Bevey Miner Talks Interoperability in Digital Health Policy

In this interview with The American Journal of Managed Care^® (AJMC^®), Bevey Miner, executive vice president of health care strategy and policy, Consensus Cloud Solutions, discusses the evolution of digital health, challenges in achieving interoperability, and policy development.

Bevey Miner

Consensus Cloud Solutions

This interview has been lightly edited for clarity.

AJMC: Given the importance of interoperability in health care, what initiatives or strategies are in place at Consensus Cloud Solutions to promote data sharing and collaboration among different health care systems and stakeholders?

Miner: It’s interesting because when I first joined this health information technology industry, it was pre-EHRs [electronic health records]. We had EHRs, but we didn't have meaningful use. I hate to date myself. I've been in this business for 2 decades; it's given me a perspective that it's important to look at what we've tried to do in terms of Herculean steps that didn't get anywhere and the baby steps that amounted to what we didn't even envision when some of these new models of care were put into place.

I worked for Allscripts, a company that was very large in the EHR space. We were pushing and promoting and giving physicians money to get on an EHR because these paper files had such manual intervention to update. Anywhere between 10 to 15% of the content in a paper file was inaccurate, wrong, or missing, and could really harm a patient. It was manually intensive. Doctors didn't want to get off those paper files and they were very used to just going through paper files.

We gave them incentives; we moved them to EHRs. In doing so, we never envisioned that we would now have different structured data elements, included things like diagnosis code and treatments that were done on patients. We could look at comparative effectiveness, what treatments work and don't work, we can do population health, we can look at our total populations across the board and see which ones are trending towards prediabetes. We can put wellness programs in place because data being structured sits in a data store that can be mined in such a way that you wouldn't be able to do with paper files. Patients that qualified for clinical trials waiting on lists to get lifesaving treatment in a paper file system made it impossible to identify all the patients that yet could benefit from a clinical trial.

Because we have EHRs, we can look at inclusionary and exclusionary content for a trial and we can search that electronically. There have been big efforts for us to be able to treat patients better. When you look at interoperability, it's been a word that's been around for a long time. Some people would say interoperability is really interface engines. It's when you create a model where you want to send information from one system over to this end point. Interface engines facilitate that for the most part. That's what we kind of thought of as interoperability. But interoperability is also the way we look at interoperability is the ability for us to transform, enhance and, securely send data and exchange data back and forth. It's much more than just interface engines. And that I think is starting to become much more nuanced and developed as we look at some of the rules that are coming out from CMS.

Initiatives like the TEFCA [Trusted Exchange Framework and Common Agreement] framework (a legal agreement among stakeholders) and QHINs [Query Health Information Networks] are shaping a more nuanced understanding.

CMS has done a very poor job of educating the industry. In fact, I just got back from moderating a focus group that was all CIOs for Chime. And as I was facilitating this focus group, I asked how many of you plan on implementing the TEFCA framework, and the smaller hospital systems didn't even know what that was.

But there were some systems that felt that if they shared data on a particular patient, that they would lose that patient or that there would be leakage; they liked holding patient data hostage. It was really harming patients when they went from one setting to the next and not having that data can be extremely critical.

Information blocking, a significant concern addressed by the 21st Century Cures Act (2016), aims to prevent entities from withholding patient data.

So we passed some laws that said you cannot block data once it's requested. For your network, whether hospital or health information exchange, you have to send the data, and that's kind of where the cue hands are going to start to promote that more and more and more. So another part of interoperability is now that we believe we're setting a framework to create an interoperable data-sharing environment, backbone and blueprint for health care. There is no excuse why you should block information from being shared. And there's going to be some pretty heavy fines. So this one is pretty punitive.

In fact, CMS just came out with their rule on how much they're going to fine providers and hospital systems if they are found guilty of data blocking and that consumers and patients can even whistleblow on a particular hospital or a care setting.