Working to Address Interoperability and Data-Sharing

Hirschorn David 2016-02-24This post was contributed by David S. Hirschorn, MD, who serves on the ACR Government Relations Commission-Federal Regulatory Committee and Informatics Commission

Policymakers continue to be interested in barriers and opportunities related to interoperability and heath information exchange. The American College of Radiology (ACR) Government Relations team has worked closely with ACR Informatics to help address these issues.

In 2013, the ACR Council passed a resolution (Res. 53) directing the College to explore legislative and regulatory mandates that would promote interoperability and exchange of patient data across disparate systems and providers.

Soon after the resolution, ACR successfully advocated for the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) to strengthen the interoperability requirements of the EHR exception/safe harbor from self-referral/anti-kickback prohibitions. The goal was to ensure that EHR technology donated at low cost to referring physicians could not be legally used to discourage referrals to competitors.

In 2015, ACR endorsed legislation to expand OIG’s authority to investigate and penalize anticompetitive “information blocking” practices by dominant providers and health IT vendors above and beyond the restrictions of self-referral and anti-kickback regulations. The language evolved into Section 4004 of the 21st Century Cures Act (Cures), which was signed into law in December 2016.

In March 2019, ACR provided feedback to the Networking and Information Technology Research and Development (NITRD) Program addressing high-level questions on medical device interoperability. The ACR discussed ways NITRD-participating agencies could collaborate with other actors to improve exchange between of FDA-regulated “medical devices” and EHR technology.

After an extended delay, CMS and ONC released proposed rules in March 2019 to implement, among other things, certain key aspects of the aforementioned information blocking provision mandated by Cures Section 4004. If implemented and enforced appropriately by HHS agencies, the information blocking provision could help reduce anticompetitive practices and other nontechnical barriers to data-sharing. Additionally, the proposed rules would expand the U.S. Core Data for Interoperability to include imaging narrative data, implement requirements for vendors and payers around API-enabled access to health information, and update the requirements of ONC’s health IT certification program. (CMS NPRM summary | ONC NPRM summaries)

The long-awaited CMS and ONC proposed rules, while encouraging, are not perfect. The ACR Government Relations Commission-Federal Regulatory Committee, Informatics Commission leaders, and individual volunteers are currently reviewing the details and providing input for ACR’s future comments.

  • We encourage members interested in providing feedback to contact Michael Peters, ACR Director of Legislative and Regulatory Affairs, at mpeters@acr.org within the next few weeks.
  • What barriers are you facing when it comes to interoperability and data sharing in your practice?

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

Evolving Board Certification: What the ACR is Doing

Eric Friedberg_ACR17-116rThis post was contributed by Eric Friedberg MD FACR, chair of the American College of Radiology Certification in Radiology Task Force.

Controversies surrounding Maintenance of Certification (MOC®) are increasingly dynamic and of considerable interest to American College of Radiology (ACR) members.

As Chair of the newly created ACR Certification in Radiology Task Force, I want to update you on what the ACR is planning, studying and doing to address this important issue.

In response to a recent request from the American Board of Medical Specialties (ABMS), the ACR created a work group to comment on a report on the status of MOC® across all specialties. That group worked tirelessly over the winter holidays to prepare a detailed comment letter.

The ACR also signed on to a letter from the Council of Medical Subspecialty Societies (CMSS), which represents approximately 800,000 physicians from 43 medical subspecialty societies.

Both the ACR and CMSS letters call for an immediate moratorium on MOC® until many programmatic deficiencies are corrected.

At the combined Board of Chancellors (BOC) and Council Steering Committee (CSC) meeting in January, the Certification in Radiology Task Force was created as a partnership between the BOC and CSC. This task force also includes several at-large ACR members.

The Task Force is propelled by recognition that ongoing certification is an area of increasing physician and ACR member interest and concern. An ABMS survey of approximately 35,000 physicians revealed that only 12 percent of the physicians value the current MOC® programs.

The ACR is aware of these concerns, stating in its ABSM response letter that, “[t]he ABMS Vision Initiative report both underestimates and understates the reality, robustness, and energy of a growing grass roots ‘anti-board movement.’”

These important ACR member issues have recently been amplified by the backdrop of various ABMS member boards coming under intense scrutiny and even legal actions for financial practices, lack of transparency, non-democratically elected leadership, high-stakes non-validated psychometric testing and concerns about monopolistic behavior. The American Board of Radiology (ABR) was named as a defendant in one class action suit and a “co-conspirator” in another.

Our Task Force is studying these issues and preparing to make recommendations to the BOC and CSC at both the ACR 2019 and ACR 2020 annual meetings.

The ACR online member forum, ENGAGE, has become a hub for communication on related issues. We encourage you to participate in those discussions.

Your opinions matter. We are listening, and are committed to acting on your behalf.

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

ACR 2019 Attendees to Get a Taste of AI

Am. College of Radiology-AMCLC

Dr. Allen

This post was contributed by ACR Data Science Institute Chief Medical Officer Bibb Allen, MD, FACR, and Chief Science Officer Keith Dreyer, DO, PhD, FACR.

 The American College of Radiology (ACR) Data Science Institute (DSI) is developing a framework for radiologists in all practice settings to use artificial intelligence (AI) tools to help improve performance and efficiency.

As a first step toward allowing local radiologists to take part in AI development, the ACR DSI will allow attendees at the May ACR 2019 annual meeting to use ACR DSI data and cloud-based computing to gain experience annotating cases and see how AI algorithms can improve with additional training.

  • Attendees can assess breast density using ACR cases and annotated cases which will then be used to train an algorithm to perform the same function. The more members who take part in contributing cases, the more accurate the algorithm will become.

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    Dr. Dreyer

  • In order to specifically target trainees, over the summer, radiology residents will be invited to participate in a 60-day “Resident Breast Density Challenge” where they will use ACR DSI-hosted data and computing to train and develop an ACR DSI Breast Density Algorithm.

The ACR DSI is enabling radiologists to shape the future of radiology technology and patient care.

We hope that you will take advantage of the opportunities this process will bring in 2019. 

Please share your thoughts in the comments section below and join the discussion on Engage (login required).