ONC releases 5-year federal health IT road map pushing data access through smartphone apps and APIs

Federal health IT officials released on Wednesday a draft strategic plan that outlines priorities over the next five years with a focus on pushing the industry to make more patients' health data accessible through smartphone apps and application programming interfaces (APIs).

The draft plan outlines federal health information technology goals and objectives to ensure that individuals have access to their electronic health information to help enable them to manage their health and shop for care, according to officials with the Office for the National Coordinator for Health Information Technology (ONC) within the Department of Health and Human Services.

The strategic plan was developed by ONC in collaboration with more than 25 federal organizations. The draft plan is open for public comment until March 18.

The draft federal strategic plan (PDF) supports the provisions in the 21st Century Cures Act that will help to bring electronic health information into the hands of patients through smartphone applications, Don Rucker, M.D., National Coordinator for Health IT, said in a statement.

“We look forward to public comment to help guide the federal government’s strategy to have a more connected health system that better serves patients," he said.

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The strategic plan matches up with two big data-sharing rules developed by HHS now under review by the Office of Management and Budget, the last step before publication. ONC released its proposed information blocking rule (PDF) in February 2019 that outlines seven exceptions to the prohibition against information blocking and provides standardized criteria for application programming interface (API) development. That rule could be published soon.

Many industry groups have voiced strong concerns about the interoperability rules and have appealed to congressional leaders to help slow down the rules, citing concerns about patient data privacy, the implementation timelines and increased burden on clinicians.

The draft strategic plan is deliberately outcomes-driven with a focus on meeting the needs of individuals, caregivers, populations, healthcare providers, payers, researchers, developers and innovators, ONC officials said.

In the draft plan, ONC outlined four broad goals for the use of health IT: promote health and wellness, enhance the delivery and experience of care, build a secure, data-driven ecosystem to accelerate research and innovation, and connect healthcare and health data through an interoperable health IT infrastructure.

The plan is intended to serve as a road map for federal health IT initiatives and activities and signal priorities to the private sector, Elise Sweeney Anthony, executive director of policy at ONC, and Seth Pazinski, director of ONC's Office of Planning, Evaluation, and Analysis wrote in a blog post.

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"ONC and our federal partners strive to promote a health information technology (health IT) landscape that can increase transparency, competition, and consumer choice while also seeking to protect the privacy and security of individuals’ health information. These efforts include making coordinated investments; developing standards and policies for secure, standards-based application programming interfaces (APIs); and promoting user-focused technologies," Anthony and Pazinksi wrote.

Key health IT objectives outlined in the strategic plan include improving individual access to health information, advancing the use of evidence-based digital therapeutics and integrating health and human services information to help address social determinants of health at the individual and population levels. 

ONC is pushing for SDOH data to be captured and integrated into EHRs to assist in care processes as one strategy to address social determinants, according to the plan.

RELATED: Epic's Judy Faulkner: ONC data blocking rule undermines privacy, intellectual property protections

ONC also is calling for the use of advanced capabilities like machine learning, evidence-based clinical decision support, smart dashboards and alerts and improved patient matching to improve the safety and quality of health care.

The federal IT agency also wants to see increased use of health IT to foster competition, transparency and affordability in healthcare. ONC's strategies to do this include making care quality and price information available to patients in an accessible, easily understandable format and encouraging pro-competitive business practices that allow individuals to easily use and choose from multiple validated health apps without special effort.

Another key objective is to use health IT to reduce the administrative and documentation burden on providers by simplifying and streamlining documentation, promoting the use of evidence-based automated tools and supporting the use of electronic provider-to-provider data exchange.

RELATED: Final ONC, CMS interoperability rules under review by OMB

Jeff Smith, vice president of policy at the American Medical Informatics Association, said the goals, objectives and strategies in the draft strategic plan are "directionally consistent" with the major provisions of the 21st Century Cures Act. The scope of the strategy also nicely aligns with AMIA's conception of health informatics policy, he said.

"I am especially excited to see ONC consider the emerging ecosystems outside the traditional care delivery paradigm. Focusing on ways that health IT can impact social determinants, public health and clinical research are important additions to the delivery and experience of care," Smith said.

Patients’ right to control their health must include the right to access and control of their health information, ONC officials said.

John D’Amore, president and chief strategy officer of Diameter Health, a clinical data integration company, said ONC's 2020-2025 strategic plan is an evolution of the 2015-2020 strategic plan but also marks strategic shifts for the federal IT agency, including a more targeted focus on APIs and patient-oriented data exchange.

"Coming off the August ONC Interoperability Forum, it’s clear that ONC sees a future where any patient can easily place data on their smartphone from the electronic health record," D'Amore said.

This patient focus draws some of the resources and attention away from the business-to-business exchange of health data, which is increasingly important for analytics, research and machine learning, D'Amore said.

"In my estimation, the willingness of patients to download and manage their own health data is still over-estimated. The people most likely to want health data on their smartphones, Gen Z and millennials, who are relatively healthy, are not the ones who would see the greatest benefit, as compared to those who cost the most to the healthcare system, such as elderly patients or patients with multiple comorbidities," he said.

He also notes that balancing easy access to data and high security will be hard to achieve.