ONC to focus on health equity, data sharing, public health IT  

HHS and ONC leaders use the IT agency’s annual meeting to report on continued efforts to harness health IT to improve outcomes.

As it works to support the widespread adoption of health IT and nationwide health information exchange to improve healthcare, the Office of the National Coordinator for Health IT is focusing on several key issues, including: reducing health disparities, improving data sharing and advancing public health use of IT.

Micky Tripathi, Lisa Lewis Person, and Xavier Bercerra headlined ONC’s annual meeting

“There have been significant advances in health IT and interoperability,” noted Department of Health and Human Services Secretary Xavier Becerra, speaking at ONC’s annual meeting plenary session on Wednesday, April 13.

Becerra outlined some of the areas that ONC expects to concentrate on this year.

Health equity

Reducing health disparities is a top priority, the HHS secretary stressed. “We’re putting equity at the center of the decisions we make,” Becerra said.

“It is vital to mobilize health IT to mitigate disparities and, even more importantly, to not allow health IT to perpetuate or magnify health equity gaps."

For example, ONC will use a “health equity by design” approach. That means policies, projects and technologies will be looked at early in the process through the lenses of equitable healthcare, access to treatment and outcomes, said Lisa Lewis Person, deputy national coordinator for operations and COO at ONC.

“It is vital to mobilize health IT to mitigate disparities and, even more importantly, to not allow health IT to perpetuate or magnify health equity gaps endemic to our system today,” she said at the plenary session.

ONC also plans to review algorithms used to support clinical decisions to make sure they don’t contain biases.

The agency is well-positioned to address algorithm bias because of its relationships with electronic health records system developers, said Micky Tripathi, national coordinator for health IT. EHR data is frequently used to create algorithms, and the resulting tools are often then injected into records systems, he explained.

To improve health equity, healthcare professionals need to “commit to rowing in the same direction for better health outcomes,” Person pointed out.

Battling against information blocking

Another hot topic for ONC this year is to improve data sharing, now that the regulations implementing the information blocking provisions of the 21st Century Cures Act have been in effect for a year.

“Every patient has a right to their information.”

Becerra noted that more than 75 percent of the complaints ONC has received regarding information blocking have been against providers, and most of those were filed by patients.

Part of the problem, Becerra acknowledged, is an “enforcement gap.” The 21st Century Cures Act includes civil monetary penalties for networks and developers that engage in blocking of information sharing, but it does not establish penalties for providers.

“Every patient has a right to their information,” Becerra said. “The consequences of not being able to access that information can be devastating and can be deadly.”

Another factor impeding information sharing, Tripathi said, is that too many organizations have been engaging in minimal compliance – doing just enough to meet Cares Act requirements, but not embracing its spirit.

“I have a lot of hope that we’ve turned the corner and encourage everyone to make compliance a floor and not a ceiling,” Tripathi said.

Advancing public health use of IT

To support its goal of helping the public health sector implement IT, ONC is working with the Centers for Disease Control and Prevention on a project called the North Star Architecture. It’s designed to enable public health agencies to enjoy the benefits of cloud-hosted infrastructure without sacrificing their autonomy, Tripathi said.

Also, ONC and the CDC are also working on a project called HELIOS, an accelerator program launched by HL7 to expand the use of the Fast Healthcare Interoperability Resources (FHIR) standard. The project is designed to help use the FHIR standard to strengthen and streamline data sharing across all levels of public health.

Speakers at Wednesday’s session also pointed to some of ONC’s recent milestones, including launching the Trusted Exchange Framework and the Common Agreement (TEFCA) in January.

Presenters also highlighted new projects on the horizon. For example, ONC will soon be launching FHIR pilot projects, such as “facilitated FHIR,” which will use existing networks to make it easier for apps to connect with each other, and “brokered” FHIR transactions, which will send the entire transaction through the infrastructure.

ONC, the principal federal agency that coordinates the government’s healthcare IT efforts, is celebrating its 18th anniversary this month. “Our current healthcare system is rooted in paper, bricks and mortar. Over the last decade, we’ve established an electronic overlay,” Tripathi said. “And the exciting, inspiring part is to get to think about designing our healthcare system without the constraints of paper, bricks and mortar.”

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