Welcome to the 21st Century!

A review of the Cures Act and how it will re- shape the healthcare industry in America

Back in March, much of the healthcare world expected to gather in Orlando at the annual and extravagant HIMSS conference.  Tremendous buzz surrounded the expected appearance by “45” himself and the announcement of 21st Century Cures Act, Final Ruling - that is, until COVID took the national stage.

It’s through this lens that we can start to understand how such an anticipated piece of healthcare legislation has been largely brushed aside.  Healthcare institutions of all kinds were faced with addressing the pandemic; either overwhelmed with COVID patients or unable to keep their doors open and furloughing staff due to the staggering drop in patient activity.

While entirely coincidental, this is exactly the right time for 21st Century Cures - and here’s why:

Pandemics expose the need for coordinated healthcare data

If you were lucky enough to have a governor like Andrew Cuomo (New York) or Gavin Newsom (California), you know that data helps communities make intelligent decisions about how best to manage public health crises.  Data can also be used to help determine protocols for managing resources such as staff and ventilators that may be in short supply.  Aggregated health data is vital to be able to accurately assess the impact of a public health crisis on a community and the available resources, allowing both decision-makers and the public to be informed about the situation.

There’s a functional foundation for implementation

Luckily, thanks in part to the Affordable Care Act, there has been a steadily improving technical foundation for healthcare in the United States.  We have a network of health information exchange (HIE) that allows the movement and the aggregation of health information. These HIEs are mostly regionally and state-based and are often interconnected with local health departments.  While HIEs have struggled to find a successful business model over the years, the pandemic highlighted their critical role in a connected health infrastructure of the future.

This background is critical to understanding how the 21st Century Cures Act and the current COVID-19 pandemic collide.

The 21st Century Cures Act enables a response

The concept of “Proof of Health” (PoH) is new to our generation.  Historically during health emergencies, we were able to identify the sick and keep them isolated. We didn’t require healthy people to “prove” they were healthy. That’s due in part to the fact that COVID is a highly contagious respiratory-spread virus rather than one transmitted through deliberate activity like sex.  The closest example we have to Proof of Health are vaccine records required for school attendance or travel, stored in paper booklets, and from my own experience, lost or misplaced over time.  We’ve never had the need or ability to support a near real-time Proof of Health verification to enable day to day life.  However, since it’s 2020 and unprecedented is the word of the year (and maybe the coming decade), the Proof of Health idea arose. 

Here’s why our current situation is ripe for this concept:

• There’s a test that can determine if someone is “safe”

• Patients want access to their data to prove/share that they’re “safe”

• Businesses/Organizations want to know if people are “safe” to ________[fill in the blank: travel, go to concerts, go to school]…

• We want to get back to “normal” life

21st Century Cures tees up the opportunity to provide a solution for the Proof of Health concept and it’s amazingly simple.  Enable patients to have access to their COVID lab results through the use of qualified apps.  Enable patients to then share their COVID result with whomever they choose so they can safely _______ [fill in the blank].  The information blocking provision of the 21st Century Cures Act enables (and in some cases forces through risk of severe penalty) this exact concept.

While the immediate use case is to support COVID lab data, the same concepts can be leveraged to support future COVID vaccine(s), and also allow us to upgrade the current vaccine records management systems so we can finally throw away those little yellow booklets.

HIEs can be the trustworthy source for Proof of Health data - as an aggregator and a facilitator for the release of a patient’s data to apps.  It’s not only the responsibility of the HIEs to support 21st Century Cures, but also an opportunity for patients and healthcare facilities as we move to a more integrated, app-driven healthcare world.