EHR Reporting Program RFI offers a window into ONC’s 21st Century Cures implementation

A new request for information issued by the Office of the National Coordinator for Health IT offers a peek into the agency’s sluggish progress implementing provisions of the 21st Century Cures Act. And not everyone is thrilled with the direction the agency is headed.

The RFI, released (PDF) last week, asked for public input regarding the EHR Reporting Program, a mandatory program built into the 2016 law designed to ensure EHR vendors are meeting specific measures around interoperability, security, usability, conformance to certification standards and any other appropriate criteria. The ONC plans to use stakeholder feedback to create formal standards for the program.

“ONC is especially interested in feedback targeting users in ambulatory and small practice settings, where providers typically do not have substantial time and resources to conduct broad market research,” the agency wrote.

Jeff Smith, vice president of public policy for the American Medical Informatics Association (AMIA) was hesitant to criticize an RFI that touches on some critical issues but couldn’t ignore some of the subtle differences between the request and what is described in Cures.

Although the RFI includes some “meaty” questions, Smith said the original purpose of the program, as outlined in the law, was to give federal regulators a policy lever that keeps vendors in check without punishing providers. As written, the RFI describes a program that serves as more of a Consumer Reports-style program to help providers differentiate between vendors.

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“The original intention of reporting program was to compel the reporting of performance data not so a purchaser could determine which EHR to buy, but so that EHR vendors, if they didn’t meet certain performance standards, would be unable to participate the certification program,” Smith said.

“That purpose doesn’t necessarily shine through,” he added. “Certainly, though this RFI, that purpose doesn’t exist.”

That could change as a more robust program takes shape. 

At one point last year, it was unclear whether the ONC would have the resources it needed to begin working on the program at all. Last October, the ONC’s Deputy National Coordinator for Health IT Jon White, M.D., told senators the EHR Reporting Program was the only portion of the 21st Century Cures Act that the ONC wouldn't be unable to complete in light of a proposed 37% budget cut. But in February, Congress passed a spending bill maintaining the ONC’s budget from previous years.

It also comes as lawmakers and advocacy groups are becoming more inpatient with other Cures' provisions, particularly the information blocking rule. Earlier this month, 15 organizations led by Health IT Now, urged (PDF) the ONC to issue its long-awaited rule on information blocking, arguing that, “every day that the administration delays implementation of these critical provisions places patients at risk of harm.”

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Similarly, the EHR Reporting Program is well behind schedule. The 21st Century Cures Act required HHS to convene stakeholders to develop reporting criteria no later than one year after the law was passed.

“While I think this is a well written RFI, there’s nothing in here that couldn’t have been done earlier in the year,” Smith said.