- In a press conference yesterday, ONC officials appointed by the Trump Administration cited EHR usability improvements and interoperability as the agency’s top priorities moving forward.
To tackle the EHR usability problem, ONC intends to reduce regulations and reporting requirements keeping providers busy with data entry at their monitors to promote more patient-provider interaction, according to National Coordinator for Health IT Donald Rucker, MD.
Deputy Assistant Secretary for Health Technology Reform John Fleming, MD, will also assist in advancing this priority.
“EHRs are more of a burden than a benefit, and providers look to us to help solve those problems,” Fleming said.
The newly-appointed Deputy Assistant Secretary sees reducing administrative burden as necessary to helping providers become acclimated to potentially overwhelming new technologies so that providers and patients alike can begin reaping the benefits of EHRs as soon as possible.
“Remember when commercial aircraft became more complex, pilots had systems overload and it made it very difficult to fly the plane when they had to pay attention to all of these new controls,” Fleming said. “That is going on in healthcare right now, it’s hard for a doctor to spend time and attention on patients because they are so focused on the different administrative requirements.”
“At the end of the day, we have an onion of many layers of administrative burden on healthcare providers, and they particularly impact the private independent physician to the point they have given up their practice,” he added.
While EHRs could eventually become a natural, efficient tool physicians can comfortably use to enhance patient care, the technology is still widely considered a time-consuming hindrance to care delivery.
One of the reasons EHRs have become a double-edged sword in the healthcare industry is because EHRs were initially developed for improving documentation and billing as opposed to simplifying clinical processes, Rucker said.
“That is a funny kind of beast,” he maintained. “All other industries use computerization for automation and to become more efficient. We are the only industry I know that has used computerization to become less efficient.”
ONC and CMS will work together to look for ways to reduce reporting requirements for providers.
CMS has already made progress on this front, and recently received praise from several associations across the industry for its Quality Payment Program (QPP) proposed rule.
The proposed rule will be open for public comment until August 21, 2017.
ONC intends to handle its second priority by encouraging the proliferation of new technologies to meet provider expectations surrounding seamless health data exchange.
“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.
“When you look at it, Congress has spoken on this with two laws that really define the ONC mission,” he continued. “The first is MIPS/MACRA—the MACRA law and the MIPS provisions. The successors to some of the meaningful use rules, quite explicitly.”
Rucker stated MACRA was a way to encourage providers to use existing tools to assist in achieving value-based care and quality improvements.
By setting forth incentives for fulfilling certain reporting requirements, Congress is encouraging providers to embrace and increase health data exchange to pave the way for a more interoperable, data-driven healthcare environment.
To this end, Rucker stated ONC will shift the focus away from encouraging EHR implementation and instead look toward ensuring existing EHRs are efficient and interoperable.
“The easy stuff is done, getting an EMR and paying for it,” Rucker said. “Now we are working on interoperability and using EMRs, and that is the hard part.”
Apart from MACRA, Rucker cited the 21 Century Cures Act as another law designed to carry out the ONC mission.
“I think the top level takeaway of the Cures Law is that Congress wants a more explicit definition of interoperability,” he said.
Guiding ONC’s efforts to improve interoperability are three major use cases: patient data access, accountability and security, and open competition with health IT product development including APIs.
Rucker stated the market for developing APIs in healthcare should optimally resemble what is happening in Silicon Valley with the rapid development of apps such as Twitter and Facebook.
The advantages of API development are two-fold: open APIs both advance interoperability and improve efficiency with easy-to-use interfaces.
Additionally, ONC aims to continue cracking down on information blocking to encourage easier access to patient health data.
“There’s explicit prohibitions against [information blocking] and we will need to work to define how that plays out,” said Rucker.
The ONC Interoperability Roadmap
The new Principal Deputy National Coordinator for Health IT at ONC Genevieve Morris stated in the press conference that her contributions at ONC will largely focus on carrying out the objectives outlined in the ONC Interoperability Roadmap of 2015.
“The way that we’re thinking about interoperability right now is basically as four targets: technical, trust, financial, and workforce,” said Morris.
Taking feedback from industry stakeholders has helped the agency develop a fuller picture of what issues need to be addressed to improve interoperability, and industry insiders have largely pointed to these four target areas as priorities, Morris said.
Despite the changing of the guard at ONC, the department intends to stick to the original plan. Morris stated ONC will address all four of these targets using the steps previously laid out by past legislation.
“We are going to be building strategies around those four targets, but making sure that we’re pulling in from the roadmap the items that haven’t been accomplished yet but still need to be accomplished in order to move us forward,” explained Morris.
“A lot of the way we’re attacking interoperability problems aligns with how we organized the roadmap to start with,” she added.
The 21 Century Cures Act in particular will guide interoperability improvements moving forward, Morris said.
For example, the Cures Act calls for the development of a trusted exchange framework and common agreement to promote full network to network health data sharing. In keeping with this provision, ONC is holding three multi-stakeholder meetings starting July 24 to begin designing the framework.
Using information collected during these meetings as well as subsequent periods for public comment, ONC intends to have a draft of the framework and the common agreement ready by next year.
Enabling a learning health system
In terms of achieving a learning health system, Morris stated the department needs to address several more immediate roadblocks before turning its attention to larger goals.
“While we want to achieve full interoperability and a learning health system, there are some really practical next steps and some hard slog things we have to do in order to move forward down that path,” she said.
However, the original three use cases ONC highlighted as priorities in achieving interoperability will also pave the way for the future learning health system, Morris added.
Specifically, bulk accountability allowing for big data analytics will give rise to its development.