The Federal Strategy For Collecting, Sharing and Using Electronic Health Information

Screen Shot 2014-12-09 at 9.19.49 AMMaking our nation’s health and wellness infrastructure interoperable is a top priority for the Administration, and government plays a vital role in advancing this effort. Federal agencies are purchasers, regulators, and users of health information technology (health IT), as they set policy and insure, pay for care, or provide direct patient care for millions of Americans. They also contribute toward protecting and promoting community health, fund health and human services, invest in infrastructure, as well as develop and implement policies and regulations to advance science and support research.

The Office of the National Coordinator for Health IT (ONC) has a responsibility to coordinate across the federal partners to achieve a shared set of priorities and approach to health IT. To that end, today we released the draft Federal Health IT Strategic Plan 2015-2020, and we are seeking feedback on the federal health IT strategy. This Strategic Plan represents the collective priorities of federal agencies for modernizing our health ecosystem; however, we need your input. We will accept public comment through February 6, 2015. Please offer your insights on how we can improve our strategy and ensure that it reflects our nation’s most important needs.

A collection of 35-plus federal departments and agencies collaborated to develop the draft Federal Health IT Strategic Plan: 2015-2020, identifying key federal health IT priorities for the next six years (Exhibit 1). The landscape has dramatically changed since the last federal health IT strategy. When we released that Plan, the HITECH Act implementation was in its infancy. Since then, there has been remarkable growth in health IT adoption. Additionally, the Affordable Care Act implementation has begun to shift care delivery and reimbursement from fee-for-service to value-based care.

Goals of the Federal Health IT Strategic Plan

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A central component of the prior Strategic Plan was increasing the adoption of certified EHR technology among hospitals and professionals eligible for Medicare and Medicaid EHR incentive payments, and encouraging its use in clinical care. While this effort is still incredibly important, our national agenda broadened to improving health, not only health care, through health IT beyond EHRs, as well as leveraging policy and programs beyond the EHR incentive program known as Meaningful Use. Our proposed federal strategy supports this agenda to engender a healthier nation through the collective impact of integral stakeholders, across multiple sectors, using a broader set of technologies.

Collection Of Health Information

Implementation of the HITECH Act accelerated adoption of certified EHR technology among hospitals and providers that were eligible for incentive payments from Medicare and Medicaid. However, health IT adoption across the care spectrum is far from ubiquitous. Adoption among ineligible providers continues to lag. Federal actions will support health IT adoption among these providers to improve care coordination across settings.

Federal actions will also focus on health IT broader than EHRs. Widespread telehealth use can increase care access and improve care quality. Remote monitoring can allow a care team to monitor an individual’s health status while she is in the comfort of her home, improving the individual’s care experience. Mobile health apps can remind an individual to take his medication. Granular information on community health indicators can inform targeted initiatives by innovators from various sectors.

Federal agencies must also help create a fertile and competitive marketplace ripe for innovation. Health IT adopters must have the mobility to switch products without fearing the loss of important health information, productivity, or undue financial hardship. Use of health IT should increase patient safety and prevent vexing events from occurring, not the reverse. Technology developers should work with end-users to design more user-friendly health IT, making technology use a more rewarding and effective experience.

Sharing Of Health Information

Complete, timely, and accurate health information across the care continuum can help prevent adverse events from occurring. Unfortunately, widespread exchange remains elusive. We must do better. Secure and interoperable health information is paramount to the goals of care delivery system transformation and improving the nation’s health.

This goal aligns with the Nationwide Interoperability Roadmap, a parallel activity led by ONC. The Roadmap is guiding interoperability solutions based on five key building blocks: core technical standards and functions; certification to support adoption and optimization of health IT products and services; privacy and security protections for health information; a supportive business, clinical, cultural, and regulatory environment; and rules of engagement and governance of health information exchange.

Federal strategies will center on creating an infrastructure that encourages interoperable health information regardless of technology developer, platform, location, provider, or other boundaries. It is also essential that federal efforts promote privacy and security protections to support the collection and sharing of interoperable health information, as breaches and illicit disclosure of sensitive information may seriously jeopardize trust in our health care system.

Use Of Health Information

The collection and sharing of interoperable health information are prerequisites for using electronic information effectively. Strengthening health care delivery; advancing the health and well-being of individuals and communities; and advancing research, scientific knowledge, and innovation are the Plan’s raisons d’être. This is what we intend to accomplish, in concert with individuals, the private sector, local and regional entities, and as a nation in the next six years.

Strengthen Health Care Delivery. The typical Medicare beneficiary receives care from numerous physicians in a given year. This sets the stage for missed care interventions, lack of available health information, and worse health outcomes. Barriers to seamless care coordination include overstressed primary care physicians; financing that rewards the number of services administered rather than outcomes achieved; lack of integrated systems; and the lack of interoperability.

To achieve this goal, the Plan features flexible strategies to improve care quality, safety, and outcomes through use of electronic clinical quality improvement tools and measurements, and through supporting health care providers’ adherence to evidence-based guidelines. A key underpinning of this goal is supporting delivery reform by identifying and increasing administrative efficiencies that reduce cost and improve provider and patient experiences.

Additionally, this goal focuses on improving preventive services and population health. Federal actions aim to create an environment where providers can conduct analytics to benchmark, trend, and improve outcomes across their patient population. Federal agencies will also work to identify how health IT can help connect individuals and providers to home- and community-based supports, social services, and health education programs.

Advance the Health and Well-Being of Individuals and Communities. A connected delivery system can help improve the health of Americans; however, health care accounts for only about 10–20 percent of health outcomes. On a daily basis, most individuals do not interact with the delivery system.Engaged individuals are more likely to be proactive in practicing wellness, prevention, and disease management behaviors. However, most individuals were not offered access to their online medical record in 2013. The government needs to take steps to empower individuals and families and to engage and integrate them in health management. Our strategy focuses on increasing individuals’ access to their electronic health information and improving their ability to share and use this information.

The quantified-self movement views health IT solutions as a key component for basing health choices and actions on personal metrics and goals. Although most Americans track at least one health indicator, the majority of those individuals monitor progress “in their heads,” while few use technology. There is a significant opportunity to engage individuals in their health by using health IT.

This goal also focuses on improving community health, long-term service and supports, and home and community-based services. Economic, social, and physical environment have an extensive effect on health. Federal activities will focus on enhancing public health situational awareness with health IT. This will help public health entities assist communities in managing and preventing chronic health conditions and health care-associated infections; it will also help in dealing with urgent threats such as those resulting from natural disasters or disease outbreaks, and promote community well-being and resilience.

Advance Research, Scientific Knowledge, and Innovation. Electronic health information will stimulate a new frontier in research, scientific knowledge, and innovation. This information can help us realize immediate benefits of clinical quality improvement, post-market surveillance tracking the effects and use of biopharmacologic drugs and medical devices, and research on prevention diagnosis and treatment of disease and disability. It can help the nation reach some longer-term goals of personalized medicine, distributed analytics, and person-centered outcomes research. It can also lead to substantial cost savings.

Federal government actions will be critical to successfully achieving this goal. Private-sector innovators, entrepreneurs, and researchers will benefit from increased access to and usability of high-quality electronic health data, tools, and services. From the internet to GPS and microchips, government investments have spearheaded cutting-edge technological advancements; our strategy identifies vehicles to continue to foster private-sector innovation and solutions through government funding and open-data initiatives. Finally, federal agencies will continue to invest in, disseminate, and translate research on how health IT can improve health outcomes and care delivery.

The Federal Health IT Strategic Plan 2015-2020 is more than a static document that meets a statutory requirement. It is a path forward for catalyzing healthier people and communities through information and technology. Federal agencies have numerous levers available to encourage private-sector innovation and advancement. This strategy represents a coordinated and focused effort to empower the unencumbered collection, sharing, and use of interoperable health information to improve health care, individual and community health, and research.

Yet the federal agencies cannot and should not work alone to accomplish this Strategic Plan’s goals. We look forward to feedback from our partners and to working with state, local, and tribal governments. Additionally, efforts by front line health care providers, public health agencies, social service organizations, individuals, and other stakeholders are needed so that health IT can enable health for all.

Karen DeSalvo is National Coordinator for Health IT , Seth Pazinski is the Director of the Office of Planning, Evaluation, and Analysis at ONC; Matthew Swain is a program analyst at ONC; and Gretchen Wyatt is a policy analyst at ONC. This post first appeared on the Health Affairs Blog, December 8th, 2014. 

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10 replies »

  1. Thanks for the hat tip.

    This really reeks of a CYA campaign to insure Dr. DeSalvo’s silence as she’s escorted from the building.

  2. Folly, Dr. DeSalvo. After decades of dysfunction and dead people, your plan is over years. Gag me! You ONC folk are in bed with the vendors.

  3. So happy to be able to play off Granpappy who has a unique ability to get to the heart of the matter.

    I have to admit I chortled at the oxymoronic phrase Federal [IT] Strategic Plan. Nothing might frighten Americans more than to envision bureaucrats with plans, kind of like kids with visions of sugar plum fairies dancing in their heads.

    “Private-sector innovators, entrepreneurs, and researchers will benefit from increased access to and usability of high-quality electronic health data, tools, and services. From the internet to GPS and microchips, government investments have spearheaded cutting-edge technological advancements; our strategy identifies vehicles to continue to foster private-sector innovation and solutions through government funding and open-data initiatives. Finally, federal agencies will continue to invest in, disseminate, and translate research on how health IT can improve health outcomes and care delivery.” — To paraphrase Paul Starr and the beginning of his classic book, The Social Transformation of American Medicine, this is the dream. But the dream will eventually run smack dab into a wall of reality that very few things (and an immeasurably small number of government initiatives) end up working the way the sugar plum fairies said they would, as they confront every conceivable kind of complexity from technical to personal.

    At the end of the day, here is the only health IT experience I need or want: I wake up every day and can deduce in a fraction of a second whether or not I feel good. If I don’t feel good, I don’t first turn to the healthcare industry, I turn to my own resources. The absolutely last place I want to be and the very last place I want to interact with is the medical care industry. There are more people like me than not, and most of us just want the government to demonstrate some basic elements of good judgment and competence. Just leave aside the dreams of grandiosity.

  4. Such lofty goals are admirable, but my base data entered by my GP conglomerate (entered by disgruntled Admin staff to save $) is garbage. My GP stared at the screen for the whole 10 min appt, when she should have reviewed it with me — I only discovered it later when a summery sheet was hidden behind the invoice at checkout. So I can’t trust much data in the sloppy hurried environment on the front line of EHR. Good luck.

  5. Yup.

    No acknowledgement of what a cluster f*** ONC has given us so far.

  6. What is so interesting about the latest effort to proclaim the need for interoperability (who is against?) is that remains toothless and without incentives or disincentives. How about the following: Any vendor who offers HIT with data that cannot be fully communicated in clear format to XYZ standard is declared unsafe. Also, healthcare providers can not claim the use of that software for incentives and subsidies. At the recent AMIA meetings, where one vendor said they were pleased to make everything work with FHIR standards, the other vendors (within minutes) insisted the FHIR is only a nascent effort and it would be unwise to demand it or any other standard. Ultimately, the vendors or the gov’t (or both) will have to select a standard and just go with it — just do it: Data format standard and data standards. How about 6 months rather than 5 years for the start of the journey. We’ve been on this journey of HIT interoperability for 45 years. Just decide and do it.

  7. Yes, there are going to be some major issues with trust. We got the data mining part, but have not seen much else. Many more care silos…now we need a plan to break those down. “In over their heads” is the way it keeps looking. It needs to be simple like that cartoon…but it is not, and continues to get worse.

  8. This is a very worthy goal since the absence of promised interoperability has plagued HITECH for years and partially prevented it from reaching its lofty goals of improved health, reduced mortality and lower medical costs. Many syntheses of the scientific literature have shown that HIT has largely failed to achieve these benefits.

    Now we must ask: can we trust that a new multi year plan (perhaps too long) can go where we haven’t gone before? Technical standards are only part of the solution. Can the government now insist that HIT vendors cooperate and share this important proprietary information — currently in silos? Can hundreds of vendors finally agree how to code controlled and uncontrolled blood pressure? Or whether to measure weight in pounds or kilos (an important issue for medication safety).

    There are huge barriers to success, including commercial, organizational, clinical and technical domains. What is different now, especially from the perspective of commercial incentives, to think that that the next five years will be different from the last ones. Is the federal government ready to “bang some heads together.?” And when will we have some solid data that we know that we are achieving some bang for the buck, not simply some changes in processes of care.

  9. Interesting. I have the document up. Searched both “HL7” and “FHIR.”

    “Not found”

    Though, searching the new JASON report finds them:

    4.2.2 The proposed FHIR standard

    The recent introduction of FHIR[16] by HL7[19] is in JASON’s view a signifi­ cant improvement over CDA. FHIR attempts to standardize the exchange of information through a set of modular components that are called Resources. Resources have standardized names and provide basic pieces of information but can be extended to fulfill specialized requirements. Examples of Resource names are CarePlan, FamilyHistory, Medication, Patient, etc. Resources are grouped by functions. For example the Administrative Resource grouping contains essential information about the patient, the treating practitioner, workflow associated with that patient’s care and so forth…