Written by: Stephanie D. Willis
The HHS Office of the National Coordinator (ONC) released its report “Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure” (the “Vision Plan”) last week to help refocus stakeholders on HHS's goals for the use of health IT in the U.S. health care system. Although the goals are largely aspirational, the Vision Plan nevertheless articulates the ONC’s expectations of the IT capabilities that patients, providers, and other health care stakeholders should be able to leverage to improve health care quality and lower costs by 2024.
The ONC’s approach to the next decade of health IT advancement follows a three-phase approach, using the three-, six-, and ten-year marks as milestones for achieving broadly-defined goals. To better understand the ONC’s milestones for health IT infrastructure development and usage, it is helpful to visualize the phases as one would envision building a house from the ground up.
The first three years of the ONC’s Vision Plan are focused on foundation-building. The foundation of health IT infrastructure comes from laws like the Health Information Technology for Economic and Clinical Health (HITECH) Act, and the ONC’s standards and certification processes, including the Medicare and Medicaid EHR Incentive (also known as Meaningful Use) Programs. In the short term, by ensuring that these foundational laws, standards, and certifications apply to a common set of health data elements and that the sources of such data provide reliable and relevant information about patients and the care that they receive, the ONC believes that it can improve interoperability for the long run.
The ONC’s Vision Plan expects that with this foundation, the next three years will focus on building the “floors” of the health care system’s IT infrastructure to achieve coordination in the health care system. The ONC’s Vision Plan mentions population health management as an example. Using the health IT house imagery, a floor of the house may belong to an accountable care organization (ACO), and each of the rooms on that floor signifies the participating providers in the ACO who hold data corresponding to a patient’s journey through the health care continuum. The hallways and doorways that connect the rooms also embody the connections that need to exist among the different providers in the ACO to ensure continuity of care for the patient. By building an efficient floor, the ONC seeks to “close care gaps and improve the quality and efficiency of care.”
And in the last phase ending in year ten, the ONC’s Vision Plan envisions a “Learning Health System” that essentially builds the stairways and the elevators between the stakeholders’ floors to effectively share health information for individual and population-level purposes. The public health system on an upper floor will be able to intelligently use individual patient data that comes from a different floor belonging to a health care system to better address larger events like disease outbreaks in the future. The communications between floors will be the ultimate test of the interoperability of health care data systems from different stakeholders like payors, public health agencies, and research organizations.
Just as a homeowner may renovate a house from time to time, the ONC envisions continued evolution of the “standards, policies, and data infrastructure” as the health care system’s demands and uses for data become more sophisticated. In addition, as a homeowner or building manager may install security measures to protect the tenants and contents of the building, the ONC recognizes that "it is essential to maintain public trust that health information is safe and secure . . . [and] ensure that appropriate, strong, and effective safeguards for health information.” Overall, according to the ONC, “the nation’s health IT infrastructure will support better health for all through a more connected health care system and active individual health management . . . Advanced, more functional technical tools will enable innovations and broader uses of health information to further support health research and public health.”
Based on the ONC’s Vision Plan, health IT stakeholders should think critically about how their input can help design the blueprints that ONC will use to construct the health IT infrastructure and best achieve interoperability. The Centers for Medicare & Medicaid Services (CMS) and ONC recently published a proposed rule that would delay portions of and relax requirements under the Meaningful Use program, which shows that CMS and ONC are aware of stakeholder concerns about building a sound health IT infrastructure. Additionally, previous posts have discussed the ONC’s joint efforts with the Food and Drug Administration and the Federal Communications Commission to create a risk-based regulatory framework for health IT that promotes innovation, protects patient safety, and avoids regulatory duplication. The ONC’s Vision Plan represents another call to action for all stakeholders to inform HHS's plans for the expansion, usability, and interoperability of data throughout the health care system.