Since its inception in 2004, the Office of the National Coordinator for Health Information Technology (ONC) has delivered outsized results for its size. This subdivision of the US Department of Health (HHS) has a budget of approximately $ 60 million and a team of approximately 150 people – small by federal standards – to do the great job of “improving (improving) health and well-being.” fulfill. by individuals and communities through the use of technology and health information accessible when and where it matters most. “
Each generation of ONC executives has skillfully focused the agency on some pressing priorities. In its first phase, ONC laid the blueprint for the nationwide exchange of information. Then ONC led the rapid adoption of electronic health records by almost all hospitals and most doctors in the United States. More recently, ONC has advocated breaking information silos through new standards for application programming interfaces (API), patient data access, and information blocking regulations.
Given the increasing urgency to modernize public health data, the urgent need to improve equity in health care, and ongoing challenges over the cost and quality of health care, President Biden has proposed a 40 percent increase in funding for ONC. If Congress approves, ONC will receive $ 87 million for fiscal 2022. Where should ONC focus on more funding, awareness, and demands?
First, focus on your efforts
A small agency doesn’t have the luxury of having everything for everyone, and constraints and focus will drive faster progress and innovation. We’re excited that ONC is prioritizing modernizing public health data, health equity, and accelerating progress toward value-based care:
- As Micky Tripathi said this spring at a Health Information Technology Advisory meet“Covid is a top administrative priority, ONC included, period.” In this area, we welcome ONC’s collaboration with CDC in building a modern public health data infrastructure that will break the silos between clinical care and public health and accelerate our recovery from this pandemic and support better preparedness, faster response and greater resilience the next. The aid packages will provide funding to states, but much more is needed. The ONC’s budget proposal recognizes this priority with a $ 13 million increase to “build the future health data infrastructure needed to better respond to public health emergencies, including the Covid-19 pandemic to prepare for it ”.
- Improve health equity by working with private and public executives to develop standards, policies and systems to ensure that data on race and ethnicity, demographics, housing and social services is consistently shared between health care providers, health plans and social services. With this information, clinical and public health executives can quickly identify emerging disparities, offer services that better meet patient needs, improve reach, and develop systemic solutions to increase equity.
ONC has done important development work as part of the Gravity Project. But we also need pragmatic short-term solutions to increase the completeness and accuracy of the racial and ethnic information in the data exchanged today. This would be an ideal topic for an ONC data challenge. Or ONC could partner with CMS on Medicaid incentives, like this program in Arizona that offers providers who share and improve data quality a payment increase of up to 3 percent. Finally, ONC could fund the combined data from health information networks and run a pilot project to fill data gaps. One state recently closed 42 percent of Covid data gaps related to race, ethnicity, and contact information through such a partnership.
- Help Centers for Medicare and Medicaid Services (CMS) accelerate the transition to value-based care by addressing the data challenges that are holding back progress. Last year, CMS took a bold move by asking all hospitals to provide admission, discharge and transfer (ADT) notifications to community providers as a condition of participation in Medicare and Medicaid. These ADT notifications are an important tool used by Responsible Care Organizations (ACOs) to improve care transitions and reduce readmissions. What’s next? Standardized exchange of claims data with providers? Greater reliance on data aggregators to reduce quality reporting overhead?
These findings are in line with the ONC goals and the January issue of Health Affairs’ Vital Directions as three of the top priorities for our healthcare system in 2021.
Second, understand your power
The direct political levers of the ONC will not have as much weight in the next few years as they did before. Yes, the ONC regulates electronic health record (EHR) certification – but the technology ecosystem we need now is far more extensive than just EHRs. Yes, ONC sets the guidelines for information blocking – but in the years to come the key factors will be whether the HHS inspector general’s office sensibly enforces the guidelines already set and whether CMS sets sanctions for providers.
ONC’s strength lies in its coordination – that is, its partnership and collaboration with sister agencies to achieve mutual results, and its ability to engage and guide change in the broader technology ecosystem. In the past, when the ONC has tried to take bold steps without closely coordinating with peer agencies holding the larger policy levers and budgets, progress has been slow.
The White House can support and strengthen this important coordination work. During the HITECH era, ONC led a White House task force on health information technology. The task force brought together the Veterans Administration, the Department of Defense, the Department of Commerce and several HHS agencies to define an ambitious strategy for concerted progress in the adoption of electronic health records using all government powers. The same structure is now needed to design and build modern public health data infrastructure for states and the nation.
Third, build blueprints, not just standards
We have seen that strong partnerships between government health authorities and robust government “health data services” like Maryland’s CRISP, Indiana’s IHIE, or Nebraska’s CyncHealth are a key component of a modern public health data infrastructure. Health data service providers aggregate clinical and harm data, reconcile records, and clean and normalize information to help their states track public health trends and identify and address gaps. Health data services will be indispensable partners for states that want to:
- Identification of high risk patients and populations who have not been vaccinated
- Track outbreak infections after vaccination
- Schedule booster campaigns
- Examination of the health system in terms of prevention and other services needed
- Analyze vaccination equity efforts
Hand in hand with a small number of states, existing data services, and federal partners, ONC can define the blueprints for these collaborations that can be adopted across the country. This work will be more practical and overarching than recent ONC initiatives to develop standards that require technical, governance, funding and policy strategies. The results will be pragmatic and reusable roadmaps, governance models, technical guidelines, open source modules, funding options and supporting guidelines to transfer this model to other countries.
Tie everything together
Under Micky Tripathi’s leadership and team of experts, ONC has an incredible opportunity to “improve the health and wellbeing of individuals and communities through the use of technology and health information.” To do this, it must be surgical in its priorities, make effective use of its partnerships with agencies that have the size and resources, and jointly develop the blueprints needed to modernize public health data.
Photo: Eichinger Julien, Getty Images