ONC 2020-2025 Strategic Plan: Not Much for Public Health
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)
The plan does a good job of acknowledging public health and the use of heath information technology (HIT) to collect data on reportable conditions and to stop outbreaks, while pointing out how HIT helps Federal agencies carry out their mission in these areas (p. 7). The plan recognizes how the “digital divide” among citizens in the US has an impact on their access to data and the public’s health (p. 9), and the need to integrate health and human services data (including support for social determinants of health, or SDOH) as service delivery continues to be Intertwined and interdependent (p 14).
Among the plan’s objectives is the need to ensure safe and high-quality care through the use of HIT including (among other things) better patient matching and identity management, and interoperability and standards (p. 15). There is also recognition that, “Stakeholders, including healthcare providers, healthcare staff, and developers may not understand what actions are required for compliance with the applicable federal and state privacy laws” (p. 19), something that has hindered interoperability for years.
The plan’s principle of “putting the individual first” (p. 5) is supported throughout the goals and objectives, but it must be balanced by a similar principle to support public health with the requisite goals and objectives. Included in the plan is a goal to accelerate research, including population health management, and buried within that goal is a strategy that includes support for, “… appropriate use of health and human services data across federal- and state-level systems to enable population health planning, analysis of quality and patient outcomes across care settings and programs, and clinical research.” (p. 17) Population health continues to be a vague and misunderstood term, and most public health professionals do not consider it synonymous with public health.
This plan clearly puts the patient first, and just about everything else – including public health – is pushed to the back burner. If the primary audience for this plan is other Federal agencies who are expected to implement programs that support its goals and objectives it should perhaps have addressed support for population level activities in a more balanced way. Given the significant role that Federal agencies play in not only managing major public health initiatives, but also in funding many more, this plan need to more prominently and less ambiguously ensure continuing support for these activities. The recent Congressional funding for data management to support CDC’s public health surveillance is a step in the right direction, but even $50 million is barely enough to get started. Perhaps Goal 1 (Promote Health and Wellness) should include an additional objective along the lines of, “Sustain the collaborative activities necessary to ensure public health surveillance, readiness, and response.”
ONC welcomes comments on this plan through March 18, 2020.