Information blocking regs align with healthcare’s new path

ONC’s National Coordinator Micky Tripathi believes that ‘information sharing’ is the inexorable force that will power the industry in the next few years.


When Micky Tripathi came to the lead role in the Office of the National Coordinator for Health Information Technology earlier this year, it signaled a continuation of the push to advance the use of IT to improve healthcare delivery and consumer engagement.

He comes to the role with a long history of participating in efforts that enabled data to be exchanged – he most recently served as the project manager for the Argonaut Project, an industry collaborative to accelerate the adoption of FHIR, and a board member of HL7, the Sequoia Project, the CommonWell Health Alliance and the CARIN Alliance.

Micky Tripathi, chief executive of the Massachusetts e-Health Collaborative
Micky Tripathi, National Coordinator for Health Information Technology

Tripathi heads ONC as the agency looks to implement provisions of the Cures Act Final Rule, widely known for its information blocking provisions. He wants to put a positive spin on the rules, preferring to call them information sharing regulations. Improving the flow of information will be important as patients seek more access to their medical information from providers to use as they choose.

In this two-part interview with Health Data Management Editor Fred Bazzoli, Tripathi discusses the challenges of the regulations and the rationale behind them.

Why is information blocking such a critical focus for ONC in achieving interoperability and facilitating information exchange?

There are a couple different dimensions to that. One is certainly the law. I think it also is a reflection of wanting to be able to have it as a part of day-to-day business and healthcare delivery – not just that, if you have information that authorized parties can use to improve the quality, safety and efficiency of care, it’s not something that you can gate for arbitrary reasons, but it actually should be an obligation to share that information, especially now that we live in a world of EHRs, where more of that can be automated.

That’s a small but really important change, from, “You’re permitted to do it (share data)” to saying, “You’re obligated to do it.” Also, it reflects, as expressed in law, the near unanimous approval that the law got when it passed Congress. There’s a certain degree of frustration that the Congress is expressing – not seeing the kind of information sharing that they expected to see with the wide adoption of electronic health records systems.

How do information sharing regulations governing information blocking fit into the overall federal vision for getting consumers more involved in healthcare decision making?

Not to be too flip about it, but the information blocking construct has the suggestion in it that the federal government thinks that all the actors are guilty until proven innocent. I think it’s really much more about saying, well, everyone’s got priorities, and providers are doing everything they can to deliver the highest possible care. There’s a ton of priorities that every organization has, and so if you don’t say that something needs to be a higher priority from the outside, then it just keeps getting moved down. And I think this is really more of an expression that this needs to moved up higher on your priority list. That’s an Important distinction.

First and foremost, it just makes clear that patients have a legal right to have that information, and it is an obligation to make that a priority to figure out how you’re going get it into their hands in ways they can find usable and not have the cumbersome practices that we have today. All of that is really a barrier to getting the information that they have a legal right to have.

A part also is because this information is more and more natively electronic, and less and less is found in paper archives, there is more ability to do more and more things with that. So you need to place a priority on making that data available to individuals, because they have the ability to do stuff with it that they didn’t have before.

The other part is creating the ecosystem, the ability to have the tools to be able to do things, relies on the availability of data, so you can have the private sector respond and actually develop the applications that deliver things to patients that have value, If we didn’t have more of a uniform way of making that data available, we wouldn’t have scale of business and wouldn’t be able to have that innovation occur. This ought to be a level playing field of information availability, with the appropriate privacy and security protections. So this way, you can have a real competitive marketplace, so individuals can express their demand for these those kinds of capabilities that, right now, without regulations, they wouldn’t be able to have.

The last important point of the regulation, which isn’t explicitly about information sharing, is about the standards-based API. There’s been a lot of great stuff happening in the API world, driven by the march of technology, and certainly, driven by regulations that say providers and EHR vendors have to have APIs available. But there’s still variation – we’ve done some work on APIs and found there is still a large fraction of those are proprietary APIs. If you’re a small creative developer on the other end, it’s still hard to scale your investment – you still have to develop an Epic unique solution, a Cerner unique solution, a Meditech unique solution.

But by the end of 2022, we will have requirement that they support a particular technical specification for that API that is an open industry specification. You will see a lot more ability then for the development community to come in and scale these. The ROI will be better than it is right now. That’s the other thing the regulations do, which is allow these apps to be developed so patients have more opportunity to do things with that data rather than just download it to your phone; that’s a dead end.

There seems to be a real patient education component to this as well, for patients to realize they have access to this information and also to realize they can make better use of it. Is that a role that ONC hopes to play?

It’s one that we already do. One dimension worth calling out is educating patients on the benefits, but also the risks of their taking their data into their hands, because one thing they may not appreciate is once they hold the keys to that data, it now lives outside of HIPAA, and is no longer protected by HIPAA.

HIPAA is one of the least understood but most ubiquitous laws in the country. In the U.S. we don’t have a general privacy law that protects that data in any other way. So that’s a part of what we promote, and I think it’s really important that patients be educated about that. We still think we should err on the side of patients having access to their information, but that they should be fully aware of the risks they may be taking and be very careful about how they use that information and make it available once it’s in their hands.

Do you anticipate that further regulations to curtail information blocking might result if current regulations don’t produce desired effects? How does ONC plan to monitor the progress of the industry?

That’s always on the table, for sure, that further regulations could be required if we don’t see the kinds of changes that we anticipate seeing. I don’t anticipate that, frankly, because I think we’re already seeing a tremendous amount lot of progress; we’re already seeing a lot of adoption, and once that snowballs and starts building, I think we’ll see the momentum go in that direction.

It’s not just the regulation; it reinforces where all this is headed, the way individuals like to interact with their information, the comfort that individuals have with (doing so in) banking, travel, and everything, every other walk of life. They expect that more and more. With healthcare, you have generational differences that start to take place. There is a whole generation of people that expect to experience that and expect that as a patient and, frankly, as physicians. The regulation is just one of many drivers pushing in this direction. When you think about clinician burden, there’s an opportunity to automate more things as a way to reduce burden, It’s all headed in the same direction.

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