lot of times is the health system. So even if I, as the patient were to say, look, I, I want to give access to my medical record to this innovative new company, which is gonna build a national vaccination record, regardless of who it is.

Could be Apple, could be anybody. The owner of the record doesn't necessarily have to share the information. That really takes out all third parties from the innovation equation. And it turns out that the federal government really doesn't have a mechanism for stepping in and forcing health systems and EHR providers to give them the information, nor would we ever want them to.

Well, the foundation to change all this was laid in 2016. The 21st Century Cures Act of 2016 was passed in the waning days of the Obama administration. It was the last piece of major legislation that I can remember being this bipartisan. It was passed in the house by a vote of 3 92 to 26 in the Senate by a vote of 94 to five.

That's an amazing amount of bipartisanship around this. So the 21st Century Cures Act was passed in 2016, but it still required a lot of definition. So ONC and CMS went to work. They did a lot of sessions with people to try to understand what was needed, and then they came out with a set of proposed new regulations to advance interoperability across key sectors of our nation's healthcare system and empower patients and their caregivers.

With easier access to their personal health information. What did ONC and CMS propose? Rapid advancement of APIs enabled by data standards. Which they believed was critical expansion of interoperability and API framework to health plans, which they believed was game changing. So not only is this health systems, it's also health plans.

Now it's health systems. Today it's health plans. Uh, a little later I. But that's coming as well. The third thing, Medicare conditions of participation as a powerful tool to help drive interoperability in exchange. The fourth thing, information blocking provisions, and that's what goes into effect today.

And strong compliance mechanisms are essential to making this a reality. The fifth thing, a new privacy framework should be developed in parallel with the implementation of the proposed interoperability rules to protect the consumers, and finally, resources for robust stakeholder education. Well, that's just crazy, right?

That was under the Trump administration. No one really agrees with this. Right? Well, except. All the other administrations. This is from the six people who have served as National Coordinator for Health Information Technology since the ONC was formed in 2004. Dr. David Blumenthal, Dr. David Brailer, Dr. Karen DeSalvo, Dr.

Robert Codner, Dr. Farzad Maari, Dr. Del Washington, and here's what they had to say. We unanimously believe that these rules have the potential to transform how information flows. Through our healthcare system catalyzing broad innovation and engaging and empowering consumers. We strongly support the proposed proactive measures for the acceleration of information exchange.

And interoperability, including the promotion of technical standards and the use of hospital conditions of participation. We also applaud the proposed rules enforcement mechanisms against the use of pricing to restrict patients' access to their health information and other types of information blocking.

So there you have it. It's not only the previous administration, it's every administration since the ONC was formed. So information blocking rules go into effect today. It was delayed, but now they're in effect. There's a lot of work to do, but we're already seeing the fruits of this. Remember the story from last week where New York Life and Cerner are working on a, a pipe between the two.

Well, guess what? This is. The kind of thing that will happen. This is a patient initiated request for the health record. This is covered under the information blocking rules. This could and should be coming to Epic, Allscripts and Meditech implementation near you soon. I. All right. The information black and rules went into effect.

There are gonna be some challenges with this. In fact, there's an article that we talk about on today's Newsday show and at John Mass from Cerner and Dr. Joseph Schneider, chair of Texas Medical Association, commented on some of those. Challenges the definition of electronic health information. Is any information contained in a designated record set?

He said, and that is a whole lot of information. That's true. It is a whole lot of information. Providers, on the other hand, are more concerned with the various scenarios. For example, Schneider. From the Texas Medical Association recalled how a physician recently went to the Texas Medical Association to sort out the a data conundrum.

The doctor's office had asked a local hospital for information on the clinic's patients that were also admitted at the facility. The office requested that the hospital send the information directly. Or via a local health information exchange as it had a non-Epic EHR. But the hospital's Epic system could neither coordinate with the office EMR, nor was it set up to integrate with the local HIE resulting in a potential information blocking violation.

So you can see there's a lot to work through. There's a lot going on. The reason I commented on this is to say there's been significant amount of leadership. It's taken some time. We've gotten the foundation for the medical record digitized, and now we're addressing one of the biggest flaws associated with mu, which is we created alleys.

And we do this in technology an awful lot where you get to the end and you realize, I have nowhere to go from here. I'm stuck. And they address that this information needs to be used. It needs to be used by the patient, on behalf of the patient, and we need to allow the patient to engage the innovation community.

I. Around the use of their medical information. And so we are at the starting gate of what could be a significant renaissance in the use of medical data and healthcare data on behalf of the patient. I. So I chose to comment on this LinkedIn post because A, I believe it's incorrect to think that we have not had national leadership on this.

I believe we have had national leadership on this. And the second thing is to say, I believe we're at the starting gate. I believe not only will we see a national vaccine record, if that's what the patient wants and if there is a market for that, but I think we're going to see an amazing amount of innovation between now and the next five years.

Almost to a point of it being unrecognizable. The patient initiated things you are going to be able to do to manage your health, to engage third parties, to utilize technologies and tools to live a healthier life. That's probably enough for today. If you want more information, check out our website and listen to some of the episodes we've had.

We've recorded with some experts on this. An Chopra has been on the show. Two or three times. Donald Rucker's been on the show twice. Mickey tpa, who's the current ONC lead in this area, has been on the show as recently as last year, and did a amazing deep dive on all of these topics that we covered today.

Great resources to understand what's coming next. All right. That's all for today. If you know of someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week,, or wherever you listen to podcasts. Apple, Google Overcast, Spotify, Stitcher, you get the picture.

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