WEDI: ONC Health IT Certification Should Require ePA Data Exchange

The Workgroup for Electronic Data Interchange (WEDI) recently submitted a letter responding to an ONC electronic prior authorization (ePA) request for information, noting that the ePA component of the ONC Health IT certification program should be mandatory.

The letter, written by Nancy Spector, WEDI chair, gives several recommendations for ONC to help guide a transition to automated prior authorization.

“Meeting the goals of the expected future ONC and the Centers for Medicare & Medicare (CMS) prior authorization proposed rules require that relevant stakeholders have ready access to several key capabilities and functions,” Spector wrote.

“Providers must know whether payers require prior authorization for a service, and they must know what information is required by the payer to adjudicate the request,” she added. “It is important to focus first on making these criteria as widely available and useful as possible, even if multiple approaches may be necessary.”

A transition to ePA should promote seamless data exchange through mature, clear, and unambiguous standards, Spector said. ePA data exchange should also integrate easily within payer and provider workflows to ease the shift to automated prior authorization.

The WEDI letter noted that for providers and payers to take full advantage of ePA standards, the ePA component of the ONC program should be a mandatory part of ONC Health IT certification.

“While ONC does have an optional prescription drug prior authorization component based on National Council for Prescription Drug Programs (NCPDP) SCRIPT standard, we do not believe that approach will be appropriate for the future ePA standards for medical services,” she wrote.

“If only a small percentage of health IT developers support ePA, providers, payers, and patients will not fully reap the benefits of the automated process,” Spector added.

WEDI also recommended that ONC consider a certification that includes a “complete” ePA software product.

“The ePA process involves both administrative and clinical elements. For providers, some functions of the transaction are conducted through the practice management system (PMS) software while other functions are conducted through the EHR,” Spector wrote.

Some EHR systems incorporate the PMS component directly, while others connect to an outside product.

To ensure that smaller health IT developers can take full advantage of the ONC certification, WEDI suggested ONC consider creating a certification for ePA-specific modules.

“Modules developed in the future to support ePA may perform specific tasks related to prior authorization,” Spector said.

The group also called for ONC to ensure each stakeholder group has the appropriate incentives to support forthcoming ePA standards.

“Payers will be mandated to support the ePA standards and may be concerned that if a significant percentage of providers do not adopt the new approach, payers will not receive full benefit for their investment,” Spector explained.

“A major incentive for providers will be if their EHR supports the national ePA standard,” she said. “Having an ONC certification process in place would allow providers to require compliance with the program in contract language.”

Additionally, WEDI recommended ONC establish and support a Health Information Technology Advisory Committee (HITAC) workgroup mandated to guide ONC’s ePA efforts and advise the agency on other automation opportunities.