Trump budget plan would slash ONC funding, reorder its priorities

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President Trump’s proposed federal budget for Fiscal Year 2018 would slash funding for the Office of the National Coordinator for Health Information Technology by about 35 percent, from $60 million to $38 million.

While the budget proposal formalizes the priorities of the Trump administration, Congress has the final say on funding levels for agencies and programs in the federal budget.

The electronic health record meaningful use program is winding down, and the administration’s budget foresees a new mission for ONC to focus on improving interoperability of information systems and the usability of EHRs. “The interoperability of health information is central to the core mission of the Department of Health and Human Services to enhance and protect the health and well-being of all Americans,” according to the budget document.

The budget also calls for ONC to focus on opposing information blocking and prioritizing work on standards, implementation and testing in pilot programs to accelerate progress on interoperability. ONC will continue its core mandate to develop health IT policies to support an interoperable learning health system; it also will be tasked with implementing parts of the 21st Century Cures Act. ONC’s two federal advisory committees will be reduced to one, which is mandated under the 21st Century Cures Act.

Also See: Obama signs 21st Century Cures Act into law

“We are disappointed by the administration’s proposed cuts to the Office of the National Coordinator for Health IT,” noted a statement by the American Health Information Management Association. “The bipartisan passage of the Cures Act by Congress last year made clear that investments in our nation’s health IT infrastructure are critically important if we are to advance new drugs and devices and fully realize the benefits of a learning healthcare system. ONC is a critical partner in this endeavor.

“We hope that as congressional appropriators draft the Labor, Health and Human Services, Education and Related Agencies bill for fiscal year 2018, they will ensure that ONC is properly funded and signal their commitment to meeting the goals of the 21st Century Cures Act,” the AHIMA statement concludes.

The HHS Office for Civil Rights, which also enforces the HIPAA privacy and security rules, is slated to get $33 million, a $6 million drop from 2017. “In FY 2018, OCR will reduce overhead and non-personnel costs,” according to the budget document. “OCR also will use civil monetary penalties to support HIPAA enforcement activities.”

While the budget foresees a narrowing of ONC’s mission, the agency still is needed, industry observers contend. Whether ONC can attract talented individuals as its budget gets cut concerns Jeff Smith, vice president of public policy at the American Medical Informatics Association. The Trump administration, he notes, already is having difficulty recruiting talented people for federal agencies.

That could be an immense challenge for the Food and Drug Administration. “We need to attract the best talent,” Smith contends. “The FDA soon will be grappling with software they haven’t seen before.” The agency is said to be creating a new digital health unit by tapping into funds from user fees imposed on medical device manufacturers.

That means FDA will be working to learn about three new types of software it soon could be seeing from device companies: Software to manufacture the device, software inside a device and software as a medical device. “These are applications the FDA is getting now,” Smith says. Whether FDA will get adequate funding to oversee these devices is not yet clear.

For now, one of the big winners in the Trump budget is the 21st Century Cures Act and its Precision Medicine, BRAIN, Cancer Moonshot and Regenerative Medicine initiatives.

Under the Trump plan, precision medicine’s $40 million budget in fiscal 2017 jumps to $100 million in fiscal 2018 to support the collection of clinical, environmental, lifestyle and genetic data to find new ways of preventing and treating disease based on the variability of individuals.

BRAIN goes from $10 million to $86 million for its work on how individual cells and the neural circuits they form interact.

Funding for the Cancer Moonshot, to improve prevention and early diagnosis, stands at $300 million in both 2017 and 2018. And, Regenerative Medicine, seeking to develop functional tissues and organs to repair or replace lost biological functions, has funding increased from $2 million to $10 million.

Overall, however, the National Institutes of Health takes a big hit in the Trump 2018 budget, down 17.4 percent from 2017 funding levels. Ironically, Congress less than three weeks ago boosted the 2017 NIH budget by $2 billion, says Smith of AMIA.

The Agency for Healthcare Research and Quality would be eliminated, with 84 percent of its 2017 funding put in NIH. The National Library of Medicine loses 5 percent of 2017 funding and the National Center for Advancing Translational Sciences loses 18 percent of its budget.

The National Human Genome Research Institute takes a cut of $118 million and the National Institute of Biomedical Imaging and Bioengineering takes a $64 million hit.

“The ecosystem that entices young scientists and clinicians to pursue their passion to help patients will be severely damaged, resulting in a downward spiral of innovation, delayed or forgone investment in new treatments, and a stagnant patchwork of IT-enabled patient care,” AMIA asserted in a statement.

Health IT Now, a coalition of providers, patient groups, employers and insurers supporting incentives to deploy information technologies, issued a statement opposing cuts to Precision Medicine and other health IT priorities.

“We hope Congress’ support of increased NIH funding in the recent omnibus bill indicates a preparedness to reject these dangerous cuts that would set us back in healthcare technology and innovation,” said Joel White, executive director. “While the administration additionally tasks ONC with adopting a usability focus, we believe patients and providers would be better served by ONC working to remove regulatory burdens that stand in the way of private sector innovations that could improve usability on their own.”

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