Passage and implementation of the 21st Century Cures Act has ushered widespread electronic health record adoption by providers, forward momentum on interoperability and more vendors incorporating data standards in their products, the Biden administration’s health IT office wrote in a recent congressional report.

The report highlighted what the Office of the National Coordinator for Health IT (ONC) called the U.S. health system’s “tremendous progress” on electronic health information.

As of 2021, 96% of non-federal acute care hospitals and nearly four in five office-based physicians are using an EHR certified by ONC, according to the report.

ONC and Health and Human Services (HHS) recently celebrated the inaugural cohort of companies approved to begin onboarding as Qualified Health Information Networks within the Trusted Exchange Framework and Common Agreement (TEFCA), a key step for cross-network interoperability.

Additionally, the office’s report touted a new round of United States Core for Data Interoperability (USCDI) updates that proposed 20 new data elements and a new data class, advancing the data standard supported by developers.

Still, the 2022 Report to Congress outlined several barriers that are dragging ONC and the industry’s efforts to implement the 2020-2025 Federal Health IT Strategic Plan—some of which have become particularly apparent due to recent events.

“The COVID-19 pandemic exposed gaps in health IT systems that support capturing and using population data,” ONC wrote in the report (PDF). “The challenges exposed during the public health response to the COVID-19 pandemic pinpointed the importance of health IT to monitor population health regarding public health surveillance of testing, diagnosis and vaccine distribution.”

The barriers highlighted by ONC include:

  • ONC and HHS’ lack of authority under the Cures Act to tell entities whether their specific instances constitute information blocking. Subsequently, ONC wrote that it is unable to disseminate such advisory requests and responses to the rest of the industry “so that other entities could review them and apply the analysis to consider whether their own practices might be assessed if subject to HHS review."
  • Insufficient progress on electronic health information sharing. As of 2019, 70% of non-federal acute care hospitals had at least one challenge in public health reporting, despite requirements from the Centers for Medicare and Medicaid Services. These systems between hospitals and public health entities need to be modernized with, among other means, the use of standardized application programming interfaces (APIs) and TEFCA to unlock pandemic-relevant capabilities.
  • Fragmented state/regional health information exchanges (HIEs). Most HIEs are only serving their local markets and lack the common information standards to share information between hospitals or other entities. “This presents barriers to better care, higher costs to the healthcare system, and a diminished user experience for patients and healthcare providers," ONC officials wrote in the report.
  • Few incentives for health IT and data exchange adoption for certain portions of the care continuum. HHS’ authorization to incentivize providers to adopt certified EHRs doesn’t extend to certain types of behavioral health professionals, long-term and post-acute care, hospice and home and community-based providers. Particularly in regard to interoperability, gaps in adoption are hamstringing care transitions from hospitals to other settings.

With these roadblocks in mind, ONC listed several recommended actions for the federal government:

  1. Prioritization of information sharing
  2. Promotion of nationwide exchange across networks
  3. Improvements in certified health IT and user experiences
  4. Advancement of standards
  5. Coordination of health IT efforts
  6. Protection and security of EHI
  7. Modernization of public health data systems
  8. Support of health equity and comprehensive health and care needs
  9. Advancement of health IT for research and data analytics

“As the nation continues its response to the challenges presented by the COVID-19 pandemic, the need for technology and access, exchange, and use of EHI to support a variety of health IT users has never been greater,” ONC officials wrote. “Although this report mainly focuses on specific actions taken by the federal government, contributions and collaboration across states, tribes, communities and the private sector are also critical for progress toward a modern and connected health IT infrastructure.”