Health data sharing is an important aspect of health reform, but it needs to be done with privacy and security issues in mind. That point was further underlined by The College of Healthcare Information Management Executives (CHIME) when it submitted formal comments on the ONC 2015 Edition HIT Certification Criteria notices of proposed rulemaking (NPRMs).
CHIME said that overall it agrees with the ONC’s new approach to privacy and security requirements, and “and appreciates efforts to reduce burden on health care providers where possible.” Furthermore, it is “logical and feasible” to require health IT vendors to assure that their Health IT Modules have necessary privacy and security functionalities. This will then take some pressure off of the health IT user, according to CHIME.
However, there are some concerns, including end-user device encryption. There are also already barriers built into health IT to the transmission of patient information among providers, CHIME stated.
“If the precision of the [privacy and security] requirements vary significantly among Health IT Modules and electronic health records, CHIME is concerned that the patient information will not be easily transferrable among providers,” the group stated. “We encourage ONC and software developers to avoid or eliminate software functionality restrictions that block patient information transfers among providers to the greatest extent practicable.”
CHIME also discussed data segmentation, and how ONC plans to implement two new certification criteria for data segmentation in order to separately track or “segment” individually identifiable health information in an EHR. While the policy goal is sound, this will be a particularly complicated product to develop, CHIME explained.
“This is in part due to the specificity required to address the myriad privacy rule rules and their interaction; another issue is the degree to which tagging is done,” the letter said. “For example, would tagging be done at the patient level, the encounter level, or some other level?”
Therefore, more study and testing are needed before the data segmentation policies are introduced, according to CHIME.
Along with its ONC certification comments, CHIME submitted comments on the CMS proposed rule to change meaningful use Stage 2 criteria. The group explained that it supported modifications pertaining to Patient Electronic Access, Secure Messaging & Summary of Care measures. Moreover, CHIME said it opposes requirements that place accountability for patient behavior beyond what clinicians or providers can control and that CMS must address patient engagement more innovatively.
“As our industry continues the discussion of how best to engage the patient through technology, and how best to measure these efforts, we encourage CMS to think more innovatively around the concept of patient engagement, how to differentiate between those that do it well and those who do not, and how to incentivize laggards,” CHIME said.
The group added that it strongly supported a corresponding CMS proposal that would shorten meaningful use reporting in 2015 from a full year to any continuous 90-day period. Overall, the federal plans for the third stage of meaningful use too ambitious and in need of several important changes, including the following:
- A 90-day reporting period for the first year of Stage 3 compliance, at least for payment adjustment purposes;
- Modify requirements for and retain the 90-day reporting period for providers attesting to meaningful use requirements for the first time, whether in a Medicare or Medicaid context;
- Eliminate patient action thresholds for the care coordination objective;
- Reduce the number of required measures in multi-measure objectives, health information exchange and care coordination;
- Create hardship exceptions for providers switching vendors;
- Allow providers to take a 90-day reprieve during any program year for upgrades, planned downtown, bug fixes related to new technology or optimizing the use of new technology within new workflows; and
- Allow, in limited circumstances, paper-based means to achieve measure thresholds
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