The Obama administration is hoping to increase funding in Fiscal Year 2017 for its ongoing Precision Medicine Initiative and to jump-start a recently announced Cancer “Moonshot” effort— both of which will need significant congressional funding to leverage large patient datasets, sophisticated health IT, and advanced computing and analytics capabilities.
The FY17 budget request sent to Congress this week is also seeking a substantial increase in funding for the Office of the National Coordinator for Health IT, as that agency aims to improve interoperability in support of value-based payment and delivery system reform. However, increases in spending seem unlikely to pass muster with lawmakers, particularly with the Republican party controlling both houses of Congress, and President Obama in the last year of his presidency.
"These areas of focus—health IT, cancer/medical research and precision medicine—also are priorities shared by many in Congress. I believe they will all receive funding, but whether the ultimate appropriation aligns with the President's budget request remains to be seen," says Samantha Burch, senior director of congressional affairs for HIMSS.
Overall, ONC’s FY17 budget request is for $82 million, an increase of $22 million based on what the agency was appropriated in FY16. However, the likelihood of Congress increasing funding for ONC is slim.
Its FY16 budget request was for $92 million to fund accelerated improvements in health IT interoperability, including strategic investments to support development and testing of interoperability standards and the agency’s Interoperability Roadmap. But, congressional appropriators only authorized $60 million. Likewise, ONC’s FY15 budget request of $75 million fell on deaf lawmaker ears, remaining at the same $60 million level, which is a more likely authorization for FY17.
"I’m not bullish on ONC funding, given the recent history of flat-lined budgets,” says Jeff Smith, vice president of public policy for the American Medical Informatics Assn. “However, health IT patient safety, interoperability and the federal certification program will remain central issues of public policy moving forward. I believe it will be up to public stakeholders to help make the case for increased ONC funding.”
ONC in FY17 will “focus on supporting interoperability by establishing consensus around standards development activities and policies related to health information exchange, Precision Medicine and the Medicare Access and CHIP Reauthorization Act (MACRA).” Specifically, the agency will gather data and evaluate progress towards achieving interoperability, as required under MACRA.
HHS also informed Congress in its budget request that ONC is proposing additional authorities for the agency to combat information blocking, enhance transparency, implement governance activities to guide business practices, and establish a Health IT Safety Collaborative.
That collaborative is described in the budget document as public‐private partnership designed to “provide a confidential space for developers and providers to address concerns and cultivate new educational resources and training materials to build health IT safety competencies,” while identifying and strengthening ways to “encourage better reporting of health IT‐related safety events.”
However, lawmakers so far have refused to authorize $5 million in funding to initially establish the Health IT Safety Collaborative—previously called a Health IT Safety Center—which HHS requested in both its FY15 and FY16 budget requests. It seems unlikely ONC will secure funding for the collaborative in FY17.
A January 2015 memorandum from the Congressional Research Service (CRS) to the House Committee on Energy and Commerce questioned ONC’s legal authority to establish such a Health IT Safety Center, arguing that ONC “cannot legally engage in such activity without an affirmative grant of authority from Congress.”
For the Precision Medicine Initiative, HHS requested $300 million for the NIH—an increase of $100 million above FY16—to scale up PMI’s national research cohort of a million or more Americans who will volunteer their health data . The large-scale study will not focus on a specific disease, like cancer, but instead will serve as a broad resource to aid scientists in answering a wide range of important health questions to improve treatments for many diseases.
“There is bipartisan agreement that increasing NIH funding is important,” says AMIA’s Smith. “Vice President Biden’s rapport with appropriators on the Hill bodes well for Cancer Moonshot funding, and the Precision Medicine Initiative has inspired a sense of support across both Chambers and parties.”
Quote“There is bipartisan agreement that increasing NIH funding is important.”
“Recent breakthroughs in genomics computing, and molecular medicine have created extraordinary opportunities to advance healthcare into a new era where many more treatments are based on the genetic characteristics of each patient,” states an HHS budget justification document sent to congressional appropriations committees.
Besides genomics information, volunteers will share several types of biological data including clinical information from electronic health records and mobile health data and technologies that will help correlate activity, physiological measures and environmental exposures with health outcomes. Participants must be able to not only access their clinical data and donate it for research, but they require a secure infrastructure that protects their privacy. In support of these efforts, ONC is supposed to receive $5 million to facilitate the development of interoperable and secure health data exchange systems.
“In FY 2017, ONC will engage industry and other stakeholders to identify the standards and policy necesssary to support the Department‐wide Precision Medicine Initiative,” according to budget documents. “By aggressively pursuing a portfolio of standards and technology activities that support precision medicine and protect user privacy, ONC will advance the basis on which precision‐based medicine can be practiced.”
As part of Vice President Joe Biden’s Cancer Moonshot, the Dept. of Health and Human Services wants to provide $680 million to the National Institutes of Health to expand clinical trials for health disparity populations, pursue new vaccine technology and fund “exceptional opportunities” in cancer research. Under the new Cancer Moonshot effort, the HHS budget also includes $75 million for the Food and Drug Administration to develop “regulatory pathways for these new technologies, ensure quality systems for trials, and facilitate the sharing of important data across government, academia, and industry.”
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