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The 2019 Wrap Up: Mandate, Mandate, Mandate with a Splash of AI

healthcare mandates
Associate Vice President Sales, Provider Market

2019 was the year of government mandates — interoperability, drug pricing, price transparency, data privacy. With large multinational tech companies not formerly in the healthcare space coming to play in the market, agencies like the Office of the National Coordinator (ONC) and Centers for Medicare and Medicaid (CMS), had something to say about it.

Interoperability and the Rise of Digital Health

As we got closer to defining what this really means and how electronic health record systems can really talk to each other — how they can exchange patient data and information between providers, payers and pharmacies for efforts like telehealth and remote patient monitoring — the ONC’s interoperability mandate had EHR vendors all abuzz about what the data sharing really means.

By defining the way providers and EHR vendors can provide standardized criteria for interface development, these mandates may actually make achieving interoperability harder rather than easier.

Earlier this week. Epic CEO, Judy Faulkner weighed in that forced criteria could jeopardize patient privacy. The new CMS rules, which open EHR and claims data for IT developers so patients can access data through mobile apps may help with interoperability, but causes grave concern for patient privacy.

Faulkner suggested putting more safeguards in place to protect patient data. This is where having a strong identity authentication strategy, especially one that is integrated within an EHR like Epic, and a focus on identity governance and linking and patient record matching, can help strengthen data sharing if the mandate goes through.

Emerging Technologies

As new flavors of AI and machine learning came into the market, many health systems were still scratching their heads trying to figure out how to integrate new data sets like social determinants of health into existing EHRs. 

A recent survey of members of the College of Healthcare Information Management Executives (CHIME), at their annual CIO Forum in November, identified AI as creating “hero-like” industry buzz but failing to deliver. Will that change next year?

AI has been seen to be impactful in small and deliberate delivery, but whether the technology can accurately and safely be deployed is yet to be determined. Only until AI is utilized operationally to save a clinician’s time will we see its real value and return on investment.

Social Determinants

While the value of addressing socioeconomic factors in patient care was the buzz word du jour, the ethical and practical use of the data still generated discussion. Groups like eHealth Initiative & Foundation weighed in with guidelines on the ethical use of the data from industry heavy hitters.

2020 is the year when payers, providers and health systems need to figure out how to operationalize and take action on the data within analytics and pop health initiatives to see its real value. In light of the move to value-based care and ACOs proving their value in saving Medicare billions, the likelihood is, the move from FFS to quality will definitely incorporate social determinants as a part of the puzzle to better target populations.

Price Transparency

As the 2020 Presidential election gets closer, big pharma and hospitals are laser focused on talk of drug price and hospital pricing transparency rules. We know that healthcare spending increased in 2019 but providers are scrambling to figure out how to meet the CMS regulations to disclose prices charged to different payers.

2020 will be a year for healthcare to pivot, but if it pivots too quickly, a mandate may come down to slow progress, both in technology, innovation and cost savings. I believe the answer will be a more focused approach on smart data sharing and technology innovation within existing platforms that can meet privacy concerns and look at the needs of the whole patient.

The DNA of Healthcare

At LexisNexis Risk Solutions, our goal is to provide the healthcare industry with insights and innovations to improve outcomes, grow market share, reduce fraud and increase compliance.

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