Ryan Howells, Principal at Leavitt Partners, envisions a wholesale move by the health IT industry to open standards, health care providers moving data from the EHR into their own data centers for more flexibility in AI use, patients sharing the insurance information with providers without paper cards, and 93% of prior authorizations requests answered in real time.
In a recent interviw with Howells, we explore the regulatory and technical advances in interoperability that might even kill the clipboard that patients fill out on each visit. And yes, “Kill the Clipboard” is a reference to a paper that Howells and Leavitt Partners published wich many of the ideas expressed in the paper being reflected in CMS’ Kill the Clipboard effort.
Leavitt Partners brings together multisector alliances, including providers, payers, IT experts, and others, to help health care organizations handles policy issues at the federal level. In addition to offering services, the Leavitt Partners proposes policy changes to CMS and ASTP (ONC) about what needs to be written or changed. We dive into some of these learnings with Howells.
Howells laments that the EHR certifications set up in the Meaningful Use period did not require standard interfaces; therefore, each vendor has a different interface and apps can’t easily be designed to tie together different EHRs. (As an example of how bad the current situation, my PCP merged with a hospital in the area and “migrated” patient records to the new EHR, which was from the same major vendor. Most of the information got lost and had to be re-entered for thousands of patients.)
Now that FHIR is widely adopted, ONC certification is requiring interoperability, and Howells says it “could unleash more innovation in healthcare tech than ever before.” Payers and priorities now have to share data prior authorizations and payments. The ONC also pared down its certification.
CMS has a new, loose collaboration to implement the idea of a CMS-aligned network. It has 13 workgroups, currently involving more than 600 organizations and 1,000 individuals. Leavitt Partners, since 2016, has run the CARIN Alliance to empower digital access by consumers to health care data, with the goal of single sign-on from anywhere.
Howells and Lynn discussed the recent importance of AI for consumers. Howells said that 20% of searches on popular sites such as ChatGPT are health-related.
However, the real value of AI comes from understanding the complete patient. To do this, the patient would need to upload their entire history, but that complete record doesn’t exist. Instead, records are scattered among EHRs that don’t talk to each other.
The video also discusses the barriers to sharing data, including those erected by HIPAA. Howells says that rules for business partners, which require fees and the involvement of layers to set up data agreements fees, effectively constitute blocking. Although patients should have unfettered access, the technology hasn’t been created to allow this. And the lack of interoperability ensures that the system doesn’t scale, although TEFCA should help.
The EHR, in Howells’s opinion, has been asked to do too much. EHRs weren’t designed to help physicians determine how much risk to share, or to report quality measurements to regulators. Interoperability is indispensable to the development of a third-party ecosystem where providers can extract data from the EHR, store it in their own cloud instances, and run their choice of applications and AI models.
Thus, openness is the wave of the future: open data models, open AI agents for routine tasks, etc. Open standards allow federal agencies to require their use.
The Rural Transformation Program will help less financially endowed providers adopt the new technologies.
Howells has much more to say in the video concerning digital identity, how we can emulate Africa in leapfrogging to new technologies, the upcoming crisis in finding primary care physicians, why revenue cycle management is a tremendous waste that interoperable technologies should render obsolete, and more about openness.
Learn more about Leavitt Partners: https://leavittpartners.com/
Learn more about the CARIN Alliance: https://www.carinalliance.com/
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