How Major Changes Are Shaping COVID-19 Strategies

John Halamka, MD, MS, President, Mayo Clinic Platform

“It has been a remarkable few weeks.”

An understatement if ever there was one. Not only because healthcare IT leaders have had to reprioritize to create effective strategies in response to COVID-19, but because the pandemic came on the heels of ONC releasing the final interoperability rule.

The two events, of course, are not unrelated. In fact, some of the provisions in the rule — particularly those focused on enabling patients to more easily access their records — could play a significant role in the fight against coronavirus.

In the most recent installment of healthsystemCIO’s quarterly Policy Update, John Halamka, MD, President of Mayo Clinic Platform, offered his take on how the current situation will impact the lives of CIOs and other healthcare leaders, both now and in the future. “We’re looking at the movement of medicine from bricks and mortar to a more digital delivery environment,” he noted.

This “movement” has required an unprecedented amount of agility from state and federal agencies, whether it’s waiving state-level licensure requirements to enable qualified and credentialed clinicians to deliver care in multiple states, or the relaxing of HIPAA penalties for text-based communications.

“This has been percolating for years and not making a lot of progress, Dr. Halamka noted. “The fact that we’ve now been able, in a matter of days, to implement these relaxations of the telehealth restrictions is extraordinary.” And because he believes many of the changes being made during the COVID-19 outbreak will likely remain in place, it’s critical that leaders work through the logistics.

Another technology that has seen a dramatic uptick is SMS messaging. Providers were already able to communicate via text with patient consent. However, as different platforms are being utilized for virtual visits, the risks are amplified, as not all devices have BAAs, and not all are encrypted.

Fortunately, the Office of Civil Rights has granted a waiver for HIPAA sanctions, enabling the use of platforms that aren’t traditionally covered, said Dr. Halamka, who fully supports the decision. “Privacy is an important focus, but we need flexibility to deliver care in a digital fashion and do so in such a rapid way,” he noted. “Obviously, we’re all going to do everything to keep the patient data secure and private, but it certainly is beneficial that OCR has given us flexibility during the transition.”

The last component he discussed is remote care delivery, which can be leveraged to free up hospital space for COVID-19 patients. However, moving patients with conditions like chronic heart failure and COPD into the home is a complex process, particularly when it comes to recording and transmitting certain metrics such as pulse blood pressure, and ensuring the right providers are involved.

“It’s going to be supply chain coordination to the home. It’s going to be getting the right services and bringing in the right specialists,” he said. “All of these things are doable from a technology standpoint, but there are regulatory issues,” including licensure restrictions, Stark/Anti-Kickback, and the cost of transferring patients.

What needs to happen, according to Dr. Halamka, is the creation of a diagnosis related group (DRG) that enables an acute care hospital to transfer a patient to another setting of care without reducing the reimbursement. And it needs to happen soon.

“We’ve seen HHS offer sub-regulatory guidance on telemedicine very quickly. A lot of smart people in CMS are considering these issues now, and hopefully we’ll get adjudication soon,” he said.

Along those lines, Dr. Halamka also reviewed some of the implications of the ONC/CMS Final Rule, which was made public on March 9 (during what would have been the HIMSS20 Conference). Below are some of the most significant:

  • Deadlines haven’t changed. Although policymakers face some pressure to rethink the deadlines for the rules, no action has been taken yet, which Dr. Halamka feels is the right move. “In a COVID virtual world, it’s going to be more important than ever that you can be the steward of your own healthcare data,” he noted. And the best way to facilitate that is by ensuring patients can easily access, and exchange, their medical records.
  • API as the standard. The final rule puts the onus on hospitals and practices to ensure patients can access information — and not through a paper chart or PDF, but through FHIR APIs, using an app that is appropriately functional and adheres to standards. This extends to vendors, who will be required to provide APIs with the USCDI [United States Core Data for Interoperability] and FHIR implementation guide. Halamka believes this will actually reduce the burden on vendors, “because it makes it clear that one standard, one implementation guide, one set of data has to be made available.”
  • Removing the “whole.” An extremely important component of the final rule is that providers no longer have to make the entire patient record available. Now, APIs must be applied to the core set for data interoperability, which includes problems, meds, allergies, labs, radiology, and care plan, “but doesn’t include the million other things that potentially could have been in a medical record that have no standards associated with them,” he noted. Therefore, “including USCDI as part of the final rule was very reasonable.”
  • Clarity on what data blocking is. One of the most significant — and anticipated — pieces of the rule was to define information blocking, which it did, according to Halamka. Put simply, “a product cannot block the flow of information for care coordination or the delivery of records to the patients,” he said. Every EHR must have a standard, certified API that can be consumed by any app or service that has appropriate authentication. In other words, “there has to be some usability. There has to have been appropriate testing to make sure the burden of being able to exchange medical records securely with these apps isn’t so hard or expensive.” While it might not seem groundbreaking at face value, he believes it’s “an exciting move forward for interoperability. The EHR vendors have already created much of this technology. The challenge will be figure out the workflow.”
  • And what data blocking is not. According to the final rule, information blocking occurs when “a party in the ecosystem is interfering to discourage access exchange or use of electronic information.” What it is not? “The result of incompetence or lack of technical capability,” said Halamka, who believes the notion of data blocking “has been more political and psychological than technical.”

It’s a lot to digest, particularly as healthcare organizations grapple with a pandemic that has reached levels few expected.

“This is all-consuming,” said Graham Hughes, MD, president of COO of Saykara. “The planning, readiness, and execution are continuing all the time. It’s not like you plan once and you then work on that. Everything has continued to evolve,” whether that means setting up drive-through testing sites, retrofitting hospitals, or postponing elective surgeries. Saykara, a Seattle-based company, is doing its part by offering its scribe services at no charge for covered visits.

It’s one of many examples of private sector organizations “stepping up to the plate” and working together to create novel solutions, share knowledge, and ease the financial burden being faced by hospitals, noted Halamka. Another is the COVID-19 Healthcare Coalition, which brings together heavy-hitters from across the industry and leverages their strengths to improve care.

“This is an opportunity for leadership,” he said. “The next few months will try us. But by working together, we can overcome this.”

To view the archive of this webinar – HIT Policy Update: Covid-19 Special Edition (Sponsored by Saykara) – please click here.


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