In December 2019 the Office of the National Coordinator for Health Information Technology (ONC) released a draft 2020-2025 Federal Health IT Strategic Plan and invited public comment. The plan is intended not only to provide a roadmap to Federal agencies but also to “…provide signals to the private sector on the direction of the federal government, which may guide coordination and investment decisions” and serve as a “catalyst for activities” (p. 21)
We have spent years involved with the management of the Center for Medicare and Medicaid Services (CMS) Electronic Health Records (EHR) Incentive Programs which were created by the HITECH Act (2009). These programs were recently renamed Promoting Interoperability (PI) programs. In a nutshell, these programs were tied to the Medicare and Medicaid insurance programs and provided financial incentives over a number of years to ambulatory providers and hospitals to adopt and use EHRs. Vendors submitted their technology products for testing and certification that they performed specific functions and could exchange data using specified message formats.
On December 5, 2019, Michael Suralik, project manager at HLN, attended The Sequoia Project’s annual meeting in Washington, D.C. TEFCA and Information Blocking were the big topics of the day. It was a very substantive meeting and there was vibrant back and forth discussion and exchange of ideas between and among the presenters and the other meeting participants (see this report that summarizes the meeting).
In November 2019 the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a new report, Top Management and Performance Challenges Facing HHS. Divided into six major sections, this report reviews the OIG’s observations with respect to financial integrity of HHS programs, value and quality, protecting the health and safety of beneficiaries as well as the public at large, harnessing data to achieve these goals, and working across government.
On August 21 and 22, 2019 the Office of the National Coordinator for Health Information Technology (ONC) held its third Interoperability Forum in Washington, DC. More than 600 individuals participated in person with many others viewing the general sessions via webinar. The conference began and ended with half-day plenary sessions while providing five tracks with smaller sessions in between. I attended the Health Information Exchange (HIE)/Community-based Information Exchange (CIE) breakout session on both days.
The plenaries (aside from the usual welcome and farewell messages) focused on the current state and the future state of interoperability. Lots of talk about TEFCA, FHIR, and patient-centered control of health records, but I really did not hear anything new or terribly interesting. There was a fascinating presentation by Dr. Simon Eccles, head off Great Britain’s NHSX project, but this is their third attempt at an integrated health information system and it seemed more aspirational than actual.
In the track I attended on Tuesday there was a very good session on public health and health IT, very well attended with varying presentations from CDC, AIRA, APHL, and others. The second set of presentations was on improving coordination between acute and post-acute facilities using FHIR. On Wednesday, the same track had presentations on advancing social determinants of health using FHIR (including the HL7 Gravity Project), and a second set of presentations on health IT and behavioral health. It was nice, frankly, to finally hear some presentations on this topic that were not completely dominated by the opioid crisis.
To be honest, my expectations were fairly low for this conference. FHIR was all the rage. but its limited deployment still has it fairly early in the hype cycle. Until an RCE is named and begins its work, TEFCA is still a distant idea. The major market-driven HIE activities (Commonwell, Carequality, SHIEC) did not seem to have a terribly visible presence at this meeting. In fact, the more established HIEs seemed to spend the whole conference wondering out loud why no one was recognizing their role in interoperability. Likely we will have to wait until the publication of the final rule on Information Blocking before we really know what the HIE landscape will look like for the next few years.