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The Vision of ONC: Interoperability, Key Priorities and Partnerships for Success

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June 15, 2021

Ciox Chief Innovation Officer Shannon West hosted a Webinar featuring Micky Tripathi, PhD, MPP, National Coordinator for Health Information Technology. In light of recent information blocking changes and rapid development in the health IT environment, Tripathi and West explored topics including interoperability, FHIR adoption, regulations, and the future of technology applications in healthcare.

Importance of Data Access and FHIR Adoption

“The whole opportunity for the future of healthcare really lies in data access,” West said, noting that ONC has been a productive partner for many entities working on new applications for information flow.

FHIR, or Fast Healthcare Interoperability Resources—an emerging technical standard for interoperability—is largely responsible for the recent surge in healthcare information flow. Adoption is growing rapidly, Tripathi reported, noting that over 80% of deployed EHR systems have some type of FHIR-based capabilities in them, supporting a richer pattern of data exchange.

Information Blocking Changes and Challenges

After numerous delays, April 5, 2021, was the deadline for complying with information blocking provisions of the Office of the National Coordinator for Health IT Interoperability and Information Blocking Final Regulation; which includes establishing API requirements using FHIR so patients can have access to and exchange their health information—structured or unstructured. Tripathi noted that this information blocking requirement has brought many considerations and variations across various settings and providers nationwide, and that the ONC is available to support affected entities with resources for clarification.

Leveraging Information Blocking Regulations

Instead of getting bogged down from a compliance perspective, Tripathi hopes the industry can take advantage of the opportunities the information blocking regulations bring, including better care management processes, useful smart applications, shared patient care planning, and social determinants of health applications, all made possible by FHIR. In essence, he presented in the Webinar, value-based care is the real driver of interoperability, which in turn ends up being a real driver of greater value in healthcare, enabling a “virtuous cycle” via information exchange.

Enhancing Data Access and Usability

From public health data to patient specific data, it’s also important to have bidirectional exchange with payers. The breadth of clinical data available, aided by the right technologies, will enable stronger outcomes, greater transparency, and more cost effective care delivery. With improved data access in healthcare, patients will start to enjoy “more facile, more user-friendly, more highly adoptable” ways of interacting with their information as they have in other industries and Internet economies, Tripathi added. “That’s why we want to be able to move the industry to a set of conventions and a set of technical approaches,” which FHIR is supporting. FHIR hooks, for example, allow users to passively trigger a query through configurations to ascertain information from a third party or provider organization and have it right in the EHR flow. These types of exciting technologies provide a richer pattern of exchange and usability which is a huge opportunity for the health IT industry now and moving forward.

USCDI and Data Elements

On the Webinar, West and Tripathi also discussed USCDI (U.S. core data for interoperability), the standardized set of data elements required to be available in all certified EHR systems. As the data elements change year to year, the process is a “rising floor” for only those data elements that are mature enough from a standards perspective, says Tripathi, who noted that by October 6, 2022, all data will have to be available whether it’s standardized or not. “The philosophy behind it is to make the data available, and the users will start to figure out how to make sense of that data,” he said, adding that the industry needs to move as rapidly as possible on algorithmic approaches and other tools like natural language processing (NLP) to help make sense of unstructured data.

Patient Education and Privacy Concerns

Finally, ONC—as well as other federal agencies, provider entities, and technology vendors—must prioritize patient education from a health information exchange perspective. There’s a common misconception, Tripathi said, that HIPAA applies to medical record data regardless of where it lives. Of course, HIPAA is not defined by the data, but rather by the entity that is holding that data, which certainly presents challenges regarding recent information blocking changes and the availability of data to patients. Even if there are not ideal regulatory protections in place, “We need to move forward with individual access to information and individual ability to control their information,” he said.

Challenges and Future Focus

West noted, however, that it is concerning when research indicates 63% of Americans say they understand very little or nothing at all about the laws and regulations that are currently in place to protect their data privacy.[1] Policymakers should be able to create policies that balance the needs of patients for privacy rights while also supporting secure, simple flow of health data.

The ONC remains committed to working with various organizations to develop standards and rules to help them achieve business goals, enabling information flow that improves healthcare and drives a healthier future. Ciox also drives that vision to leverage health data for improving patient outcomes and lowering healthcare costs.

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