- EHR interoperability will likely improve in the next few years as ONC makes progress toward promoting the use of application programming interfaces (APIs) and implementing provisions of the 21st Century Cures Act, according to National Coordinator for Health Information Technology Donald Rucker.
In his keynote speech at the ONC 2018 Annual Meeting, Rucker outlined the federal agency’s plans to reduce provider burden and boost interoperability.
Rucker and others at ONC are teaming up with CMS to develop a strategy for addressing problems with regulatory and administrative burden. The draft strategy is open for public comment until January 28.
“If you identify burdens, I'd like you to take the time to comment on that,” said Rucker. “You’re going to be already seeing, even before the report goes out, our first major effort, which is rethinking evaluation and management codes.”
ONC is also taking steps to make charts easier for clinicians to read as part of an effort to cut down on the time it takes providers to find relevant patient health information in clinical notes.
“It probably hasn't escaped anybody in the room that if you look at most modern medical records, much of the text is actually just template and boilerplate that actually has nothing specific to do with the patient and is entirely a fulfillment of the level four and five AMA CPT4 codes,” said Rucker.
“This makes charts very hard to read,” he continued. “As a clinician, it's sometimes a treasure hunt trying to find an actual true clinical fact in these charts.”
Simplifying documentation and ensuring medical records are easy to read and interpret will become more important as patients gain complete access to their own EHRs.
“With the other provisions in Cures on open notes, patient access to their medical records, patients are going to have access to this,” said Rucker. “Patients will be quite curious when they look at stuff in boilerplate text and ask themselves, and then their providers of course, ‘What does this have to do with me?’”
While reducing provider burden will largely affect the relationship physicians and patients have with EHRs, improving interoperability will likely affect every facet of the value-based care system.
“The vision of interoperability is something much broader than just moving the medical record from one provider to another provider,” said Rucker.
“We really have to look at interoperability in the context of empowering patients,” he continued. “Getting the data on your smart phone, having control of it, getting really back involved in healthcare.”
Forthcoming information blocking regulations should help to further the aims of the 21st Century Cures Act and push interoperability further.
“Even while the rule making has been cooking, we've seen a number of the folks where you could argue maybe there's been not as much information as quickly as appropriate,” said Rucker. “We’ve already seen a lot of behavioral change since the Cures Act was passed in December of 2016.”
“We’re hoping that as the APIs get better, as the technology gets better, that this will not be an issue,” Rucker added.
Another provision of Cures ONC hopes to soon put into action involves the Trusted Exchange Framework and Common Agreement (TEFCA), which will help to standardize and streamline health data exchange.
“The structure that Congress envisioned is really the sense that the various networks, which have some fragmentation as we know, they have some locality to them,” explained Rucker. “Whether it's by a geographic territory or a vendor base or a business model, they should talk to each other.”
Under TEFCA, a Recognized Coordinating Entity (RCE) from the private sector will build out the framework into a single set of guidelines and technical standards comprising the common agreement. Health information networks can agree to follow the requirements outlined in the common agreement to become qualified health information networks (QHINs).
“We're going to have the specific provisions of this Recognized Coordinating Entity of the qualified health information networks that are going to do that support in the interaction,” said Rucker. “And that are going to allow a variety of business models and approaches here. We're going to have that out for further comment.”
“We absolutely want to expand the permit of uses to really make this look like a true network,” Rucker added.
Rucker also said ONC will work to improve the integration of social determinants of health into HIEs and EHR systems.
“The reality of, in my case, practicing in urban ERs where there's a huge set of patients with complex mental health, behavioral health, substance issues,” said Rucker. “And we don't really have any modern computing to support them. We can do better here. The health information changes that are very local are going to be a great tool to help put these resources together.”
While Rucker did not reveal the exact day TEFCA will be released, he said the framework should be out soon.
Rucker also echoed the sentiments of HHS Deputy Secretary Eric Hargan about the importance of ensuring regulations are not too prescriptive to allow the private sector to innovate and explore new ways of leveraging health data.
“We are going to be as absolutely minimalist as we can on those things,” said Rucker. “But we do want to have all the potential competitors in the provider space have a shot. We want to get the smaller providers in.”
Overall, ONC and other federal entities are committed to giving health IT developers the flexibility necessary to innovate while also promoting the use of health data standards to ensure new apps and health IT systems can seamlessly exchange information.