Interoperability, EHR usability top priorities for ONC
Under the Trump administration, the Office of the National Coordinator for Health Information Technology will be focusing on reducing the burden of EHR usability on healthcare providers as well as seeking to improve interoperability among clinical systems.
That’s the message to industry from National Coordinator for Health IT Donald Rucker, MD, who discussed his plans for the agency during a press briefing on Tuesday.
“We’ve obviously spent a lot of money collectively in the country on these systems, and there’s a widespread dissatisfaction with the level of interoperability,” said Rucker, who previously worked as a clinical professor of emergency medicine and biomedical informatics at the Ohio State University and Premise Health.
Rucker noted that ONC’s mission going forward is defined by two laws: the Medicare Access and CHIP Reauthorization Act (MACRA) and its Merit-Based Incentive Payment System (MIPS), as well as the 21st Century Cures Act.
According to Rucker, Meaningful Use is essentially being restructured into a new Advancing Care Information performance category as part of MACRA’s MIPS, which he called the “successor” to the MU program based on the measures adopted by the EHR Incentive Programs for Stage 3 in the 2015 EHR Incentive Programs Final Rule.
“Our focus is not on simply finding more things to apply the Meaningful Use methodology to,” emphasized Rucker. “Our focus is on the usability of these systems and interoperability. A lot of this comes strictly under Cures. What the remnants of the Meaningful Use framework around that are, I think are to be determined.”
At the same time, he said the “top-level takeaway” of the Cures Act is that “Congress wants a more expansive definition of interoperability” while explicit prohibitions against information blocking will necessitate that ONC “come up with language that meets everyone’s needs here—and that’s a difficult task, but that’s what the law requires.”
Rucker touted the value of open application programming interfaces in helping solve the problem of health IT interoperability. “You look at Silicon Valley, you look at modern computing,” he added, “it’s all about APIs.”
According to Rucker, the 21st Century Cures Act includes several health IT interoperability provisions, such as calling on HIT developers to publish APIs to assist with the access and exchange of health information.
APIs were also included in the final Meaningful Use Stage 3 rule, requiring certified EHR technology to provide an API through which patient information can be viewed, downloaded and transmitted to a third party. Further, APIs are part of the 2015 Edition of Health IT Certification Criteria, which requires certified EHRs to demonstrate the ability to provide a patient-facing app access to the Common Clinical Data Set via an API.
ONC’s Genevieve Morris, principal deputy national coordinator, is taking the lead on interoperability. She said the Cures Act calls on the agency to advance the seamless exchange of health information and that the ONC is working collaboratively to implement the trusted exchange framework and common agreement provisions in the law.
ONC will host a kick-off meeting in Washington on July 24 at which it will share the results of a recent analysis of existing frameworks that support the interoperable flow of health information across different networks and supportive principles that enable trusted exchange nationally. In addition, the meeting will provide an opportunity for stakeholders to comment on existing national trust infrastructures used to exchange health information electronically and on electronic data sharing best practices.
“The 24th is meant to sort of level set everyone around what the different networks currently have in place in their participation agreements—where there’s alignment, and where there’s not alignment—so we’re all starting from the same place,” said Morris. “From there, we move into a 30-day public comment period where we’re asking folks to give use feedback around what they think should or should not be in the common agreement. There will be two more listening sessions after that to get input.”
Reducing the regulatory and administrative burdens on providers related to the use of EHRs is also on ONC’s agenda, said Deputy Assistant Secretary for Health Technology Reform John Fleming, MD.
“The (HHS) Secretary feels that it’s very important that we look at the burdens on providers in healthcare,” Fleming said. “We hear more and more complaints from both doctors and patients as to the inability of doctors to focus 100 percent on the patients.”
According to Fleming, physicians are distracted from focusing their attention on patients because of burdensome administrative requirements, which he likened to an onion with many layers of regulations that have negatively affected private independent practices in particular.
“Many have given up their medical practices and now have become employed with larger institutions,” observed Fleming, who was an early adopter of HIT, having implemented an EHR in his Minden, La.-based practice in 1997. “There’s nothing wrong with it per se. But, the problem is that in many ways that actually increases the cost of care.”
When it comes to EHR usability, Fleming’s charge is to examine ways to streamline the documentation process and to make the technology more readable, usable, cogent and analytical. He lamented that physicians have become data entry clerks, which is time-consuming and adds to their duties beyond patient care.
“It really involves the reimbursement system, because under the current fee-for-service methodology doctors are paid for documentation, not necessarily for their medical care,” he concluded. “We’re also talking to CMS about innovative methods of care delivery and reimbursement.”
Rucker agreed that EHRs are essentially about documentation for billing, while other industries outside of healthcare use their enterprise computer software to achieve automation and efficiency.
“We’re the only business I’m aware of that uses computers to become less efficient,” he quipped. “Those are the areas that we think we potentially, as an administration, have some ability to affect.” However, Rucker added that “unpeeling the onion is a challenge.”