Health information technology’s national blueprint for COVID-19
By Stuart N. Brotman
It’s been ten years this month since the release of the National Broadband Plan, a 376-page document that was one of the products of the American Recovery and Reinvestment Act of 2009.
In our current COVID-19 crisis, its Chapter 10, covering healthcare, deserves immediate and close attention to determine how its analysis and recommendations might be applicable to the critical decisions that must be made – both in confronting our pandemic and in anticipating the next pandemic to come.
First, let’s focus on what the plan revealed that underscores a persistent problem in dealing with COVID-19. "The United States is not taking full advantage of the opportunities that health IT provides."
Three national gaps were identified that remain today: adoption by health care providers, information utilization by them, and connectivity to patients.
The current crisis certainly must deal with connectivity issues, particularly in rural areas where sparse population density has made construction of high-speed fixed networks to homes economically unattractive and unsustainable for private companies. The reality of a digital divide remains, and it places millions of Americans with inferior access to health information and online educational resources as public schools begin to close en masse.
Unfortunately, this structural problem cannot be addressed in real time now. Enabling more mobile broadband connectivity in these unserved or underserved areas, making available more connection hotspots there, and encouraging private sector cooperation in lifting monthly data gaps all can be helpful in the coming weeks and months, however. They can help make more robust broadband connectivity a reality for so many in need.
The more dramatic immediate impact should build upon the Plan’s analysis, which current circumstances demand. It called for our nation to "marshal support from Congress, states and the health care community to drive e-care use” and to “provide the health IT industry with a clear understanding of the federal government’s policies toward e-care."
Here, the reduction of regulatory barriers should be a top priority. Stimulating capital investments may be commercially infeasible, and may take too much time even if large federal grants or loan guarantees are made available. Although some Congressional action may be needed, the emphasis should be on Executive Branch Action that can be put in place on an accelerated basis.
For example, the Centers for Medicare and Medicaid Services, which is the largest financial force in health care delivery, can reduce regulatory barriers that inhibit the adoption of health IT solutions. And the Office of the National Coordinator for Health Information Technology has the power to establish interim common standards and protocols for sharing administrative, research, and clinical data.
As the plan wisely noted: "Video consultation and remote access to patient data may also be critical during pandemic situations. If hospitals are at capacity or if isolation protocols are necessary to prevent the spread of the infection, these technologies can help health care providers assist more patients and help patients avoid public areas."
Adjusting other current high regulatory barriers, at least until the pandemic subsides, also is envisioned in the Plan, and would be accepted as common sense today. CMS can revise its standards that make health care credentialing and privileging overly burdensome for e-care. This means that the site where the patient is located is not now allowed to rely on the site where the physician is located for credentialing and privileging the doctor prescribing the care.
States have an important role to play in revising licensing requirements to enable timely e-care, too, so as not to limit practitioners’ abilities to treat patients across state lines.
The plan suggests that the "nation’s governors and state legislatures could collaborate through such groups as the National Governors Association, the National Conference of State Legislatures and the Federation of State Medical Boards." Given the scale and speed of the pandemic, such coordination should be pursued quickly with this focused goal in mind.
A decade ago, the plan asserted: "Health IT enables widespread data capture, which in turn allows better real-time health surveillance and improved response time to update care recommendations, allocate health resources and contain population-wide health threats."
Especially given the bipartisan Congressional support it received then, the National Broadband Plan should be a front-line document for government executives and legislators, pulled off the shelf for ideas that can be implemented quickly, then extended in the long term if they prove to be as effective as envisioned.