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Episode 174: A Community of Practice, A Community of Value. Sequoia Projects Payer to Payer FHIR API Implementation Workgroup

August 23, 2017

Additional keynote featured Madhu Annadata of CMS on the agency’s growing relationships and communications efforts with the industry’s major players

RESTON, Va. — August 23, 2017 — Earlier this month, the Workgroup for Electronic Data Interchange (WEDI), the nation’s leading nonprofit authority on the use of health IT to create efficiencies in healthcare information exchange and a trusted advisor to the U.S. Department of Health and Human Services (HHS), held its 2017 Summer Forum which featured keynote addresses by Donald W. Rucker, MD, head of the Office of the National Coordinator for Health Information Technology (ONC/HHS) and Madhu Annadata, director, Division of National Standards, Centers for Medicare & Medicaid Services (CMS). Speaking before a gathering of provider, payer, vendor and government sector decision-makers in Chicago, Dr. Rucker and Annadata highlighted a successful two days of high-level discussions focused not just on the burdens prior authorization and other transaction policies pose, but, more importantly, potential solutions the industry can implement to address these hurdles.

“As a trusted HHS advisor, WEDI was honored to have Dr. Rucker and Mr. Annadata address our Summer Forum, which gave participants unprecedented advocacy access so their voices could be heard by the highest levels of HHS and CMS,” said Charles W. Stellar, WEDI president and CEO. “Their remarks on interoperability and burden of usability were extremely insightful and we look forward to future collaboration with the Office of the National Coordinator for Health Information Technology and Division of National Standards, Centers for Medicare & Medicaid Services.”

After giving a brief overview of HHS and the two recent laws that have impacted the health IT landscape, the 21st Century Cures Act and MIPS/MACRA law, Dr. Rucker shared with attendees how the ONC is focused on two complex tasks as related to electronic health records (EHR) –  burden of usability and interoperability.

On the topic of burden of usability or provider burden reduction, Dr. Rucker told Forum attendees that most issues stem from how EMRs are designed as software, how they are installed as software, and policy issues such as prior authorization saying “purchase for value seems entirely reasonable but somehow collectively as a country what we’re implementing in software, we’re missing some of the opportunity here and generating another layer of costs to massage and capture and curate this data which we ultimately pay for as a taxpayer.”

Turning towards the theme of interoperability, Dr. Rucker explained how “ONC is charged with effectively coming up with definitions for interoperability, for information blocking and for open APIs” as mandated by Congress through the 21st Century Cures Act. According to Dr. Rucker, the ONC approach to tackling interoperability issues is by looking at three use cases. The first, how patients can get their records electronically if it was generated electronically; the second, institutional accountability, an area where Dr. Rucker feels “many healthcare markets providers have merged and aren’t competing on price anymore. They’re simply not. There needs to be institutional accountability.” The final use case according to Dr. Rucker focuses on the question of what is an open API? “What does an open API look like if I’m a small provider, small practice or chain of hospital?” he asked attendees.

Following Dr. Rucker’s keynote, Madhu Annadata’s presentation shared how CMS is focused on maintaining relationships with the industry, enhancing communications and improving the quality as well as the volume of those communications – especially with stakeholders. His remarks also included news on the implementation of a new complaint and enforcement system, one that will make it more usable and nimble as well as the goal to implement a viable audit program later this year to increase overall enforcement efforts. Future collaboration with the National Committee on Vital and Health Statistics (NCVHS) on their signature project, the predictability roadmap – focused on standards update and adoption process – is also on the horizon for CMS.

WEDI’s outstanding programming continues this December with WEDI-Con 2017. Taking place at the Hyatt Regency Reston in Reston, Va. from December 4-6, 2017, WEDI-Con will convene hundreds of healthcare leaders looking to network and collaborate with a diverse cross-section of the industry including payers, providers, government regulators and industry vendors. Lead by a host of industry thought leaders, WEDI-Con sessions will touch upon important issues impacting the healthcare arena including privacy and security; data exchange topics such as prior authorization, attachments, eligibility and transactions; risk management and data security; a primer on blockchain technology and more.

About WEDI

The Workgroup for Electronic Data Interchange (WEDI) is the leading authority on the use of health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency, and reduce costs of our nation’s healthcare system. WEDI was formed in 1991 by the Secretary of Health and Human Services (HHS) and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI’s membership includes a broad coalition of organizations, including: hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. To learn more, visit www.wedi.org and connect with us on Twitter and LinkedIn.

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