HHS: EHR Adoption, Meaningful Use Are Primary Challenges

By Megan Williams, contributing writer

The Office of the Inspector General (OIG) has released its list of top management and performance challenges facing the Department of Health and Human Services (HHS) last year.

The issues of technology and data are detailed in the subsection “Management Challenge 8: Effectively Using Data And Technology To Protect Program Integrity.”

The Challenges

The department indicates that challenges around data and technology made the list because of continuing issues around the effective use of data collected from federal health insurance programs, public health and human services, and the beneficiaries enrolled in the programs, and using that data to prevent payment issues and ensure consumer patient safety and care quality. It additionally lists challenges around maintaining the security of data it collects and maintains.

The Response

The department lists four initiatives it plans on addressing in response to the identified challenges:

1. Improving The Effectiveness Of Medicaid Data. The Congressional Budget Office has estimated that Medicaid will expand an average of 8 percent each year between 2013 and 2023. In response to this expansion, the department has indicated that the maintenance of a national Medicaid database is an imperative. In their current states, national data are “not complete, accurate, or timely,” and additional data would be needed to create an effective national database. The Centers for Medicare And Medicaid Services (CMS) has made an effort to improve this quality through the Transformed Medicaid Statistical Information System (T-MSIS) initiative.
2. Demonstrating Impact From The Fraud Prevention System (FPS). The department is already in the practice of using predictive analytics technologies to identify fraudulent claims before they’re paid, but still faces the challenge of demonstrating the effectiveness of those technologies. Upon review, OIG found that some reporting requirements were not met and that the methodology for calculating savings estimates, recovery, and ROI included some invalid assumptions.
3. Ensuring HHS Data And Systems Are Secure. Pursuant to the Privacy Act, all information that HHS agencies, their contractors, state agencies, and hospitals deal with must be adequately protected. Vulnerabilities have been identified in security controls, access controls, and configuration management, which pose a threat to data integrity. These threats will only become more serious as data from the marketplaces are processed.
4. Protecting Information Contained In Electronic Health Records And Guarding Against Fraud. Just as experts warn that the use of EHRs (electronic health records) can make it easier to commit fraud, the HITECH Act has encouraged the widespread use of the electronic record and other health IT across the nation. Most of the development focus has been on creating criteria, defining Meaningful Use, and paying associated incentives. Attention is only just now being paid to the threat of fraud as a serious side effect of EHR use.

Progress Being Made

CMS has been active in taking action on all these initiatives, including partnering with 12 volunteer states in the planning and development of T-MSIS in 2012; conducting OIG audits of information security systems resulting in recommendations for HHS agencies, states, and hospitals; and addressing security issues through EHR adoption incentive programs.