ONC to Congress: More work needed on interoperability

While hospitals and physicians are using healthcare IT at unprecedented levels, providers must now make progress to ensure the seamless and secure flow of electronic health information that is necessary to improve patient care.

That’s the contention of the Office of the National Coordinator for HIT in its annual report to Congress.

According to ONC, interoperability is foundational to several national priorities including delivery system reform, the Cancer Moonshot, and the Precision Medicine Initiative, as well as the modernization of public health and the advancement of research and innovation.

Although providers are currently exchanging more electronic health information than ever before, the agency argues that the healthcare industry must shift from adoption of electronic health records to using health IT as a tool to achieve better health outcomes.


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Despite “widespread progress in modernizing the U.S. health IT infrastructure, there is more work to do to achieve truly seamless and secure flow of electronic health information for all clinicians, hospitals, communities, and individuals,” states the report.

Toward that end, ONC notified lawmakers that it is focused on three priority areas:

  • Promoting common standards to facilitate the seamless and secure exchange of data, including through the use of standardized, open application programming interfaces (APIs);
  • Building the business case for interoperability, particularly through delivery system reform efforts that change the way the Centers for Medicare & Medicare Services pay for care to reward quality over quantity of services; and
  • Changing the culture around access to information through: combating information blocking; ensuring that individuals know they have a right to access and transmit their health information and that providers know they must provide access to the individuals; and reminding healthcare providers that they are legally allowed to exchange information in the course of treatment or coordinating care.

“Standards help individuals, healthcare entities, public health agencies, health IT products, and medical devices consistently and accurately find, send, receive, and integrate electronic health information,” states the ONC report. “Use of common technical standards and specifications are necessary for electronic health information to move seamlessly and securely.”

The report specifically calls out Health Level Seven International’s emerging Fast Healthcare Interoperability Resources (FHIR) standard for the electronic exchange of health care information.

“FHIR API access seeks to provide seamless transmission of electronic health information from a health system to consumers or the app that the consumer chooses,” according to ONC. “FHIR is suitable for use in a wide variety of contexts—mobile phone apps, cloud communications, EHR-based data sharing, and server communication in large institutional healthcare provider organizations.”

Yet, despite progress made on standards such as FHIR, the agency points out that “many health IT developers, healthcare providers and hospitals still choose not to share electronic health information for a variety of reasons, including concerns around complying with HIPAA, competing technology priorities, or a belief that the interoperable flow of health information may jeopardize competitive advantages gained from maintaining exclusive access to patients' electronic health information.”

As a result, the report makes the case that “public and private sector efforts must foster culture change around access to information—including combating information blocking—in addition to addressing technical and economic factors.”

In an effort to get tough on those EHR vendors and providers engaging in information blocking, ONC’s fiscal year 2017 budget request sent to Congress included a legislative proposal to explicitly prohibit information blocking and to provide the HHS Office of the Inspector General with additional authorities to investigate such behavior and to impose penalties on violators.

Ultimately, ONC concludes that “public and private sector efforts should together drive toward a health system where electronic health information flows seamlessly through easy-to-use technology solutions that present actionable information when it is needed most.”

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