ONC to tackle barriers to EHR usability and interoperability

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The federal government has spent tens of billions of dollars incentivizing hospitals and physicians around the country to adopt electronic health record systems. However, taxpayers have not gotten what they paid for, according to National Coordinator for Health IT Donald Rucker, MD.

“We have electronic medical records pretty much everywhere in the American healthcare system, but I think there’s really two tasks that we have left to do—which are the themes for this meeting,” said Rucker in his opening keynote at the start of ONC’s Annual Meeting on Thursday in Washington.

The theme of the agency’s 2017 meeting, which runs through Friday, is “Tackling Barriers to Interoperability and Usability,” which Rucker contends are formidable, yet achievable goals.

According to Rucker, these two objectives are the mission of the Trump administration as it seeks to realize what he called “empowered” healthcare. In particular, he said reducing the burdens of EHRs on providers is critical to enabling them to practice at the top of their license.

“Every clinician basically has dozens of workflows piled on them—it’s just an innately hard task,” Rucker commented. “Frankly, there are a lot federal policies, a lot of reimbursement policies that are candidates for change. Our reimbursement policies were designed in a world of paper documentation. Most of this was in the 1990s. We have some opportunities to change this.”

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When it comes to the lack of interoperable EHR systems, the ONC chief pointed to the 21st Century Cures Act which includes several health IT interoperability provisions—among them a mandate from Congress to empower patients with open application programming interfaces (APIs) “without special effort” to assist with the access and exchange of health information.

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, as well as 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.

“The smartphone is really the device that we need to target to have electronic ownership of patient data,” said Rucker, adding open APIs are “about trying to get medical records and move them across town, getting their mother’s or their child’s MRI result from one place to another.”

ONC’s Genevieve Morris, principal deputy national coordinator for HIT, noted that the Cures Act specifically calls on the agency to advance the seamless exchange of health information. To address this requirement, ONC is working on developing a Trusted Exchange Framework and Common Agreement (TEFCA) to establish network-to-network connectivity for the improvement of HIE.

Morris said the agency has already received stakeholder comments regarding the development of the document, including recommendations that ONC should “focus requirements on critical areas of inconsistency across existing network agreements that require standardization to enable cross-state exchange” while “avoiding disrupting or duplicating existing efforts that are successfully enabling data exchange.”

At Thursday’s ONC Annual Meeting, the agency held its third and final stakeholder listening session to get public feedback on the concept of the TEFCA that it will use to publish a proposed rule sometime in the month of December, according to Morris.

Under the Cures Act, ONC has also been tasked with developing a rule that will address the definition of information blocking. The agency’s rule will be used by the Department of Health and Human Services’ Office of the Inspector General to guide its investigations and enforcement activities related to provider and vendor misconduct.

According to Elise Sweeney Anthony, director of ONC’s Office of Policy, ONC is currently drafting a proposed rule on information blocking and will release it for public comment in the spring.

In addition, a new federal advisory committee mandated by the Cures Act to advance an interoperable health IT infrastructure will conduct its first meeting in mid-January, said Sweeney Anthony.

The Health IT Advisory Committee—which replaces both the HIT Policy and Standards Committees—is charged with making interoperability a priority and recommending standards, implementation specifications and certification criteria to ONC. Members of the HITAC have been appointed by the Government Accountability Office, HHS and members of Congress.

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