At a time when the novel coronavirus has made visiting a doctor’s office a risky proposition, more patients than ever are turning to telemedicine to get the care they need without leaving their homes. This rapid shift has shined a spotlight on an ongoing problem that both hampers routine care and introduces challenges in fighting a pandemic: the inability to effectively share health data across medical organizations and with patients.
As much of the world was turning its attention to the rising pandemic, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) in March released two long-awaited federal rules to reform the way America’s health care system uses and exchanges electronic health information. Among other things, the rules require that clinical and claims data be made available in the electronic form to patients at no cost, facilitating the flow of data among health care providers and to patients.
Recently, to avoid creating new compliance requirements on plans, providers, or technology developers as they rightly focus on COVID-19, the Department of Health and Human Services announced three- to six-month delays on the enforcement of some rules. When the initial peak of COVID-19 passes, technology developers and health care organizations can then redouble their efforts to meet the new requirements and address the inability to effectively exchange information that has hampered patient care.
Of the many lessons arising from the health care community’s response to the pandemic, one of the most important is the need for on-demand, remote access to health data for patients and providers. If anything, COVID-19 puts in stark relief why the American public needs these rules in place.
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For far too long, patients have functioned as a “human bridge” linking two ends of a broken health information highway — taking paper copies of medical records from one health care provider and hauling them to another. This antiquated approach is no longer feasible, especially in times requiring social distancing, and must change immediately for the health and safety of patients and providers.
The technology for making this change — called application programming interfaces (APIs) — already exists and will be advanced under the new rules from ONC and CMS as a way for patients to transfer and exchange data. Many Americans use these interfaces daily; for example, APIs make it possible for customers to quickly and easily aggregate banking and credit card information on personal finance websites. Once the rules are implemented, patients will be able to use APIs to access their health data on a personal device, such as a smartphone or laptop; they can then choose to share the data with providers or integrate it with personal health apps. As for data that cannot be shared using standard APIs, such as images or genetic information, patients will be able to easily request an electronic version that they can forward to another doctor.
The rules will ensure that patients are able to access all of their medical information in electronic formats, using the tools and applications they choose. Furthermore, the same infrastructure that gets patients their data can also help providers communicate more seamlessly with one another, such as when a doctor or nurse practitioner offering telemedicine services needs more information on an individual’s medical history. The data available through these APIs also can provide information on immunizations—information that will also be essential for public health agencies, providers, and patients to access once a vaccine is developed for COVID-19.
For medical professionals, having easy access to a patient’s immunization status or test results is critical; even outside of a pandemic, clinicians need to be able to obtain basic health information, such as a patient’s allergies or medications, to do their jobs and keep patients safe. Dr. Donald Rucker, the head of ONC, has argued that the country “would be in a vastly better position to fight the virus and do home-based care through technology today if we had these APIs up and running.”
COVID-19 has infected more than a million Americans already; slowing its spread and protecting lives should remain health officials’ top priorities, and the minimal delays in implementing these rules are a recognition of that fact. But the pandemic highlights that the current health IT system is broken. The new rules on electronic health information are an important step in addressing the gaps in the system and setting the health care industry on a path to a future in which technology plays a greater role in connecting patients to care, whenever and wherever they need it. These delays strike the right balance between achieving those goals in the future and allowing the health care sector to focus on the coronavirus now.