ONC strategic plan raises questions about the future of Meaningful Use

The Office of the National Coordinator for Health IT's updated health IT strategic plan, released Dec. 8, is a high-level, ambitious framework for the federal government. It addresses some of the questions the industry has had about the direction of health IT and ONC. It's also an interesting read.

The plans updated goals include:

  • Expand the adoption of health IT
  • Advance secure and interoperable health
  • Strengthen healthcare delivery
  • Advance the health and wellbeing of individuals and communities
  • Advance research, scientific knowledge and innovation

Clearly, the strategic plan is a starting point, and the details still need to be hashed out. But it raises a lot of questions in my mind.

First and foremost: What's going on with the Meaningful Use program?

The 2011 strategic plan, not surprisingly, focused its priorities on the Meaningful Use incentive program, then in its first year of implementation. The program is barely mentioned in the updated plan, and then only in passing. ONC, in the new plan, states that the "health IT ecosystem has changed" since 2011. 

I agree, but the Meaningful Use program continues through 2021. What will it look like in Stage 3? Are we to presume that it will mirror the goals listed here? Is the plan sending a message that ONC is looking beyond Meaningful Use? Or is the program simply no longer a priority?

Another of the plan's goals is to expand the adoption of health IT by assisting providers that are ineligible for the Meaningful Use program, in part by encouraging use of certified EHRs via payment policies. Would that be in the form of incentives, penalties, or both?

Interoperability is one of the strategic plan's highest priorities. How will the government's efforts dovetail with those in private industry, such as the Argonaut project, which apparently has opted not to wait for government leadership and is forging ahead on its own--and on its own terms?  

The plan aims to improve patient safety by, among other things, supporting the identification, monitoring and reporting of challenges and hazards in health IT. Does this mean that ONC will take a stronger stance than in the past and require vendors to report adverse events, as recommended by the Institute of Medicine? Or is the industry going to continue to operate under a volunteer vendor code of conduct?

The plan aims to protect the privacy and security of health IT. Does that mean that we might see changes to HIPAA? And note that the plan intends to continue enforcement of privacy and security requirements on entities not covered by HIPAA. How will that work? Will we see more regulation of wearable devices and mobile applications? Does that mean we'll see more enforcement activities from the Federal Trade Commission?

Also, will there be sufficient stability in leadership and staffing to follow through on these goals? There's been tremendous turnover at the U.S. Department of Health and Human Services and ONC of late. Will there be a steady hand at the helm?

And one final question: Why is the National Aeronautics and Space Administration listed as one of the agencies involved in increasing the percentage of hospitals and physicians to successfully attest to Meaningful Use?  

Luckily, this is a draft strategic plan. The public gets to comment until Feb. 6, 2015. It's not a long document. Please peruse it and weigh in.  - Marla (@MarlaHirsch and @FierceHealthIT)