Just before Christmas, the Office of the National Coordinator (ONC) issued its long-anticipated Health IT Patient Safety Action and Surveillance Plan for public comment. A major component of the draft is ONC’s not-so-gentle push on HIT vendors to get serious about reporting adverse patient safety event information, via affiliation with a Patient Safety Organization (PSO).
National Coordinator Dr. Farzad Mostashari, commenting a couple of days after the release: “We are saying to the vendors, ‘Step up and prove your ability to create a code of conduct that would be enforceable, that would bind you voluntarily to reporting safety events’… And what we’re saying is, ‘If you don’t step up, we can always look at more classic regulatory approaches’.”
This echoed a very similar message delivered by Dr. Mostashari to CEOs of more than a dozen top HIT vendors, at a D.C. meeting hosted on November 28 by the Electronic Health Records Association (EHRA) (see more about that meeting here): “‘Step up’ and agree to a ‘Code of Conduct’ setting forth basic principles and behavioral standards to protect patients, guard against fraud, and empower health information technology finally to revolutionize healthcare.”
I am proud to report that athenahealth is stepping up. On the flight home from that November 28 meeting, in fact, CEO Jonathan Bush talked about almost nothing but what such a Code of Conduct could look like, how to make it meaningful instead of merely symbolic, and how it could serve to coalesce industry innovators around a set of core principles to create true information fluidity that empowers both patients and providers, while safeguarding patient safety and reducing costs. Jonathan was very worked up about it.
The result of that in-flight brainstorm is the following draft that, given the season, might be called a proposed set of New Year’s resolutions for the HIT industry:
Health Information Industry Code of Conduct
Proposed: To achieve the universally supported objectives of systemic cost reduction and quality improvements, members of the health information industry should agree to maintain, uphold and abide by a uniform set of high standards related to data portability, patient safety, freedom of choice, and meaningful, ethical use by health care providers of health information technology (HIT).
Resolved: The signatories hereto, representing innovative, forward-thinking members of the health information industry, agree that they and their respective companies will adhere to each of the provisions of the following Code of Conduct:
1. Empowering Data Portability and Provider Choice
In the event that any client opts to change to the electronic health record (EHR) of another signatory, we will, at our own expense, facilitate the intact transfer to the latter’s EHR of all of the provider’s clinical data.
2. Building a True Nationwide Information Backbone
We will build, maintain, and curate reliable interfaces on behalf of any qualified healthcare provider that requests one.
3. Protecting Patients
We commit to public reporting of adverse patient safety event information. Within one year of signing, we will affiliate with a Patient Safety Organization (PSO), report all patient safety-related events to that PSO, and work proactively with clients to identify and resolve the causes of any such issues.
4. Preventing Fraud
We will actively monitor, and report to clients, changes in provider billing patterns that could indicate up-coding or fraud.
5. Driving Meaningful Use
We will adjust reporting to accommodate government quality reporting programs, at no incremental cost to clients.
We started circulating this draft in Washington (including to Dr. Mostashari) a few days before the ONC’s draft surveillance report came out, and we were excited to see the degree to which our thinking matched theirs. Of course, these basic commitments and statements of principle go well beyond just our shared concern about protecting patient safety. They also address many of the other major issues frequently identified by industry stakeholders, provider and patient advocacy groups, and policymakers in Washington in connection with the exploding adoption of HIT across the country: information fluidity and interoperation between and among disparate systems; identification and prevention of fraudulent billing practices; and the continuing evolution of Meaningful Use standards.
Commitment to these provisions will require changes—some practical, some philosophical—in how our industry approaches the products and services that we provide. But the changes are necessary and, in many cases, overdue.
Over the coming weeks, we hope and expect to garner support from our peer companies to put these ‘resolutions’ into effect, kicking off 2013 as the year when HIT finally begins to realize its potential to revolutionize health care delivery in this country.