BOSTON – "I don't have a crystal ball," said Jeff Coughlin, HIMSS director of state and federal affairs, as he offered some predictions this week about what a Donald Trump presidency will mean for healthcare in general, health IT in particular and health IT cybersecurity even more specifically.

But some things he does know for sure. Among them: "IT is fundamental to any sort of highly-functional health system. Genomic analysis costs have dropped. And data sharing is continuing."

Amid such heartening healthcare advancements comes an incoming administration whose varying signals and unorthodox messaging platforms (read: Twitter) have led many to question just what lays in store for the many facets of health IT in early 2017.

"Regulatory changes usually accompany any incoming administration, and I don't think this one will be any different," said Coughlin.

The question, perhaps, is just how they'll be communicated to the American public. "I don't know how Twitter figures into it," he added with a wry laugh. "I can't imagine trying to explain the Affordable Care Act in 140 characters."

Even if Trump were to stop tweeting post-inauguration, it seems almost certain he'll still be advocating to repeal-and-replace the landmark Affordable Care Act.

"He'd probably likely to delegate creation of a replacement plan to those who are on the front lines," said Coughlin.

Cybersecurity in focus
But in contrast to his cryptic recent pronouncements about the ACA's eventual (full or partial) repeal, however, Trump's 2016 campaign did offer a "detailed platform on cybersecurity," Coughlin reminded us. Among its proposals, he said:

• Order an immediate review of all U.S. cyber defenses and vulnerabilities, including critical infrastructure.
• Create a "Cyber Review Team" to provide specific recommendations for safeguarding different entities with the best defense technologies tailored to the likely threats.
• Establish detailed protocols and mandatory cyber awareness training for all government employees.
• Instruct the U.S. Department of Justice to create joint task forces nationwide to coordinate federal, state and local law enforcement responses to cyber threats.
• Enhance the U.S. Cyber Command, with a focus on both offense and defense in the cyber domain.

Whatever Trump's policies, the Cybersecurity Act of 2015, signed by President Obama a year ago, should continue to have a big influence on health data security. Among its provisions: a requirement that HHS identify a primary point person on cybersecurity within the department; establishment of an industry task force to assess challenges and barriers – and spot lessons learned from other industries – to develop a plan for threat information sharing in healthcare; the development of a common set of voluntary guidelines, best practices and methodologies to help address cyber threats consistent with HIPAA, HITECH, the NIST, and more.

The task force owes a report to Congress due March 2017, said Coughlin.

Healthcare policy taking shape
On the healthcare front, of course, Trump and Republican members of Congress have been talking at length about repeal and replace. That may take longer than many expect.

"A whole new regulatory regime would have to be created in response to a new law," said Coughlin. "One to two years would probably be on the low end" of how long it would take for the "replace" portions of ACA repeal-and-replace."

Beyond that, while much changes remain to be seen – notably the plans of proposed Secretary of Health and Human Services Secretary Tom Price, MD, and Centers for Medicare & Medicaid Services Administrator Seema Verma – Coughlin expects some things to stay the same on the health policy front, at least for now.

CMS' Quality Payment Program and MACRA are "likely to remain intact in 2017," he said.

The programs "resulted from major bipartisan collaboration," he said, with key leaders in both parties advocating for the law. CMS has since spent a lot of time and effort addressing many of healthcare stakeholders' concerns about the rules.

Ultimately, however, the direction of healthcare with a Trump White House and GOP Congress will depend on the position of value-based care delivery, said Coughlin.

A value-based approach is "favored by both parties," he said. The economics just make sense, with regard to the sustainability of Medicare Trust Fund and rest of the health system, as does the argument that a focus on higher-quality care will lead to better outcomes and more value.

As such, health IT could be a big part of Trump's economic stimulus plans, said Coughlin, pointing to the ability of cybersecurity defense advancements, precision medicine research and telehealth to drive growth.

In the interim, much remains to be seem. The massive 21st Century Cures Act – with its significant focus on health IT as the foundation of research and care delivery and big funding for the Precision Medicine Initiative and Cancer Moonshot – should be passed by the Senate as soon as today.

Beyond that much will become more clear with the naming of additional Trump Administration political appointees  – National Coordinator for Health IT, DoD and VA Health Leadership, VA IT Leadership – should be named in the coming weeks.

Until those appointments are made and confirmed by the Senate, the Trump transition team will develop and implement the healthcare agenda, said Coughlin, as government civil servants will continue to play a key role in interim policy execution.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

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