- The Office of the National Coordinator for Health IT's No. 1 priority over the next few years is improving interoperability throughout the industry, according to the Health Information Technology Advisory Committee's annual report workshop update.
- Rounding out ONC's top priorities are privacy and security and patient access to medical records — issues targeted in the 21st Century Cures Act.
- The 29-page update shows the progress HITAC has made toward a final fiscal year 2018 annual report, which it will send to HHS and Congress this spring. That report will include an analysis of current gaps and opportunities in health IT infrastructure, along with recommendations for addressing the gaps.
The update offers a window into how ONC plans to build on last week's proposed rule drop. The long-awaited proposed rules from ONC and CMS would give patients free electronic access to their personal health data and require hospitals to provide patient discharge notifications to relevant physicians. They would also define information blocking and call on the industry to adopt standardized application programming interfaces.
Last year, ONC released a draft for its Trusted Exchange Framework and 2019 Interoperability Standards Advisory. The latter provides guidance on current and emerging standards and implementation specifications for meeting healthcare interoperability needs. The final version of TEFCA is expected to drop anytime.
Despite those and other efforts, interoperability "remains fragmented and uneven," the update says. In fact, a recent ONC analysis found one-third of hospitals use four or more methods to routinely receive patient care records from outside sources, and a fourth have no electronic method at all.
ONC needs to address the "reality gap" between what systems are certified for and what is actually interoperable in the real world, the draft update says. Toward that end, HITAC should measure systems' true interoperability at both content and transport levels post-deployment.
The committee also calls for more training and support for technology users on privacy and security protections, and raises the possibility of federal guidelines for data exchanges occurring across state lines.
To increase cybersecurity, policymakers should push nationwide adoption of cybersecurity frameworks and specify who in an organization is accountable for data security. HITAC also recommends updating consent approaches and the technologies that support them.
ONC also wants to improve communication with patients about what to expect when they're able to access their information. For example, the update calls for monitoring how well portals work, the amount of patient engagement they see and whether patients understand the data and how to use it. ONC also want to identify use cases that demonstrate the benefits of accessing patient data to patients themselves.
Finally, the committee points to the need to support infrastructure needs for underserved populations and recommends measuring the impact of monetizing data exchange.
The update and recent ONC actions dovetail with industry priorities. In a recent report, the American Hospital Association and other national health organizations urged a shared infrastructure and rules of the road to boost interoperability. Key elements for achieving that include security and privacy, more usable solutions, cost-effectiveness and enhanced infrastructure, improved standards, connecting beyond EHRs and sharing best practices, the report said.