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Which Provisions of the 21st Century Cures Act Has ONC Implemented?

While ONC has not yet implemented all provisions of the 21st Century Cures Act, the federal agency has made progress.

ONC outlined its progress toward implementing provisions of the 21st Century Cures Act.

Source: Thinkstock

By Kate Monica

- Healthcare stakeholders have voiced concern over ONC’s slow pace in implementing provisions of the 21st Century Cures Act (Cures) passed in 2016.

However, ONC has laid the groundwork to release information blocking regulations, improve patient health data access, promote interoperability, and achieve other objectives outlined in Cures, according to recent testimony from National Coordinator for Health IT Don Rucker, MD.

In testimony presented to the House Committee on Energy & Commerce Subcommittee on Health, Rucker detailed the steps ONC is taking to ensure the aims of Cures are fulfilled in the near future.

“The Cures Act directs the HHS Secretary to adopt standards and policies that advance health IT to enable and stimulate the trusted exchange of electronic health information,” explained Rucker. “The Cures Act, thus, materially advances our mission to enable patients’ records to follow them when and where they need it.”

To support the flow of information, ONC established the Health IT Advisory Committee (HITAC) in January to provide recommendations to the National Coordinator about achieving interoperability, promoting the privacy of health information, and facilitating secure data access for individuals and their caregivers.

The establishment of this committee specifically fulfills provision 4003(e) of Cures.

ONC is also working to increase connectivity by establishing the Trusted Exchange Framework and Common Agreement (TEFCA.)

Cures called for a trusted exchange framework and common agreement in Section 4003 of Cures, which will help to expand health data exchange nationwide. In January, ONC released the first draft of TEFCA and gathered public comment from stakeholders across the healthcare sector.

“ONC received more than 200 comments on the draft, and plans to release an updated draft for public comment in the coming months,” said Rucker.

ONC will select a Recognized Coordinating Entity (RCE) through a Cooperative Agreement and this entity will develop, update, implement, and maintain the Common Agreement.

“The Cures Act’s focus on trusted exchange is an important step for advancing an interoperable health system,” said Rucker.

ONC also expects TEFCA will support community exchange efforts and improve interoperability for patients with behavioral health conditions such as substance use disorders and mental illness.

“Health information networks, as intrinsically local resources, are positioned to more effectively connect patients with the clinical services and social supports they need,” maintained Rucker.

Other provisions of Cures center on administrative burden.

“The Cures Act also gave the Secretary the authority to address clinician burden stemming from the use of EHRs and health IT, and the Secretary delegated that authority to ONC,” said Rucker.

Toward this end, ONC teamed up with CMS to release a strategy for reducing regulatory and administrative burden in November.

The strategy is informed by feedback from over 1,000 stakeholders given at public listening sessions.

“To develop this strategy, we convened four HHS workgroups comprised of policy and clinical specialists to focus on common sources of burden, including clinical documentation, health IT usability and user experience, EHR reporting programs, and other government requirements,” noted Rucker.

CMS also changed federal reporting requirements within the Merit-Based Incentive Payment System (MIPS) and the Medicare Physician Fee Schedule to relieve providers of administrative burden.

These changes fulfill provision 4001 (a) of Cures.

ONC has made progress toward implementing an EHR Reporting Program in accordance with Section 4002 of Cures.

The EHR Reporting Program will provide publicly available, comparative information on certified health IT products.

ONC received 77 public comment submissions in response to its request for information (RFI) to inform the development of reporting criteria and other components of the program.

In the near future, the federal agency plans to outline activities that do not constitute information blocking in support of Section 4004 of Cures.

To further promote seamless data exchange, ONC developed the USCDI and published the 2018 Reference Edition Interoperability Standards Advisory. USCDI specifies a common set of healthcare record data classes required for exchange.

“These efforts around standards and interoperability are foundational for having a modern and connected health system that lowers health care costs,” said Rucker.

Combined, these resources and regulations will help to ensure patients, providers, and other stakeholders can exchange and use health information without special effort.

“In summary, ONC has made great progress towards implementing key provisions of the 21st Century Cures Act,” said Rucker. “These actions will maximize the potential of health IT and result in improved care and reduced cost.”

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