Tech

National Coordinator 6.0: A Blueprint For Success

Now that it’s public, I’ll offer my thoughts on the next steps for Don and ONC.  Don Rucker is a good pick for the nation, and will be a great National Coordinator.  I’ve gone on record as saying that some others are not qualified, and as many of you know – I don’t mince words.  Don is smart, focused, thoughtful, intentional, and will make good decisions for ONC and HHS.  I have known Don for 20 years.  He’s got a long track record of integrity, he’s a nice person, he deeply understands the challenges, limitations, and opportunities of Health IT.  I have no doubt that he’ll do a good job.  He’s got a lot on his plate.

Where should he focus?

  1. Stay the course with health IT certification.  I disagree with the growing meme that ONC has broadened its certification scope too far.  Certification has one purpose:  to provide consumers with a way to be confident that the product they are purchasing will do what the seller says it does.  Some people seem to have forgotten (or don’t know) that some of the companies that sell health IT solutions have claimed that the products do things they do not do.  There needs to be a process by which these claims are tested, verified and, yes, certified.  If this program is scaled back, health IT systems will be less safe, less interoperable, less usable, and less reliable.  #KeepCertification. 

    2.Keep the Enhanced Oversight Rule in place.  My former colleagues (and Don’s former colleagues) in the vendor community will disagree, as do some of the house Republicans.  As Don will learn first hand in his initial few weeks as NC, some of the companies that have been selling certified health IT products have been misbehaving.  In some cases, products have been de-certified.  In other cases, there have been investigations and resolution of problems without de-certification.  ONC is protecting the public by doing what Congress asked it to do initially.  The certification program is more than testing of products in a petri dish, it’s about what happens with the products in the real world.  Surveillance is therefore a necessary part of making sure that the products do what they were certified to do.  #KeepOversight.

    3.

    Trim ONC.  Under National Coordinators 1.0 and 2.0, the organization was small, and focused on two things:  policy and standards/certification.  With ARRA, the organization grew to support the REC program, the HIE program, the SHARP program, and many smaller grant/cooperative agreement programs.  ONC staff grew fivefold, and with that growth came the distractions of the grant programs, the expense of salaries and physical space required to support such a large team. ARRA is over, and ONC now has responsibility for a small number of grants.  ONC should retain its autonomy (it should not become a daughter of NIH or CMS) but should now retract back to the small organization it once was.  Grants (with the people managing them) should migrate to AHRQ.  The policy work of ONC should focus on interoperability (much of the work assigned to it by congress in the 21st Century Cures Act), certification, and the usability and safety of health IT.  ONC’s standards work should focus on acceleration of standards for health IT systems, through very tight collaboration with HL7 (also required by 21st Century Cures). #TrimONC  #FocusOnCertandStandards

That’s it.  The three-legged stool of ONC’s future success.  On a silver platter, for ya, Don!  Have fun!  The people at ONC are hard-working, dedicated public servants.  They are excited to work with you.

BTW, thanks, Jon.  You will forever be 5.2 to me.  Great job.

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Margalit Gur-AriemeltootsMike MillensonHayward ZwerlingBill Hersh Recent comment authors
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meltoots
Member
meltoots

Jacob, 1. Certification has worked? How? It has NOT given confidence in what you purchased does what it says. Not by a long shot. If it did why does ONC need “Enhanced oversight”? We do NOT need a nanny state with the US gov “certifying” EHRs. They have driven innovation right out of the market. The best EHRs are the ones that are gone because of certEHR. Anyone with an ounce of experience can tell you that a policy market, like the one that Jacob helped create, hammers innovation. CertEHR is EXACTLY the buzzword, “sounds good” massive regulatory action that… Read more »

Jacob Reider, MD
Member

1. Certification worked. Before certification, (recall that ONC’s certification program succeeded CCHIT’s – I refer here to both programs as “certification” in some form) health IT systems could capture and/or share medical problems in free text, ICD-9, Medcin, or any other proprietary terminology, they could capture medications in any nomenclature, and the same for allergies, procedures, etc. There was no standardization, and therefore absolutely no interoperability. Systems shared with each other via fax or (for advanced systems) PDF documents. Your assertion that certification hasn’t provided purchasers with confidence flies in the face of the ample evidence that any purchaser of… Read more »

Paul @ Pivot ConsultingLLC
Member

I think this question you ask is key: “If not the government, who will be there to protect us and our families? Again – if you have a better solution, please tell us. If not, your critique is just noise.” Physicians have historically drawn from the brightest and most altruistic segments of our population…..and many health system administrators emerge from this pool of physicians. Are you suggesting they aren’t able or willing to carefully assess the safety and value of EHR products….or that their motivations are not the best interests of their patients…….and that they need governmental bureaucrats to mandate… Read more »

Allan
Member
Allan

Bill Hersh, several points including a disclosure: I am a physician and have children that are physicians. Many of my friends are physicians and I see fine physicians for my own personal needs. I am disappointed noting the physician’s distraction due to the EHR resulting in what I believe is poorer medical care on average. 1) How much extra time do you believe most physicians are spending? According to the those I have talked to, most say the amount of time spent is horrendous. 2) Do you believe that in determining the trade-offs we have to take into account that… Read more »

Steven Findlay
Member
Steven Findlay

Good piece and discussion. As someone who was involved in the early days of health IT/EHRs (serving on HIT standards committee and other entities) and who lobbied on ARRA, I look back with remorse and some shame on what we unleashed. I concur with many of the general and specific comments below and have long argued that ONC’s priorities and mission needs to be fundamentally rethought. I wish Don the very best on that. This may be one area where some Trump administration “deregulation” may be warranted. That said, ONC and HHS do have roles to play here in continuing… Read more »

Hayward Zwerling
Member

I must respectfully disagree with the entire thrust of this argument. Most people who have been involved in health information technology, as an innovator, will tell you that federal regulations in the EHR realm has seriously impeded the development of effective and innovative EHRs solutions. In addition, a significant fraction of healthcare providers who have been forced to use these institutional EHRs will tell you that they impede their ability to take care of patients. Unfortunately, ONC regulations, through the creation of “certified EHR’s” has now permanently altered the way medical care is delivered to patients and relegated the most… Read more »

pjnelson
Member
pjnelson

I am aware that several years ago, Great Britain abandoned its entire EHR. And now, the VA is planning to abandoned its EHR. Is it realistic to ask the ‘new’ ONC leadership what they plan to do, if anything, to structurally prevent that future waste of resources? The following answer is not acceptable: “Certification of an EHR doesn’t have a connection to its disaster management.”

Adrian Gropper, MD
Member
Adrian Gropper, MD

Certification has been a disaster for innovators and and will continue to drive consolidation into EHRs that collect and manage data on millions of people each. When an EHR is asked to manage information on a million people, the result is the same as building roads for a million people – they’re a commodity. By analogy, drive internationally in the rich world to see how little a system of roads that serves millions differs. Our EHRs are now just a bunch of roads that you can’t cross without changing cars. Certification is the principal driver of information blocking today. Beyond… Read more »

Jacob Reider, MD
Member

@adrian – despite my affection for you, I could not disagree more. The standards, as you know, are exponentially more complex than those that define roads or the gauge of a train track. Your metaphor holds no water. Cars and trains traverse the globe – and so does health information! Today, millions of “chunks” of health information moved from one facility to another over many protocols, using many payload formats. Is it perfect? No. Is it working? Absolutely. Tomorrow, even more information will be moved this way, and the next day, even more. Have you picked up a prescription from… Read more »