Steven ChiesWhen it comes to the adoption of new technologies in health care, in most cases the federal government plays a major role by implementing policies and/or setting goals that attempt to bring change to the way in which the health care sector, including long term and post-acute care (LT/PAC) providers, operate.
This was seen in years past with the legislative and regulatory push for electronic health records (EHRs), and it is being seen now with the changes in the payment structure to allow for more telehealth market penetration and interoperability of EHRs, says Steven Chies, lead consultant, Care Paradigms, and president, North Cities Health Care.

When asked what the feds are focused on of late when it comes to technology, he tells Provider that from a regulatory standpoint it is these two dual issues of telemedicine and interoperability that have taken center stage.

The Telemedicine Front

On telehealth, it is apparent from the changes put in place by the Centers for Medicare & Medicaid Services (CMS) to reimbursement rules that the agency is highly encouraging more telehealth, notably in underserved rural areas where medical specialists are becoming harder and harder to find, Chies says.

“The limitation for telehealth in rural areas is having enough broad-band access more than anything else, and not a lack of policy or promotion,” he says. “You need a pretty decent pipe size to effectively do two-way telemedicine and communication.”

There are also barriers from human sources. An example would be hospitals and physician groups that are concerned about keeping patients in their systems, which may preclude someone from having access to telemedicine.

“Doctors in one system don’t want patients to go outside their system. They want to keep everyone in their same silo, even as a patient seeks specialist care,” Chies says.

Physicians also can be averse to having to adapt their own operations or administrative software to a new group that may be providing telehealth access, like when attempting to connect EHRs for figuring out medical options on a real-time basis, he says.

CMS Wants Data Sharing

On the second matter of EHR interoperability, Chies says CMS Administrator Seema Verma has come out and said, “Look folks, we are going to push ahead with the sharing of health-related data here,” which was made clearer when CMS published requirements for hospitals and vendors to stop locking data transfer.

“They are making a major push in the Office of National Coordination for Health Information Technology to try to come up with ways to allow interoperability, clarify HIPAA [Health Insurance Portability and Accountability] issues, and generally push interoperability substantially going forward,” he says.

But, when it comes to interoperability of patient health records, there is still a lack of momentum across the overall health care sector and along the care continuum to make it happen faster, even with the federal push in that direction, Chies says.

“The challenge for the LT/PAC provider is that they are not getting a lot of interest from their admission source to be able to do that at this point in time,” he says. “I think pressure from CMS will build on hospitals and physician services to be able to do this and maybe more so with bundled payment, ACOs [accountable care organizations], and some other risk-based systems out there.”

The research is clear that the ability for providers to be able to share information in a meaningful way is going to reduce rehospitalizations and get better outcomes for the patients, Chies says. “I think everybody is on board, but it is going to be a slow building process,” he says.

Security Remains a Clear Danger

Another issue on the federal radar is cyber security and data breaches, which seem to be a constant when it comes to discussing health care and technology. One of the preferred methods for hackers to extract monetary gain from their illegal theft of data is ransom ware, Chies says. This practice involves breaching secure data and holding it ransom until a payment via a cyber currency is made.

Providers in the long term care space have been victimized in this way, as have many other businesses in nearly every industry, he says.

In reaction, CMS has recently come out with an extensive document about how to deal with data breaches for the entire health care sector. The issue is also a priority with LT/PAC advocates, with the American Health Care Association working to inform its members of the threats and what to do to prevent breaches, Chies says.