One of the most important elements for any successful business or healthcare organization is the need for certainty when it comes to planning, according to consulting firm CedarBridge Group Founder and CEO Carol Robinson.
However, the healthcare sector is in an uncertain political climate, said Robinson. There's been turmoil introduced with multiple attempts to overturn or repeal the Affordable Care Act -- and the most recent executive order canceling cost sharing payments to insurers.
As a result, healthcare organizations are going down one of two parallel tracks: "Let's wait and see what happens, or let's go as hard as we can, not knowing what will change."
To Robinson, the uncertain climate is creating challenges in two major areas: workforce and funding uncertainty.
The work shortage has been ongoing, and it will continue to be so. But Robinson is hopeful that a move toward RESTful APIs -- which make tech more plug-and-play -- will help with the staffing shortage as the technology begins to mature.
The positive results of APIs can already be seen in other industries, like the banking and financial industries. In fact, National Coordinator Donald Rucker, MD, said the Office of the National Coordinator is researching open APIs, like those used by Facebook, to advance health information sharing.
But Robinson said the even greater challenge facing the industry is funding uncertainty.
"Because so much of the infrastructure funding will run out in a year or two, or will come out of the Centers for Medicare and Medicaid Services and Medicaid agencies," said Robinson. "And with the meaningful use of EHRs, the expansion of understanding defined in 2016, that funding will only run until September 2021."
"That's less than four years," said Robinson. "There's a mental calendar running in our minds for our state clients because that's a relatively short amount of time for all of this to be deployed, built and successfully demonstrated."
Health IT payments and meaningful use requirements, in particular, are dynamic, said Robinson. Infrastructure needs are meant to be driven by a different measure of provider outcomes, but the alignment of those has never been good.
"But it may be that the alignment may lead to more turmoil in the way health information exchanges are delivered because they need to have a system ability passed -- before funding runs out," Robinson said.
"I'm hopeful that will help the mechanisms that tie health IT funding to the HIE infrastructure," she added.
For Robinson, that's the third challenge: funding and infrastructure in the healthcare information exchange world.
In the initial State Health Information Exchange Cooperative Agreement Program grants, states were provided funds to rapidly build the capacity to exchange information. But not all HIEs are finding success, due to a lack of funding or staff.
"Some organizations are running efficiently and effectively with the right amount of staff," said Robinson. "But some are running on shoestring budgets, trying to provide services and stay current on the technology and policies necessary to succeed."
Robinson is also worried that "there's not a clear understanding, necessarily, or buy in on the part of the government to support these."
Likening the HIE and API infrastructure to a power grid, Robinson said there needs to be a "public utility figure that manages the system and connects across state lines and the different companies who power the service… There's a clear understanding that without the infrastructure and rules of the road, we wouldn't have reliable power across the country."
The same model should be put into place for HIEs and APIs, with a statewide, regional or national infrastructure to manage the identities on the system and all of the data. Robinson explained that this will ensure identities are always correct and data are accurate and up-to-date.
"Health IT is a bipartisan issue," said Robinson. "We're seeing it's not a red or blue issue. What quickens or slows the pace of health IT adoption is that it's more of a healthcare leadership issue in many, many cases."
"Creating an equilibrium is tough, as you're trying to ensure this level of massive change," she said. "There will need to be carrots, sticks, leadership and dynamics for health IT to work how it needs to."