It's time for HHS to revisit its HIE strategy

You've got to hand it to the Government Accountability Office. This independent, nonpartisan organization, charged with investigating how the federal government spends taxpayer dollars, does not pull any punches when it comes to assessing the Meaningful Use program. But it always backs up its conclusions with research and offers suggestions to resolve problems, a refreshing change.

For instance, the GAO has pointed out that expanding prepayment audits of Meaningful Use incentive dollars would save Medicare millions of dollars; that the U.S. Departments of Veterans Affairs and Defense were not taking the proper steps to develop a joint EHR; that there was significant variation in which providers were successfully attesting to Meaningful Use, which could shed light on the design and effectiveness of the program; and that the clinical quality measures were "unreliable."

Now, the GAO is reporting that the U.S. Department of Health & Human Services' strategy to accelerate interoperability of EHRs, a critical component of the Meaningful Use Program, is deficient, with no specific action items, no established priorities, and no milestones to measure progress.

It's one thing for me to point out that HHS' interoperability strategy is lacking; it's another when the "Congressional watchdog" does it. Especially when the "fix" is relatively easy.

The GAO is actually being more gentle with HHS than it could have been, considering the number of obstacles providers reported about interoperability (which included fears of privacy violations, lack of standards, problems matching patients to records, and the cost of participating in HIE). All the GAO did was tell HHS to identify specific strategies to improve data exchange, prioritize the strategies and develop milestones to measure how it's doing.

These recommendations, to which HHS, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT concurred, seem pretty tame.  

But it begs the question: why didn't HHS, CMS and ONC identify and prioritize specific strategies and create milestones to begin with? Why wait until chastised by the GAO to do so?

Moreover, EHR interoperability has been a front-burner item for years, and HHS could be doing more to accelerate data sharing. The HHS health information exchange strategy GAO reviewed, released last summer, was pretty weak, with plans such as to "encourage" interoperability and "voluntary" data sharing, include HIE in Medicaid policies, and "strengthen the business case for HIE across providers."

No wonder the GAO called HHS on it.

Of course, the issue now is how HHS will prioritize and measure its strategies. Is it merely going to go back to the current strategies outlined last summer and prioritize them? What will be more important, encouraging interoperability or strengthening the business case for HIEs across providers? And how do you measure your progress on such amorphous strategies?

What this really is is an opportunity for HHS to use the GAO report as a springboard to revisit the strategies themselves, and address the real concerns articulated by providers (and the GAO): patient matching, privacy of records, standards and the cost.

The GAO didn't go as far as it could have. By listing the many problems found, the implication is pretty clear.   

HHS has finite resources to accelerate HIE in this country. I hope it doesn't squander them on the wrong strategies. - Marla (@MarlaHirsch @FierceHealthIT)