Preparing for the Next Decade of Health IT at the ONC

The Office of the National Coordinator for Health Information Technology (ONC) held it’s Annual Meeting in Washington, DC, on January 23, 2014. This marked the 10th year of the ONC, and the fifth since the passage of the HITECH Act. The ONC was created in April 2004 through an executive order by President George W. Bush, and was legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. The HITECH legislation also created the HIT Standards Committee and the HIT Policy Committee under the auspices of the Federal Advisory Committee Act (FACA).

After 10 years of activity we are entering a new era in health IT policy, and the industry is at a major crossroads.

The ONC Annual Meeting is a gathering of health IT and policy geeks made up primarily of grantees to various ONC programs. Many of these were funded through the HITECH Act, such as the State Health Information (State HIE) Exchange Cooperative Agreement Program and the Health IT Regional Extension Center (REC) Program. The HIE cooperative agreements are ending, along with the funding streams to many statewide HIE efforts, while the REC program is extended for another year.

In some cases the entity receiving the funding for these two programs is the same, and I think it is likely that those states where the REC and HIE are closely aligned are ones where we will see the most success. In any event, I expect to see up to one third of the state HIEs fold as the funding dries up. But those that have put good sustainability plans in place and ultimately succeed by providing value to stakeholders will be that much stronger a year from now. We will have to see how well the RECs can help providers over this next year in achieving meaningful use.

We now also have a newly minted National Coordinator for Health IT. In an email sent to staff at HHS on December 19, 2013, Secretary Kathleen Sebelius announced that physician Karen DeSalvo, who served as the City of New Orleans Health Commissioner and Senior Health Policy Advisor to Mayor Mitch Landrieu, will be the National Coordinator and begin the job January 13, 2014. She was preceded by physician and ONC Chief Medical Officer Jacob Reider (interim 2013 – 2014), physician and public health expert Farzad Mostashari (2011 – 2013), physician and Harvard Medical School Professor David Blumenthal (2009 – 2011), psychiatrist Robert Kolodner (interim 2006, permanent 2007 – 2009), and physician and venture capitalist David Brailer, (2004 – 2007).

The ONC Annual Meeting was Dr. DeSalvo’s first public introduction to the health IT community and her keynote was very interesting (playing off many of the themes she shared with the HIT Policy Committee earlier this month).

She spoke of her upbringing and discussed her work as New Orleans’ health commissioner. She talked about how the use of health IT has became critical in public health initiatives and emergency preparedness. She described how health IT was key in New Orleans’ recovery after Hurricane Katrina and rebuilding the region’s health system. She was also on the Steering Committee for the Crescent City Beacon Community in Louisiana.

“When asked to be a part of ONC’s leadership, I said ‘Absolutely yes’ because this is a critical period where we need to do in this nation to reform the healthcare delivery system,” DeSalvo said in her keynote talk. “We are making strides in expanding coverage and getting everybody in the tent. Our challenge now is to see that when everybody is in the tent that the care is as effective and efficient and safe as possible.”

Perhaps responding to HIT Policy Committee member John Halamka’s blog post in which he said she is a cheerleader for health IT, not an informatics expert, she stated “I’m more than a cheerleader for health information technology. I am actively engaged in the space as a doctor, as a leader, and a public health official.” Although when speaking to her privately later she readily admitted that she is not a technologist and she will lean on the expertise of the leadership assembled at the ONC and within the health IT community.

One of the more under-reported stories, and a very important milestone that occurred at the meeting was the signing of an historic memorandum of understanding (MOU) between the United States and the UK. Originally identified at the June 5, 2013, bilateral summit meeting between the US and UK, the collaboration focuses on four key areas for health IT and innovation:

  • Sharing quality indicators
  • Making better use of health data
  • Adopting digital systems
  • Working towards a more robust health IT marketplace

HHS Secretary Kathleen Sebelius attended the meeting. Bryan Sivak, Chief Technology Officer at HHS also joined Sebelius onstage while she gave some brief remarks. The Secretary said that because of the work of the people in the room, patients are more empowered to access and manage their own health information.

Then Secretary Sebelius and the U.K. Secretary of State for Health Jeremy Hunt, who was participating in the meeting remotely, signed the historic memorandum of understanding allowing the countries to share health IT tools. Bryan Sivak and Tim Kelsey, National Director for Patients and Information at NHS, also countersigned the MOU. Secretary Sebelius discussed how health IT is an important platform for healthcare delivery and stressed its role in shaping lower costs and improved quality. She expressed hope that the MOU will help to address the challenges and ultimately improve the healthcare system and the lives of patients.

Bryan Sivak moderated a fascinating panel discussion, “Spurring Innovation for Health IT Transformation” with Jacob Reider, MD, Bijan Salehizadeh of NaviMed Capital, and Polina Hanin, community director at StartUp Health. Some of the themes were taking advantage of government resources while still knowing your customers and their real world needs.

“Startups are trying to understand how they can help physicians, hospitals and organizations become more efficient, with an emphasis on quality of care,” said Ms. Hanin. Entrepreneurs interested in health IT should consider shadowing clinicians in practice or else “they will develop technology that sounds right but doesn’t actually work within the organizations,” she said.

With patients well being and very lives sometimes at stake, Dr. Reider urged providers to be measured about the way health IT is implemented in order to minimize risk. “You don’t have to do the Big Bang. You can do iterations of risk, starting in places where there is less patient risk.”

Businesses often don’t know what ONC resources are available that could help accelerate development. “They are surprised we are so helpful, and we are surprised that they didn’t know what was buried in a 2,000-page regulation,” Reider said to laughter. “They can leverage the standards instead of creating a new way of doing things.”

Taking time to get things right was a key stressed by Bijan Salehizadeh. “I think it’s important for entrepreneurs to realize that things take a little bit longer in healthcare. Often a lot longer,” he said.

At a Town Hall meeting Thursday afternoon, in which 11 senior leaders at ONC participated, Dr. DeSalvo spoke of the importance of maintaining constant progress for health IT as ONC enters a new decade and what she referred to as a “pivot” stage.

The panel was asked what is being done to help pharmacists and other providers who are not eligible for the Meaningful Use program. “We are looking at how we can leverage the certification program to be broader than just for those participating in Meaningful Use,” said Jodi Daniel, JD, MPH, director of ONC’s Office of Policy and Planning. Behavioral health and long-term care providers are high priorities, she added. A team is working on ways to best include more providers.

Kelly Cronin, health reform coordinator, said ONC is figuring out how to accelerate interoperability and support adoption of health IT by long-term care and behavioral health providers. Also, “We want to make sure that, as accountable care organizations mature, we’re thinking critically about how we weave health IT into that. How do we advance exchange as a series of applications including those that reach patients and make sure this all fits together.”

Lygeia Ricciardi, director of ONC’s Office of Consumer eHealth, said her office’s strategy for consumer engagement encompasses the three As: access, action and attitude. With access to data comes action, or the ability to enable patients to utilize tools to meet health goals. Holding this all together is attitude, the perspective that patients should be an active and core member of the team. “It’s about being a smart and thoughtful consumer and being engaged in all aspects of thinking about your health and well-being, including your privacy,” she said.

Rear Admiral Boris D. Lushniak, M.D., M.P.H., the Acting Surgeon General gave and inspiring talk and spoke about the 50th anniversary for the 1964 Sugeon General’s Report on Smoking and Health and gave a call to arms to create a tobacco-free generation. It is a laudable goal. We are half way through the first generation of the ONC, and the next decade is full of promise to improve care and lower costs using health information technology in innovative and effective ways.

Brian Ahier

Brian Ahier is a national expert on health information technology with a focus on health data exchange. He is President of Advanced Health Information Exchange Resources, LLC, which has provided consulting services to a variety of industry clients as well as the Office of the National Coordinator at HHS. Brian sits on the Consumer Technology Workgroup of the HIT Standards Committee which makes recommendations to the National Coordinator on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information consistent with the implementation of the Federal Health IT Strategic Plan. Brian is a founding Board member of DirectTrust, and also serves on the Board of HIMSS Oregon and Q-Life., an intergovernmental agency providing broadband capacity to the region. Brian helped found Gorge Health Connect, Inc. (GHC) a health information exchange organization in the Columbia River Gorge where they implemented one of the first Direct Project pilots. Brian worked at Mid-Columbia Medical Center for eleven years, most recently as Health IT Evangelist. He served four years as a City Councilor in The Dalles, Ore., and on the Board for Mid-Columbia Council of Governments. Brian helped develop the Oregon strategic and operational plans for implementing State-Level HIE under the State Health Information Exchange Cooperative Agreement. After the plan was approved by the ONC he was appointed by the State of Oregon Health Information Technology Oversight Council (HITOC) as Chairperson of the Technology Workgroup responsible for developing a framework and providing input for technology goals, including deliverables and objectives, standards, and definition of central services. Brian has worked on a number of workgroups and committees within the Standards and Interoperability Framework and continues to work on the Direct Project.

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