Since its establishment in 2004, the Office of the National Health Information Technology Coordinator (ONC) has achieved tremendous results beyond its scale. This department of the U.S. Department of Health and Human Services (HHS) has a budget of approximately $60 million and a team of approximately 150 people—small in size by federal standards—to complete the large-scale task of “improving health and welfare.” Provide services to individuals and communities by using accessible technology and health information at the most important time and place. “
Each generation of ONC leaders has cleverly focused the organization on several pressing priorities. In the first stage, ONC laid a blueprint for national information sharing. Then, ONC led almost all hospitals and most doctors in the United States to quickly adopt electronic health records. Recently, ONC advocated breaking down information silos through new application programming interface (API) standards, patient data access and information blocking regulations.
Now, with the urgency of modernizing public health data, the urgent need to improve health equity, and the continuing challenges of medical cost and quality, President Biden has Proposal to increase ONC’s funding by 40%If approved by Congress, ONC will receive $87 million in fiscal year 2022. As funding, popularity and demand increase, where should ONC focus?
First, concentrate
Small organizations cannot meet everyone’s needs, and restraint and focus will promote faster progress and innovation. We are pleased to see that ONC prioritizes public health data modernization, health equity, and accelerated implementation of value-based care:
- As Micky Tripathi said At the Health Information Technology Consultation Conference this spring Meeting“Covid is the government’s top priority, including ONC, full stop.” In this field, we appreciate the cooperation between ONC and CDC to establish a modern public health data infrastructure, breaking the island that separates clinical care and public health, and speeding up our journey from this Recovery from the pandemic and support better preparation, faster response and stronger adaptability. Next. The relief plan will provide funding for the states, but more funding is needed. ONC’s budget proposal recognizes this priority, adding $13 million to “build the future medical data infrastructure needed to better respond to and prepare for public health emergencies, including the Covid-19 pandemic.”
- Improve health equity Work with private and public leaders to develop standards, policies, and systems to ensure that race and ethnicity, population, housing, and social service data are consistently shared among health providers, health programs, and social service agencies. Armed with this information, clinical and public health leaders can quickly identify emerging differences, provide services that better meet patient needs, improve outreach, and develop systemic solutions to increase equity.
ONC has completed important standard development work through the Gravity Project. But we also need pragmatic near-term solutions to improve the completeness and accuracy of racial and ethnic information in today’s exchanged data. This will be the ideal theme for ONC’s data challenge.Or ONC can cooperate with CMS to develop Medicaid incentive measures, such as As this plan in Arizona, This provides a payment increase of up to 3% for providers who share data and improve data quality. Finally, ONC can fund and pilot the use of combined data from the health information network to fill data gaps. Through this partnership, a state has recently been able to fill 42% of the gaps in Covid data regarding race, ethnicity, and contact information.
- Helping Medicare and Medicaid Services (CMS) accelerate the transition to value-based care by addressing data challenges that hinder progress. Last year, CMS took a bold move to require all hospitals to share admission, discharge, and transfer (ADT) notices with community providers as a condition for participating in Medicare and Medicaid. These ADT notices are a key tool used by responsible care organizations (ACO) to improve care transitions and reduce readmissions. What should I do next? Standardized claims data shared with providers? Relying more broadly on data aggregators to reduce the burden of quality reporting?
These results are in line with ONC’s goals and January’s Important direction The problem is that Health affairs As the three most important priorities for our healthcare system in 2021.
Second, understand your own strength
In the next few years, ONC’s direct policy leverage will not be as important as before. Yes, ONC oversees electronic health record (EHR) certification-but we now need a technology ecosystem far more than EHR. Yes, ONC has an information shielding policy-but in the next few years, the key factors will be whether the HHS Office of the Inspector General is meaningfully implementing the policies that have been established, and whether CMS penalizes providers.
The strength of ONC lies in its coordination-which means its partnership and collaboration with sister institutions to achieve common results, as well as its ability to participate in and lead change in the broader technology ecosystem. In the past, when ONC tried to take bold steps without closely cooperating with peer institutions with greater policy leverage and budgets, progress was slow.
The White House can support and strengthen this important coordination work. In the HITECH era, ONC co-led the White House Health Information Technology Working Group. The working group brought together the Veterans Administration, the Department of Defense, the Department of Commerce, and multiple HHS agencies to develop an ambitious strategy to use all government powers to achieve consistent progress in the adoption of electronic health records. The same structure is now needed to design and build a modern public health data infrastructure for states and countries.
3. Create a blueprint, not just a standard
We have Seen State Public Health Department with a strong state-based “Health Data Utility“For example, CRISP in Maryland, IHIE in Indiana, or CyncHealth in Nebraska are key components of modern public health data infrastructure. Health data utilities aggregate clinical and claims data, match records, and clean and normalize information to help Its state tracks public health trends and identifies and resolves gaps. Health data utilities will become an indispensable partner for countries seeking to:
- Identify high-risk patients and populations who have not been vaccinated
- Tracking outbreaks of infection after vaccination
- Plan booster activities
- Check the health system to “catch up” with prevention and other services needed
- Analysis of vaccination fair work
ONC works with a small number of states, existing data utility companies, and federal partners to develop blueprints for these collaborations and adopt them nationwide. Compared with ONC’s recent standard development plan, this work will be more hands-on and cross-sectoral, requiring technology, governance, funding, and policy strategies. The result will be a pragmatic and reusable roadmap, governance model, technical guidance, open source modules, funding options, and support policies to extend the model to other states.
Tie it all together
Under the leadership of Micky Tripathi and his team of experts, ONC has an excellent opportunity to “improve the health and well-being of individuals and communities through the use of technology and health information.” To this end, it must perform surgical operations on priorities, effectively utilize partnerships with institutions with scale and resources, and jointly build the blueprint needed to modernize public health data.
Photo: Isinger Julian, Getty Images
