Erica Galvez is CEO of Manifest MedEx, California’s largest nonprofit well being knowledge community. Earlier than becoming a member of MX, Galvez led the well being data change efforts at Aledade and likewise led the Workplace of the Nationwide Coordinator for Well being IT’s (ONC’s) Interoperability Portfolio. This text relies upon her current keynote speech at Healthcare Innovation’s Summit assembly in Los Angeles. 
 
This yr has felt like the beginning of one other seismic shift in healthcare infrastructure. 

The Trusted Alternate Framework and Widespread Settlement (TEFCA) is advancing nationwide change and interoperability by designating an preliminary set of Certified Well being Info Networks (QHINs) to attach present and rising networks and broaden well being knowledge change. 
 
The Heart for Medicare & Medicaid Companies is ready to finalize necessities for well being plans to additional streamline and modernize prior authorization and knowledge sharing with suppliers and different plans via FHIR APIs. Many states are rising from the pandemic with initiatives to remodel each public well being and Medicaid — initiatives that depend upon knowledge sharing throughout the healthcare ecosystem and with public well being — to attain well being fairness, preparedness, and entire particular person care targets. In our state, California is actively implementing its first statewide well being knowledge change framework, requiring most healthcare entities to change well being data by 2024. With this wave of coverage modifications, and a few precise enforcement tooth for the twenty first Century Cures Act Info Blocking Rule that prohibits intentional interference with well being knowledge sharing, issues could be altering…quick.
 
The final time we had a seismic shift in well being IT of this scale began in 2009 with the ARRA financial stimulus plan setting out $27 billion  in incentives to assist medical organizations undertake digital well being document (EHR) know-how. Included within the particulars of the Well being Info Know-how for Financial and Scientific Well being (HITECH) Act have been specifics round figuring out “Significant Use” of the know-how to grant monetary incentives. 

Significant Use (MU) was designed to create a digital well being revolution, to maneuver us off paper information and on to computer systems. By many measures, this system was extremely efficient, introducing a rare quantity of change in a really quick time frame. In the midst of 10 years, EHR adoption in hospitals went from 9 p.c to 96 p.c because of this system, and from 48 p.c to 88 p.c amongst office-based physicians. 
 
Nevertheless, interoperability and seamless knowledge sharing between these digital techniques was deprioritized in favor of driving fundamental EHR adoption and use: We constructed the homes and companies via the MU program, however we didn’t plan and make investments adequately within the roads that join them. And whereas the MU program integrated a number of well being data sharing and public well being measures, the monetary funding in interoperability infrastructure via the one-time State HIE Cooperative Settlement Program (HIE Program) of $564 million — 2 p.c of the quantity invested within the MU program divvied up throughout 50 states and a handful of territories — merely wasn’t sufficient to allow the sturdy, sturdy “roads” we want. 
 
We see that so clearly now that we are attempting to allow generational transformation in states like California, the place our push to advance well being fairness by addressing the wants of the entire particular person via packages like CalAIM require knowledge sharing infrastructure that connects each supplier and well being plan throughout the state — in essence a digital well being knowledge security web that offers each supplier and plan the flexibility to share and use the well being data they want for his or her sufferers and members no matter their measurement, geography, or assets.  
 
Our collective expertise of the MU program affords a variety of classes which can be price making use of to present and future desirous about a digital well being knowledge security web. Listed below are three to begin: 
 
    1. Excluding segments of healthcare perpetuates fragmentation. Not each healthcare group was included in MU incentives. This system excluded long-term care, public well being, psychological and behavioral well being, ancillary service suppliers, and rehabilitation and psychiatric hospitals in addition to impartial medical psychologists, medical social employees, bodily therapists, occupational therapists, dieticians, and diabetes nurse educators — abandoning many suppliers and care groups that play important roles for our most susceptible populations. Insurance policies at the moment want to make sure that each healthcare group, particularly these serving psychological well being and the aged, can take part.  
 
    2. Incentives inspire motion, AND they need to be used to bridge the digital divide for all suppliers. MU confirmed that speedy know-how progress was attainable in healthcare. The hospital and ambulatory apply incentives instantly sparked a increase in well being know-how adoption amongst certified organizations, with even small medical practices capable of spend money on new techniques. Security web healthcare organizations similar to federally certified well being facilities (FQHCs) have been truly already forward of the sector on EHR adoption earlier than MU, discovering that the know-how was “considerably related to improved high quality of care, as measured by sufferers’ ease in getting a well timed appointment for specialty care, sufferers’ receipt of follow-up or preventive care reminder notifications, and [community health center’s] receipt of discharge summaries following their sufferers’ hospital admissions.” For these security web clinics, the MU incentives helped them proceed accelerating their innovation and gaining extra affect within the healthcare panorama. With future packages, we should always proceed to make sure incentive packages are arrange in order that under-resourced healthcare organizations — notably these left behind by MU — obtain probably the most monetary help and may make the largest distinction for well being fairness.  
 
    3. Public well being must be greater than a passive participant. Our public well being techniques have for too lengthy been not noted of packages like MU — often set as much as passively obtain knowledge for issues like immunization registries, however not engaged as companions to design and broadly advance knowledge sharing and infrastructure for inhabitants well being and well being fairness. Public well being should have a seat on the desk of a digital well being knowledge security web to make sure the bridges between the care supply system and the general public well being system are designed, carried out, maintained, and funded adequately.
 
In 2015, the American Journal of Public Well being printed a report on missed alternatives in MU to handle well being fairness: “The science of eliminating well being disparities is complicated and depending on demographic knowledge. The [HITECH Act] encourages the adoption of digital well being information and requires fundamental demographic knowledge assortment; nonetheless, present knowledge generated are inadequate to handle identified well being disparities in susceptible populations, together with people from various racial and ethnic backgrounds, with disabilities, and with various sexual identities.”
 
We’re at an necessary inflection level at the moment to proceed delivering on the worth of digitized well being information by serving to that data get to the precise care workforce(s), on the proper time. To construct a well being knowledge security web requires coordination between state and federal leaders and ongoing funding for infrastructure that delivers worth to everybody supporting particular person and group well being, not simply these with the largest budgets.



On this new TEFCA, post-COVID, well being fairness–pushed universe, the established order is our worst enemy. MU reveals us that speedy progress is feasible and that we are able to unlock change with neatly coordinated incentives and the precise companions on the desk. MU additionally reveals us that once we transfer quick, we’ve to choose a spotlight and make trade-off choices. Let’s ensure that this subsequent seismic shift doesn’t lose sight of the significance of infrastructure that connects the complete well being and healthcare ecosystem with fairness on the heart.