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Catalyst Corner

The
Office of the National
Coordinator for Health
Information Technology
(ONC) has adopted a new
strategic plan outlining
the
federal
government’s
IT
vision and
mission. The
plan’s
goals
are to
keep up
the
momentum
of
health IT
adoption and,
at the
same
time,
improve
IT
implementation
beyond
hospitals and
physician
practices. The
strategic plan
may be
accessed at
http://www.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf.

As
outlined in my September/October
2014 ComputerTalk
column,
the strategic plan includes 14
objectives under five broad
goals: expanding the adoption of
health IT; advancing secure
and interoperable
health information;
strengthening healthcare
delivery; advancing the
health and well being of
individuals and communities; and
advancing research,
scientific knowledge, and
innovation. It maps out goals
through 2020.

The
plan notes the federal IT
vision is for health
information to be accessible
“when and where it is needed to
improve and protect people’s
health and well-being.” Its
mission is to “improve health,
health care, and reduce costs
through the use of information
and technology.”

A
key part of the plan is to
address gaps in electronic
health record (EHR)
implementation, resulting from
the way the EHR incentive
program is structured. That
program, a result of 2009’s
American Recovery and
Reinvestment Act, has paid
over $25 billion since 2011, with
94% of eligible hospitals and
79% of eligible physicians
receiving payment for
either buying or meaningfully
using a tested and certified
EHR. The program did not extend
to behavioral health,
long-term care, and other
providers, however. The new
plan calls for “emphasizing
assistance for health care
providers serving
long-term and post-acute care,
behavioral health,
community-based, and other
populations ineligible to
participate in the Medicare and
Medicaid EHR Incentives
Programs.”

National
Coordinator for Health IT
Dr. Karen DeSalvo says
her vision is to have the
entire country be more like
Vermont, where nearly all
behavioral health
providers are connected to
health information
exchanges used by hospitals
and physicians.
Tackling privacy and
security protection of
behavioral health
information will be key,
and is one of the plan’s
objectives under the goal
of secure interoperability.
Behavioral health
information is regulated by a
separate federal
privacy law more stringent
than the Health
Insurance Portability
and Accountability
Act privacy rules.

The
new strategic plan
specifically suggests “the
development of policy,
standards, and technology to
facilitate patients’
ability to control the
disclosure of specific
information that is
considered by many to be
sensitive in nature.” This
includes information
related to substance
abuse treatment,
reproductive health, mental
health, or HIV, as
examples. At the present
time, software systems that
record patients’
consent regarding
others’ access to their
medical records exist,
but this function has
not been required
within the testing and
certification criteria of
the federal


EHR
incentive payment
program. The plan calls to
change that by requiring and
testing that certified
health IT products
incorporate privacy and
security standards.

ONC
privacy and security
workgroups have recommended
that ONC take very small
steps in this area, while
embracing voluntary
testing and certification
requirements for
privacy-protecting technologies,
called privacy data
segmentation. Private-sector
EHR developer Health Level
Seven, HHS’s Substance
Abuse and Mental Health
Services Administration,
and ONC are working
together to develop and
test these segmentation
technologies.

More
than 35 federal
agencies, including the
Department of Defense
Military Health System
and the Department of
Veterans Affairs
Veterans Health
Administration, participated
in drafting the plan,
which for many of the federal
agencies includes
three-year and six-year
outcomes milestones.
The ONC is mandated to
provide periodic,
long-range national
health IT plans by the
American Recovery and
Reinvestment Act. Next up
is promoting health
information exchange,
which will have a
separate federal
interoperability plan released
by the ONC in early 2015. In
an ONC press release
announcing the plan, De-Salvo
says, “The 2015 Strategic
Plan provides the federal
government a strategy to
move beyond health care to
improve health, use
health IT beyond EHRs,
and use policy and incentive
levers beyond the incentive
programs.”

Internet-Like
Interoperability Embraced
In
other big news, five
major electronic
health record system
developers and four
information technology
pioneer provider
organizations are now part
of an alliance to promote a
new, Internet-based
approach to interoperability
and clinical information
exchange. According to
leading IT physician John
Halamka, the chief
information officer at
Beth Israel Deaconess
Medical Center and long-time
HIT leader, it brings
“Facebook-, Google- and
Amazon-like thinking to
healthcare IT.”

This
is the approach that
was outlined in a report to
President Obama from the
President’s Council of
Advisors on Science and
Technology (PCAST)
several years ago. I wrote
columns about that report
and spoke at an American
Society for Automation in
Pharmacy conference
about it. What’s
different here is that the
private sector is taking the
lead.

The plan notes the federal IT vision is for health information to be accessible “when and where it is needed to improve and protect people’s health and well-being.” Its mission is to “improve health, health care, and reduce costs through the use of information and technology.”

Called
the Argonaut Project, the new initiative will
be managed by the Massachusetts eHealth
Collaborative. HL7 launched the project
with athenahealth, Cerner, Epic Systems,
MEDITECH, and McKesson on board. These five
developers control about 45% of the hospital and
28% of ambulatory care EHR markets, according
to the federal EHR incentive payment
program. Providers who are participating in the
initiative are Beth Israel Dea
coness
Medical Center, Partners HealthCare
System, Intermountain Healthcare in Salt
Lake City, and the Mayo Clinic in
Rochester, Minn. Other founding members are
The Advisory Board Company in Washington,
D.C., and the SMART (Substitutable Medical
Apps & Reusable Technology) mobile
application development project at
Boston Children’s Hospital.

All
have agreed to promote the accelerated development and adoption of HL7’s new
Fast Healthcare Interoperability Resources (FHIR) platform, which made
its debut at the Healthcare Information Management and Systems Society
convention. The platform will migrate the movement of health information
toward being more interactive, allowing other EHRs and mobile apps to not only
read but to write data on the five companies EHRs via an application
programming interface. This approach is very different from what occurs today,
which is largely a static exchange of documents. It reflects the
recommendations of the JASON group, an independent group of scientists that has
provided two reports to HHS’ Agency for Healthcare Research and Quality on HIT.
CT

Marsha
K. Millonig, R.Ph., M.B.A.
,
is president of Catalyst Enterprises, LLC, in Eagan,
Minn. The firm provides consulting, research, and
writing services to help healthcare industry players
provide services more efficiently and implement new
services for future growth. The author can be reached at
mmillonig@ catalystenterprises.net.