The Mitre Corp., a nonprofit organization that manages federally funded research, has issued a call to action with a draft national strategy for digital health. Among other things, it calls for universal broadband, a national patient identifier, and for the federal government to establish an entity to create a governance structure across the digital health enterprise.
The Mitre Corp. draft strategy calls on the federal government to “expressly and explicitly support the transformation of health systems in this country and the creation of a trusted digital health ecosystem. Such a declaration will align government and private-sector resource strategies and enable a comprehensive and transparent approach to funding.”
The draft framework has six stated goals, including access, affordability, and utilization of universal broadband for everyone and a sustainable health workforce that is prepared to use new technologies to deliver person-centered, integrated quality care.
Other goals include making sure that digital technologies empower individuals to safely and securely manage their own health and well-being.
It urges that the government specify a glide path for transition to reimbursement for digital modalities within the next three to five years. This would involve developing data-driven models of the effect of reimbursement changes on access, quality, and cost within fee-for-service and value-based care delivery and payment models for digital modalities.
The draft strategy puts heavy emphasis on interoperability, standards and data privacy and security. This includes calls for a national patient identifier, which Mitre said would ensure patient records can be reliably discovered, matched, and merged.
The section on patient data privacy, use, and governance notes that “patient data is the gold or oil of the health IT economy, so the financial incentive is to control it and limit access, which is complex and varied by jurisdiction. New Hampshire is the only U.S. state that declares that patients own their own data. In nearly all cases, the data is housed in proprietary databases or consolidated in cloud databases secured and tightly controlled by the vendors (who likely claim ownership of the data as well). The United States must adopt national patient data ownership laws, which would flip the financial and economic incentives of the industry toward interoperability and financial success based on population health rather than stockpiling and financial success based on data ownership. One benefit will be enhanced transparency of the cost of care, increasing the power of individuals and their families to manage health.”
Noting that current U.S. regulations require support for HL7 FHIR for the Patient Data Access use case, Mitre says that many other use cases remain unsupported, especially those needed for healthcare reimbursement. “Other limitations keep consumer adoption low. Future success of the digital health system will be indicated by reliable discovery and access of a full range of data via application programing interfaces (APIs). This will include data related to genomics, medical or wearable devices, benefit design, claims and coverage, appointment and scheduling, and social determinants of health.”
The draft strategy also calls for an evolution of metrics, from the status quo limited standardization in the definition and reporting of cohorts and metrics, to “standardization that includes eCQM definitions, reports, population health and public health queries, patient cohorts used in the context of CDS and research, complex target/objective/thresholds for public and private programs, social programs, and the measurement of access, quality, and efficiency.”
Concerning governance, the draft strategy recommends that a central executive entity such as the Office of Science and Technology Policy should lead. It should comprise representatives from government agencies including HHS and VHA, Department of Defense, and non-government stakeholders. Its responsibilities would include:
• Develop a task force or consortium to inform and coordinate efforts across the federal government, through a Federal Advisory Committee Act or White House Executive Office initiative.
• Capture and apply public and private-sector enterprise member feedback into a consistent and regular contribution to the governance process and advise on regulatory, legislative, and policy initiatives.
• Coordinate with private-sector professional and trade organizations to establish a Center of Excellence to identify best practices, regulatory recommendations, and ethical guidance and implement a governance structure.
• Engage stakeholders to define obstacles to the application of a trusted digital health ecosystem and identify health priorities and focus areas.
• Develop timelines and an implementation plan for a governance structure for the digital health ecosystem.
