“We need to start thinking as a society about how we can respond to events better.”
It’s been nearly a year since the pandemic turned the world on its axis, forcing healthcare leaders to do the unthinkable and shut down clinics. Although there have been silver linings — most notably the increased adoption (and acceptance) of digital health — the industry’s response to Covid-19 has exposed a significant gap when it comes to situational awareness, said John Halamka, MD, during the recent HIT Policy Update.
And it’s not just about Covid; the outages affecting Texas and other areas also demonstrated the need to reimagine how technology can be leveraged to navigate a crisis, according to Halamka, president of Mayo Clinic Platform. It starts by asking, ‘Do we know who needs help and why?’ During an outage, for example, that means leveraging a robust set of APIs to enable first responders and others to prioritize their efforts.
“I expect that as we’re dealing with societal challenges, whether it’s climate or infectious disease, we’re going to be building more and more of these situational awareness components and dashboards,” he said. “And we’ll do it through nontraditional collaborations of government, academia, and industry.”
Information blocking’s path
A key pillar in that vision is the policy piece, which Halamka addressed by providing updates on CMS’ Interoperability and Patient Access final rule. It comes with several provisions, including requirements for patient-facing API and ADT transactions, he said. “All this technology has been in the EHR for years. It’s just a question of implementing some the workflow processes around data flows. There are going to be some who are not quite ready but, by and large, the industry is ready for this.”
The information blocking component is scheduled to take effect on April 5, 2021; and although it’s been pushed back twice, he expects the date to stick. “The overwhelming sentiment is, let’s not defer the information blocking rule any further,” he noted. “It would send a very bad sign; especially during a pandemic, when we need more information for more purposes.”
As healthcare has moved through the various stages of Covid — isolation, testing/contact tracing, therapeutic measures, vaccination, and the “new normal” — those purposes have evolved. As organizations move to distribute the vaccine, one of the key challenges that has emerged is credentialing. With bad actors quickly deciphering how to recreate PDFs of vaccination forms and enter false data, individuals are finding it increasingly difficult to provide proof of clinical data.
One solution is a digital certificate with detailed information about vaccines received. According to Halamka, hundreds of US-based companies, including government and academia, are “using a FHIR-based standard called the smart health card, which enables us to instantiate any clinical data — not just vaccine records, but PCR tests as well — into a signed phone-based QR code and certificate or file for exchange.” What makes it so promising, he added, is the fact that it utilizes verifiable, signed clinical data.
For example, if an airline like Delta requests credentials to let someone fly to another country, its app might have an identity validation function. “The combination of the verified clinical credential, plus proof of identity, then goes into a set of rules. Then Delta issues a passport to travel to the person’s phone. That would be the workflow.”
And while what he described above is a hypothetical situation, companies from different verticals are having discussions to make that — or at least, something close to it — a reality.
“As we envision going back to work and life, being able to have transportable credentials is so important,” Halamka noted. “I think in the next 60 days, you’re going to see products coming out that support these standards and help us get to a post-Covid new normal.”
And while accurate credentialing is critical, along with continued testing and contact tracing, those are merely building blocks “in a long litany of IT improvements, we need to ensure society is capable of responding to any event that comes our way.”
Knowing the data
A significant part of that, according to Jay Sultan, VP of Healthcare Strategy at LexisNexis Risk Solutions, is authentication, which is where the vendor community comes in. “We have the ability to electronically figure out whether the person who wants to get your data is who they say they are.” With its vast data assets – which includes 2.5 billion claims from government and commercial sources – LexisNexis Risk Solutions is able to support providers and health plans in validating, authenticating and matching a patient’s identity as these entities work to track vaccine rollout.
That last piece is particularly important as information changes (such as a patient’s address or insurance), or data is entered incorrectly. “We know about every data point for basically every adult in the country,” Sultan added. “We can plug our reference data into your existing infrastructure to allow it to more accurately figure out who is who.”
And as the information blocking rules go into effect, this becomes even more critical. “You have to match data correctly. You can’t aggregate too little or too much data. You have to get it right. I believe healthcare delivery systems need more and better information so that we can provide some forms of reference data to be able to do a better job with EMPI management.”
Halamka agreed, noting that it will be especially important as organizations like Mayo must contend with increasing amounts of data coming in—and not just EHR data, but data from wearables and mobile devices. “You’re going to need to ingest, as a health system, all of these new kinds of telemetry, normalize them into standards, bring them together with algorithms, and then return a result in workflow.”
Without the right components, however, those workflows aren’t possible, said Halamka, whose team has developed an algorithm to diagnose COVID-19 infection from an Apple watch. “We’re working across the industry with multiple startups and multiple companies to ensure we have these components. It’s not just for the Mayo clinic; it’s for the whole industry.”
To view the archive of this webinar — HIT Policy Update (Sponsored by LexisNexis Risk Solutions) — please click here.