How the ONC Interoperability Rule Could Mitigate COVID-19

Government officials should utilize the 21st Century Cures Act to enhance patient data exchange between the state and local health departments, a move that might slow down the spread of COVID-19, according to Ben Moscovitch, project director of Health Information Technology at Pew Charitable Trusts and Janet Hamilton of the Council of State and Territorial Epidemiologists.

“The problem is that, according to epidemiologists, up to 80 percent of COVID-19 laboratory reports omit individuals’ addresses, phone numbers, or race,” explained Moscovitch and Hamilton. “This information gap deprives the nation of opportunities to contain outbreaks, save lives, and make data-driven policy decisions to fight the pandemic.”

For example, a commercial lab took four months to send the state of Florida 75,000 COVID-19 test results, Moscovitch and Hamilton said. The state needed those results to create an effective COVID-19 response.

While providers enter this information into their respective EHRs, the information does not always flow through the system and share or report the information in a timely or accurate manner. And if the data is sent to the correct location, it is not always received properly due to outdated formats and a lack of interoperability.

The authors said the government is receiving upwards of 1,000 COVID-19 case reports per day through fax machines, which is an outdated method of exchanging health information.

All in all, these patient data faults are connected to information blocking, which the final Office of the National Coordinator for Health Information Technology (ONC) interoperability rule prohibits. In fact, the rule aims to drive patient access and sharing of her own electronic health information, allowing the individual the ability to coordinate their own healthcare.

“HHS leaders can and should use their authority to ensure that vital data on coronavirus cases is transmitted in formats that state and local officials can readily use,” said Moscovitch and Hamilton.

But, the two explained, HHS has yet to establish a plan to work with both clinicians and laboratories.

“That needs to change,” they remarked. “HHS should take a collaborative, broad and firm approach to enforcing information-blocking rules during the pandemic by issuing regulations or other policies that make clear that the department’s information-blocking rules apply to health care providers and labs when they send COVID-19 data to health agencies to work towards establishing a true ‘culture of health.’”

If it were to be enforced right now, the Cures Act would allow HHS to punish EHR vendors up to $1 million in fines per infraction.

“First, patient data, including the person’s phone number, address, race and ethnicity, must accompany testing orders and reports,” Moscovitch and Hamilton recommended. “Second, health care providers and labs must exchange and report information electronically using widely available standards, barring extenuating circumstances such as a health department’s inability to receive digital files. Failure to meet either requirement would be considered information blocking.”

Next, the authors recommended sharing health data, such as test orders and results, through application programming interfaces (APIs).

“Hospitals and labs might argue that they are stretched too thin by high caseloads and test volumes to be able to improve their digital record systems now,” they added. “But sharing information in rapid seamless electronic means is critical to the country’s public health response, and health care facilities and labs can update their existing record systems with minimal time and expense.”

Since many health organizations and agencies have adopted APIs, it should be doable, Moscovitch and Hamilton said.

“To address the concern that modernizing technology to improve information sharing is too burdensome during the pandemic, the requirement could be limited to COVID-19 reporting for the duration of the public health emergency,” they continued.

If the government enforces the interoperability rule right now, health organizations would need to upgrade their health IT systems.

“The failure to share data quickly and accurately has hobbled the efforts of state and local agencies to track the pandemic’s spread,” Moscovitch and Hamilton concluded. “Federal regulators took steps at the beginning of the pandemic to improve data exchange throughout the health care system. Now they should apply and enforce the Cures Act’s ban on information blocking to protect Americans as the coronavirus continues to rage.”