Experts agree on HITECH’s value but diverge on ONC's new role in enhancing interoperability

Some of the nation’s foremost health IT experts see the value in the Health Information Technology for Economic and Clinical Health (HITECH) of 2009 that created federal incentives to entice thousands of hospitals and physician offices to adopt EHR systems in a matter of years.

Those same experts also concede that the industry is facing entirely new challenges when it comes to EHR usability and interoperability. And the federal government’s role in that next step varies depending on who you ask.

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For several former officials, that role includes a symbiotic relationship with developers and providers. Recognizing the HITECH Act kickstarted “rapid progress toward digitizing the healthcare delivery system,” four former national coordinators at the Office of the National Coordinator for Health IT—Vindell Washington, M.D., Karen DeSalvo, M.D., Farzad Mostashari, M.D., and David Blumenthal, M.D.—said the industry is “at an inflection point” when it comes to securely and seamlessly sharing health information. In order to maintain the momentum of health IT adoption, the industry must undergo a cultural shift, they wrote in the New England Journal of Medicine.

“Going forward, the national coordinator for health IT will continue to bring together stakeholders in areas where collaboration wouldn’t naturally occur and federal regulation is not desired,” they wrote. “The ONC also has an essential role in coordinating federal agencies in developing guidelines for technology deployment—collaboration that must be complemented by private-sector–led innovation.

While the former officials see a distinct role for federal oversight, particularly when it comes to privacy and security, John Halamka, M.D., the chief information officer at Beth Israel Deaconess Hospital, and Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative advocate for a much lighter touch from the federal health IT agency to reduce the burden for clinicians.

“We overwhelmed them with confusing layers of regulations. We tried to drive cultural change with legislation. We expected interoperability without first building the enabling tools,” the authors wrote in the same issue of NEJM,  outlining some of the unintended consequences of HITECH.

“In a sense, we gave clinicians suboptimal cars, didn’t build roads, and then blamed them for not driving.

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Instead, Halamaka and Tripathi advocated for “dramatically simplified” requirements under the Merit-Based Incentive Payment System (MIPS), EHR certification that focuses “exclusively on interoperability capabilities” by using a public server to test vendors, and encouraging interoperability through “market action rather than by regulation.” Incentives for adopting application program interface (API) standards could be one way to do that, but returning control to the private sector is critical.

The ONC, under the leadership of Donald Rucker, is grappling with some of the same issues outlined in both NEJM perspectives while weighing the agency’s involvement in oversight. Rucker has previously acknowledged that “interoperability is an extremely tough issue” now that EHR adoption is out of the way, and Department of Health and Human Services Secretary Tom Price has argued that government should adopt a “60,000-foot” regulatory view to overcome the barriers to interoperability.