The Health Information Technology Advisory Committee on Wednesday voted to remove price-transparency requirements from the proposed interoperability rule.
In its second meeting this month hashing out recommendations on how the federal government should address concerns related to information blocking and patient privacy, HITAC cautioned that tying price transparency to the information-blocking proposals would have an "unintended consequence of slowing down the finalization of the current ONC rule." Instead, it recommended ONC create a separate price-transparency task force within HITAC to produce recommendations for future rulemaking.
"As a task force, we absolutely agreed that we want to enable price transparency," said Andrew Truscott, the task force's co-chair and Accenture's managing director for health and public service. "We believe that (price transparency) needs to be given a focus."
HITAC, established under the 21st Century Cures Act, provides policy recommendations to the HHS' Office of the National Coordinator for Health Information Technology. The meeting Wednesday marked the committee's final opportunity to discuss recommendations to the agency's proposed interoperability rule, which closes for public comment June 3.
HITAC also voted in favor of a set of recommendations related to whether health IT developers can charge fees for access to certain data and services, which had been tabled following debate at a committee meeting last week. The information-blocking task force's updated recommendations drew a line between "basic access" and "value-added access" to information, which would have different regulations in terms of fees.
Under the information-blocking task force's recommendations, a developer would be able to charge fees to recover expenses related to basic access to patient data, but not to gain profit. Basic access would include access to a patient's medical record and the data or facts held within it.
For access that goes beyond that, such as requests for access to a developer's infrastructural systems, decision-support algorithms or artificial-intelligence tools, the vendor would would face fewer restrictions on fees. That means the developer would still be able to license and patent the value-added service, the task force said.
However, the task force specified that once data from a value-added service is incorporated into a patient record, it should fall under the purview of basic access.
"If a vendor supplies clinical risk scoring services based on the basic record, those services may be offered at market rates," the recommendation reads. "If the risk score is incorporated into or used by clinical staff to make clinical decisions, the individual risk score accordingly becomes part of the record and forms part of basic access to which basic access fee regulation is applied."
One area of contention among the HITAC members involved whether to integrate the new DS4P, or the "data segmentation for privacy," standard into ONC's health IT certification program. DS4P aims to allow providers to specify when a patient wishes to keep certain data restricted from being shared with other caregivers. HITAC's health IT for the care continuum task force said this would be particularly useful for opioid-abuse and pediatric patients.
However, Sasha TerMaat, a director at Epic Systems Corp., said the new DS4P standards need additional evaluation.
"There is important work that would have to happen in order to make data segmentation effective," she said, adding estimates from EHR vendors place the development time to implement the new DS4P standard at more than 20,000 hours per product. "Our big fear is that we would invest significant resources into implementing this standard, and we're not confident it's going to meet the need."
Providers also raised concerns over the standard.
"I don't think it's feasible as long as we have narrative (in patient notes)," said Dr. Clem McDonald, director of the Bethesda, Md.-based Lister Hill National Center for Biomedical Communications at the National Library of Medicine. "It's not possible with today's technology to peel out anything that might be classified."
HITAC ultimately decided not to voice support for the ONC's proposal to add new DS4P criteria to its health IT certification program, despite acknowledging its importance for patient privacy. The committee recommended that ONC establish a workgroup to identify how to address patient privacy and provider needs when it comes to DS4P.
"It is very complex," said Carolyn Petersen, co-chair of the health IT for the care continuum task force and senior editor for Rochester, Minn.-based Mayo Clinic's health information website. "We think that a broader approach may be more helpful, with greater involvement by more stakeholders."
