Who will take the lead at ONC in 2017?

Times of high uncertainty often produce high anxiety. Not knowing what lies ahead usually doesn’t set well with healthcare leaders. And we’re going into one of the most uncertain years in recent memory—not just for healthcare, but for the nation as a whole.

With the new Trump administration taking charge in Washington, the anxiety level is especially high. There have been mixed messages floating around about the Affordable Care Act, but change seems inevitable. With Rep. Tom Price poised to take the lead at the Department of Health and Human Services, a rollback of the ACA seems like a foregone conclusion.

Change also awaits the healthcare IT industry. Leadership of the Office of the National Coordinator for Health Information Technology awaits a new leader, and how that will affect the industry seems much less clear.

National Coordinator Vindell Washington, MD, has been in the position since August, when Karen DeSalvo, MD, stepped down. He’s not expecting to continue in the role, so the question becomes who will lead ONC into the future. That decision certainly doesn’t command the attention of who will be performing on stage at the inauguration ball, but for those crafting HIT strategies for their organizations, it’s a significant concern.

The transition to new leadership in ONC is important, because the HIT industry, while thriving, is facing many major challenges:

• Interoperability efforts appear to be at a crossroads, as pressure rises on industry players to play nice in exchanging information. The 21st Century Cures Act supplies new leverage to force more cooperation and adherence to the precepts of interoperability.
• Electronic health records are widely used, but concern is also broad that they are not doing much to improve care. They are often hard to use, with dissimilar and clunky user interfaces, and concern is growing that simply gathering volumes of data really doesn’t help clinicians do their jobs—in fact, it may make it harder for them to winnow out important clinical factors from mounds of patient documentation.
• Security of data is a growing concern. It’s now apparent that, in the rush to implement electronic health records to meet federal timelines, security was not built in, but was an afterthought. More than 300 breaches of healthcare organizations, involving records of 500 individuals or more, have been recorded in 2016, and ransomware is another surging worry.
• As reimbursement shifts to value, not volume, the types of applications used in healthcare must fundamentally change—from systems that track transactions for reimbursement, to those that analyze data, enable proactive health management and provide effective clinical decision support at the optimal time in the workflow.

And yes, there’s more worries ahead for 2017, and I don’t want you to start off the holiday weekend depressed, so I’ll stop here. The new ONC leader won’t be minding the store primarily to administer programs that are static, like Meaningful Use, but will be aiming to foster industry wide collaboration in complex, all-compassing initiatives—sometimes using a carrot, and perhaps a stick, to bring about change and compliance.

So who should the new ONC coordinator be? Here are some thoughts from David Kibbe, MD, CEO and president of DirectTrust, a healthcare alliance that enables the secure, interoperable exchange of health information. The organization submitted these thoughts to the new administration as well:

DirectTrust is a healthcare industry alliance created by and for participants in the Direct exchange network used for secure interoperable exchange of personal health information (PHI) between provider organizations, and between provider and patients, for the purpose of improved coordination of care.

Following are Dr. Kibbe’s four recommendations for the new administration:

• The President should appoint a strong leader for ONC, someone respected by the medical community and thoroughly versed in current and emerging healthcare technologies. “We need a National Coordinator with the skills to speak to technical audiences on the key standards for interoperability, security controls, and content delivery that support value-based payments,” Kibbe believes. “Also important for new ONC leadership experience will be usability of the end-user’s IT systems, integration of IT into workflows for care coordination and making improvements to health IT certification, including real-world testing. “
• The new administration should seek to “hold the gains” in both EHR adoption and interoperability. New policies should build on existing technology for interoperable exchange already integrated into EHRs under the 2014 Certification Program, such as Direct Messaging, eHealthExchange, IHE-XDR and the CCDA, while supporting development of new technologies and evolving content standards, like FHIR.
• Given the current concerns about security and healthcare, it is critical that the industry use the latest secure, reliable transport mechanisms to move data, and that policy and operational efforts focus on core requirements, such as encryption, authentication and identity management.
• Regulatory requirements that hold providers accountable for improved outcomes, such as those included in MIPS and MACRA, should be clear, targeted and evidence-based. This must be considered in the effort to reduce regulatory and documentation burden on healthcare providers, as specified in the newly adopted 21st Century Cures Act section on Health IT.

A new administration will have many important concerns than ONC in making the transition into power; it will be easy for ONC, and the healthcare IT industry, to get lost in the shuffle in the first 100 days the new president is in office. That’s a recipe that could result in lost progress, and Kibbe agrees.

“We’ve made significant progress in the areas of increased electronic health records (EHR) adoption and interoperability during the past four years. Our hope is that the momentum established to this point will continue under the new administration,” he said.