ONC prepares for its biggest challenge yet: EHR interoperability and usability

After investing its energy into EHR adoption, the federal government’s health IT regulatory agency is shifting its focus to solve long-standing problems of interoperability and usability.

Those were two challenges that senior officials with the Office of the National Coordinator for Health IT came back to time and again during a media call on Tuesday. While their objectives are clear, the precise pathway to achieving true interoperability while reducing the burdens of EHRs for physicians is still foggy.

“When you think about what is left, it’s the hard stuff,” said Don Rucker, M.D., national coordinator for ONC. “Interoperability is an extremely tough issue.”

Interoperability and usability have been part of a consistent refrain from top health officials, including Department of Health and Human Services Secretary Tom Price, who said the “administration is committed to doing all we can to align incentives and promote true interoperability” during a keynote address at Datapalooza.

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ONC senior officials offered more context to the administration’s approach. The driving force behind the ONC’s long-term objectives is based on provisions of the 21st Century Cures Act, which makes interoperability a key focal point. First and foremost, the ONC must develop a trusted exchange framework and a common agreement for exchanging information between health information networks.

ONC has already scheduled an initial July 24th meeting to begin those discussions. Two more listening sessions will take place over the next several months to get feedback from the industry. ONC plans to release a draft of the common agreement by the end of this year or early next year, with a final version scheduled for release next year, according to Genevieve Morris, the principal deputy national coordinator at ONC.

Broadly, the ONC is focusing three interoperability use cases: patient access to data—including how to easily transfer health information from on provider to another; enterprise accountability to ensure providers can access data in bulk to use analytics; and open competition and access to application programming interface (API).

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But there are plenty challenges inherent in each one. Although 21st Century Cures requires APIs to be “accessed, exchanged, and used without special effort,” those platforms require different standards and approaches for providers and software or app developers, in part because patient data is stored within health systems.

“[That’s a] fundamental delta there we have to deal with,” Rucker said.

It's also a challenge that puts healthcare well behind other advanced industries, he added, joking that he thought the issues with EHRs would have been solved in the early 1990s.

“Just look at the apps on your phone and go through the ones you use and ask yourself, do we have that in healthcare?” he said

On the usability front, John Fleming, M.D., deputy assistant secretary for health technology reform, a newly created position at ONC, is leading efforts to make EHRs more usable for physicians—particularly small, independent practices that he feels serve as the bellwether for usability across the industry. Solving the problems of small practice physicians—who feel they are spending too much time in front of a computer screen—will help larger organizations.

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“One of the things I'm looking at is how can we streamline?” he said. “How can we make the EHR much more readable, more usable, more cogent, more analytical. So it goes outside of just ONC and EHRs. It really involves a reimbursement system.”

Rucker lamented that unlike other industries that use technology to drive automation, documentation and billing have been the foundation for EHRs, which has created the complex usability issues that often make it harder for physicians to provide care.

“It’s the only business I’m aware of that uses computers to become less efficient,” he said.