President Donald Trump’s 2018 budget includes a $22 million cut to the Office of the National Coordinator for Health IT (ONC), amid broader agency reductions that left policy experts worried about ongoing health IT initiatives, including funding for precision medicine research.
The ONC budget has remained steady over the last several years at $60 million, but the president’s budget aims to reduce that funding to $38 million in 2018. The cuts were outlined in a document (PDF) temporarily released by the Department of Health and Human Services (HHS) on Monday afternoon, which indicated ONC spending would focus on two priorities: interoperability and EHR usability. The full budget is expected to be released on Tuesday.
The ONC cuts are part of $636 billion in cuts to all agencies within the HHS, including deep reductions to Medicaid funding. Similar to what Trump previously outlined in his skinny budget released in March, the National Institutes of Health will see a $5.6 billion reduction. The budget also calls for the Agency for Healthcare Research and Quality (AHRQ) to be absorbed into NIH, with $272 million—84% of AHRQ's 2017 budget—reserved to continue “key research activities.” AHRQ funds several health IT grants.
Health IT groups expressed concern about the 2018 budget and the 36% cut to ONC, particularly as the agency is gearing up to implement portions of the 21st Century Cures Act.
“We are disappointed by the administration’s proposed cuts to the Office of the National Coordinator for Health IT,” Lynne Thomas Gordon, CEO of the American Health Information Management Association (AHIMA) said in a statement. “The bipartisan passage of the Cures Act by Congress last year made clear that investment in our nation’s health IT infrastructure is critically important if we are to advance new drugs and devices and fully realize the benefits of a learning healthcare system. ONC is a critical partner in this endeavor.”
Last month, AHIMA issued a letter to the chairman and ranking member of the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies voicing pre-emptive concerns that ONC would not have enough funding to implement provisions of the 21st Century Cures Act.
Early reports of FY18 Budget proposal appear to have deep cuts for some health IT programs and agencies. Need to keep educating on #value.— Tom Leary (@TLearyHIMSS) May 22, 2017
American Medical Informatics Association (AMIA) Board Chair Thomas H. Payne, M.D., pointed to ongoing initiatives designed to improve EHR interoperability and advance precision medicine, arguing the proposed budget “stops progress in its tracks.”
Jeff Smith, vice president of public policy at AMIA, added that although every president’s budget request is “aspirational,” this one sends a clear signal about the administration’s priorities.
“It’s unsettling that this White House is promoting policies in such stark contrast to genuinely bipartisan efforts such as Precision Medicine, the BRAIN Initiative and efforts to modernize how Americans receive health care,” Smith said an email to FierceHealthcare. “At a basic level, this budget halts progress on science and technology meant to improve patient care because this administration does not compute the ramifications of their aspirations.”
Leslie Krigstein, vice president of congressional affairs at the College of Healthcare Information Management Executives (CHIME), added that executing provisions of 21st Century Cures, along with improving interoperability and maintaining EHR standards and certification efforts "will be extremely difficult, if not impossible," under Trump's proposed budget for ONC.
Not everyone had the same concerns. Although Health IT Now Executive Director Joel White worried the “draconian” cuts to NIH would be detrimental to the Precision Medicine Initiative, he argued that ONC cuts would not “pose an immediate adverse effect on health IT advances.”
“ONC has extended its reach beyond its original purpose in the past and this funding level presents an opportunity for the agency to return to a laser focus on interoperability and implementation of the 21st Century Cures Act, including its key provisions related to information blocking,” White said in a statement.
Although 21st Century Cures set aside $100 million for the Precision Medicine Initiative in 2018, Edward Abrahams, president of the Personalized Medicine Coalition, worried that broader NIH cuts would impact ongoing research. Lawmakers on both sides of the aisle have already pushed back against funding cuts for medical research.
“The president’s ongoing desire to cut NIH’s research budget contradicts the bipartisan support the agency received as recently as earlier this month,” Abrahams told FierceHealthcare. “It would be a travesty for patients and the future of personalized medicine if enacted.”