- While the healthcare industry has a strong health IT presence with high EHR adoption levels, the ONC still has work to do to improve health data interoperability, according to the federal agency’s most recent annual report to Congress.
According to the report, health IT adoption has risen considerably since the HITECH Act’s 2009 passage. In 2008, only 17 percent of physicians and nine percent of hospitals had adopted a basic EHR. By 2015, 96 percent of hospitals and 78 percent of physicians had adopted certified EHR technology, the report shows.
However, there is still a long way to go before the nation has a highly usable and effective EHR and health technology presence according to ONC.
“This progress, where an extraordinary amount of electronic health information and infrastructure now exist that the country lacked merely a decade ago, has set the stage for a transition in focus to the seamless and secure flow of this health information – also known as interoperability – to improve the health and care of individuals and communities,” the report stated.
The push for interoperability has given birth to the Cancer Moonshot and Precision Medicine Initiative, delivery system reform, the fight against the opioid epidemic, clinical innovation, and public health improvement.
In order to continue to promote these projects, ONC sets out to promote common, federally-recognized standards, build the business case for interoperability, and change the culture around access to health information.
And technology standards are critical for using the health data EHRs and other devices capture..
“Use of common technical standards and specifications are necessary for electronic health information to move seamlessly and securely,” ONC wrote. “Using data elements consistently and reliably allows for collecting information for individual health needs as well as for reuse of that information to drive decision support, quality measurement and reporting, population health management, public health, and research.”
ONC has done work to advance common health IT standards, such as creating the Interoperability Standards Advisory (ISA). This guide provides a list of health IT standards and implementation tips to help fulfill a set list of interoperability needs.
ONC is also advocating for the use of advanced programming interfaces such as Fast Healthcare Interoperability Resources (FHIR). This plug-and-play functionality allows certain healthcare technology apps work and interact with one another.
To build the business case for interoperability, ONC has supported an industry-wide shift toward value-based care. In value-based care models, healthcare professionals are paid according to the quality of care they provide. In order to meet quality benchmarks, providers need interoperable health technology.
“Seamless interoperability will facilitate better monitoring of health outcomes, as well as efficient resource use and cost analyses, particularly for care provided across multiple systems and settings,” ONC explained. “Expanded use of health IT that combines beneficial decision supports and quality measures will help the nation to achieve continuous quality improvement.”
Health IT interoperability plays a significant role in MACRA’s Quality Payment Program, for example. Interoperability health systems are key for clinicians participating in an advanced alternative payment model. Additionally, the Merit-based Incentive Payment System (MIPS) has specific health data exchange requirements that depend upon interoperable systems.
ONC has reportedly provided help to providers and health IT developers looking to advance interoperability. By offering technological assistance and a plethora of guidance and resources, ONC says it has helped support stakeholders in the shift toward interoperable health technology.
While ONC has created several initiatives and assistance programs to help build an interoperable technology infrastructure, it is still working on changing the culture of the industry. If health professionals do not believe in an imperative for interoperability, it will be difficult to achieve:
Many health IT developers, health care 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, to achieve the seamless and secure flow of electronic health information, 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.
Specifically, ONC is working to advocate patient access to their health information. The agency has spearheaded several initiatives educating both patients and providers about patient rights to their health data under HIPAA regulations.
ONC has also joined the push against information blocking, or the intentional withholding of health data. Under the Quality Payment Program final rule, for example, healthcare professionals are required to attest to a statement advocating an end to information blocking.
The agency is also promoting the safety and reliability of health technology and interoperability through better IT transparency. Reporting on the quality of technology systems will help consumers better determine which products will fit their practice needs.
Ultimately, these efforts are geared toward improving the healthcare industry as a whole, helping to promote different agendas from delivery system reform to the fight against the opioid crisis. While the healthcare industry has the tools with which to achieve these goals, ONC will need to lead a final push toward interoperability.
“Despite this 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,” ONC concluded.
“HHS will continue efforts to promote the use of common, federally recognized, national standards, facilitate culture change around access to information – including combating information blocking, and build the business case for interoperability.”