Report: ONC requires measures to enhance patient access to records

While the Department of Health and Human Services has several attempts to enhance ability of patients to access their electronic health information, HHS lacks the capability to assess the effectiveness of these initiatives. ONC requires measures to enhance patient access to records.

That is the conclusion of a new Government Accountability Office (GAO) report that particularly calls out the Office of the National Coordinator for Health IT for its shortcomings in this place. ONC requires measures to enhance patient access to records. ONC requires measures to enhance patient access to records.

In spite of the fact that ONC is needed by the HITECH Act and the Medicare Access and Children’s Health Insurance Program Reauthorization Act to establish performance measures for the adoption of electronic health records and related efforts to serve the electronic use and exchange of health information, ONC hasn’t established a specific means for measuring outcomes linked with its efforts targeted at furthering patients’ ability to electronically access their health information, in accordance to the GAO.

“Without such initiatives, HHS lacks critical information essential to determine whether each of its efforts are contributing to the overall goals of department, or if these efforts require being modified in any way,” claims the GAO report.

For example, auditors charge that ONC can’t determine if sufferer electronic access is higher for participants in the Blue Button Initiative, in contrast with access rates for non-participants, or if providers who use the Patient Engagement Playbook—a tool established by the agency to help providers in using patient portals to engage patients—acquire more patient electronic access than non-users.

To deal this shortfall, the GAO suggested that the HHS Secretary direct ONC to establish performance measures to assess outcomes of key efforts related to the electronic access of patients to longitudinal health information, involving determining whether the number of providers that participate in these initiatives have higher rates of patient access to electronic health information.

Additionally, auditors suggested that the HHS Secretary direct ONC to use the information these performance measures provide to make program adjustments—where suitable. “Such actions may involve, for instance, assessing the status of program operations or recognizing areas that require improvement in case to help achieve program goals related to increasing patients’ ability to access their health information electronically.”

ONC and HHS are seeking to the comments as opportunities for improvement, officials claim.

“HHS and ONC analyzed and concurred with the recommendations,” claims Acting National Coordinator Jon White, MD. “The GAO report is a good opportunity to review our efforts.”

In a written response to the GAO report, HHS claimed that ONC would “make every effort to develop performance measures for sufferer education and outreach initiatives but would have to balance these attempts with its efforts to develop measures for the adoption of EHRs, interoperability and sufferer engagement nationwide.”

Moreover, HHS demonstrated that ONC would use the data the performance measures provide to make program adjustments, and that it is devoted to using such metrics to guide program improvement.

“We are looking forward to working on those suggestions,” adds White. “We have got great measures on how the technology works and how the certified technology offers people access to information. But we are looking forward to establishing new, better measures on individuals getting access to their data.”

 

GAO calls CMS’ Medicare Advantage encounter data into query

The Centers for Medicare and Medicaid Services (CMS) has made insufficient development in validating the completeness and precision of Medicare Advantage encounter data, a crucial component for administering accurate payments for the program, in accordance to a Government Accountability Office audit.

CMS gathers Medicare Advantage encounter data, detailed data about the care and health status of Medicare Advantage enrollees, to evaluate payments. Although, despite GAO’s 2014 suggestions that CMS completely assess data quality before use, auditors discovered that the agency has yet to take critical measures to make sure the encounter data is right and complete, making the Medicare Advantage program susceptible to improper payments and wasted taxpayer dollars.

“CMS has still to undertake tasks that fully deals Medicare Advantage encounter data precision, like reviewing medical records,” states the audit report. “Moreover, few health insurance and provider trade associations GAO interviewed voiced concerns about CMS’s capability to accurately identify diagnoses utilized for risk adjustment…To the extent that CMS is making payments deployed on data that haven’t been completely validated for completeness and accuracy, the soundness of billions of dollars in Medicare expenditures sustains to be unsubstantiated.”

A CMS spokesperson refused to particularly comment on the GAO’s findings and suggestions, and instead referred to the agency’s official written responses released in the audit report. Among those responses, CMS officials pointed out that they are working with Medicare Advantage agencies to refine how the methodology used to gain diagnoses data is applied.

Additionally, the agency claimed that it has started compiling basic statistics on the volume and consistency of data submissions and preparing automated summary reports for Medicare Advantage agencies demonstrating diagnosis information used for risk adjustment.

Specifically, CMS started phasing in patient diagnosis data from Medicare Advantage encounter data in its risk adjustment process in the year of 2015 and told the GAO it intends to depend completely on those data by the year of 2020.

Because it has primarily concentrated on collecting comprehensive encounter data for risk adjustment purposes, CMS officials also informed auditors that the agency has highly deferred planning for extra uses of the data.

Nevertheless, in accordance to the GAO, few stakeholder agencies have objected to the risk adjustment transition time frame, compelling that it does not permit sufficient time for a victorious transition. Still, CMS asserts that the multiyear transition time frame is reasonable.

Provided the agency’s limited progress, auditors claimed that they continue to believe that CMS should execute GAO’s July 2014 suggestion that the agency completely develop plans for the extra uses of Medicare Advantage encounter data.

“This latest GAO research proves once again that the encounter data system isn’t ready for full implementation,” stated House Ways and Means Committee Chairman Rep. Kevin Brady (R-Texas) in a written statement. “While the system was developed to ensure right payments for the millions of seniors who depend on Medicare Advantage, it won’t work with incomplete and inaccurate data and could lead to higher premiums or decreased benefits down the road. CMS must ensure this significant system is based on the right information so taxpayer dollars are going to Medicare recipients who require them most.”

Likewise, House Energy and Commerce Committee Chairman Rep. Greg Walden (R-Ore.) claimed in a written statement that the GAO report “raises more uncertainties about the encounter data system and either it is ready to perform its duties.”

While applauding that few improvements have been made since GAO’s 2014 report, Walden noted that “key suggestions from the government watchdog have still to be implemented” and voiced his support for the “GAO’s asserting that CMS should completely assess its data quality before implementing” the Medicare Advantage encounter data system.

 

VA EHR Optimization Attempts an Uncertainty for Congress

A House subcommittee is looking a GAO research of the EHR optimization attempts underway or planned at VA.

The Department of Defense (DoD) is not the only federal agency in the midst of a huge EHR modernization project, with the Department of Veterans Affairs (VA) also working to upgrade its present EHR technology called as the Veterans Health Information Systems and Technology Architecture (VistA). And it is the latter that is raising concerns among members of Congress.

In a letter to the head of the Government Accountability Office, Representatives Will Hurd (R-TX) and Robin Kelly (D-IL) of the Committee on Oversight and Government Reform Subcommittee on Information Technology inquired the federal agency to study the VA's EHR modernization project of VistA.

"Given the importance of VA's electronic health record information system to the performance of its health care mission, and in light of VA's repeated attempts to modernize VistA, the Subcommittee is requesting data on the attempts to modernize VistA," wrote Hurd and Kelly.

"In specific, we would like to get data on the history of VA's efforts to modernize VistA, involving the prices and results of the efforts, the key contractors that have been involved, and the work that these contractors performed," the letter continued. "In addition, we inquire that the study determines VA's current plans and estimated costs for modernizing VistA."