Marsha K. Millonig
Marsha K. Millonig B.Pharm., M.B.A.

The federal government’s five-year strategic plan for health information technology (HIT) was released two months ago, continuing efforts toward creating a health system that uses information to engage individuals, lower costs, deliver high-quality healthcare, and improve individual and population health. In releasing the plan, the National Coordinator for Health Information Technology Dr. Donald Rucker notes the aim is to outline concrete steps that federal partners can take to improve health through HIT. The 2020-2025 Federal Health IT Strategic Plan encompasses four goals and 14 objectives, with emphasis on individuals’ access to their electronic health information (EHI). Rucker notes in the plan’s introduction, “In today’s digital world, the right to control our health must include the right to access and control our health information.”

Rucker is the latest national coordinator for HIT since the office was formed by President George W. Bush in 2004. The job of the Office of the National Coordinator (ONC) is to provide leadership in developing and implementing “a nationwide interoperable health information technology infrastructure to improve the quality and efficiency of healthcare,” according to an earlier plan. Bush’s target in establishing the office was to advance HIT so the majority of Americans could have access to their electronic health record (EHR) by 2014. Initial goals for the national HIT infrastructure were to:

  • Ensure that appropriate information to guide medical decisions is available at the time and place of care.
  • Improve healthcare quality, reduce medical errors, and advance the delivery of appropriate, evidence-based medical care.
  • Reduce healthcare costs resulting from inefficiency, medical errors, inappropriate care, and incomplete information.
  • Promote a more effective marketplace, greater competition, and increased choice through the wider availability of accurate information on healthcare costs, quality, and outcomes.
  • Improve the coordination of care and information among hospitals, laboratories, physician offices, and other ambulatory care providers through an effective architecture for the secure and authorized exchange of healthcare information.
  • Ensure that patients’ individually identifiable health information is secure, protected, and available to the patient to be used for non-medical purposes, as directed by the patient.

Much has changed since 2004, including the widespread use of mobile devices and related applications, including those for healthcare, which have only increased in number with the COVID-19 pandemic and the implementation of telehealth.

What Americans Want From Health IT

It is difficult to find accurate numbers for how many Americans can access their health information electronically and in what ways, but recent data shows that Americans are very interested in doing so. A PEW Charitable Trusts survey released in September 2020 shows 61% of those surveyed want to be able to download their health records to mobile device applications to help them manage their own health. Those surveyed were also supportive of better access to health records by healthcare providers. Eighty-one percent said they would support enabling different healthcare providers to share patient health record information between their EHR systems when they are caring for the same patient. More than two-thirds of respondents said they wanted their different care providers and sites to share advanced health directives and preferences, images, and family medical histories, areas that researchers note may not be current federal HIT priorities. Certain areas remain of concern among respondents, including substance use history, behavioral health assessments, and social determinants of health such as food access and income. Privacy concerns are also an issue, with nine in 10 respondents expressing concern when informed their health information may not be covered by HIPAA (the Health Insurance Portability and Accountability Act) once downloaded to a mobile device or application. They expressed a preference for addressing this by using apps that had been pre-approved by independent healthcare providers or independent certification boards.

Nearly 75% of those surveyed also support federal spending that would make it easier for different providers to match and link patient records held in one facility to another facility. Using individual identifiers would be helpful toward this effort, yet Congress has blocked spending on developing and finalizing standards to do so for more than 20 years, note researchers. Of interest, when asked about potential matching methods, 27% of respondents were “very comfortable” with a unique number or code and another 39% were “somewhat comfortable,” for a total of 66% comfortable with these identifiers. Sixty-five percent were comfortable with fingerprint scans, followed by smartphone or app technology and facial photos (53% each) and eye scans (51%). When asked which method they favored, a biometric option was most popular (i.e., fingerprints, iris scans, photos).

The survey was conducted in early summer among a nationally representative sample of 1,213 adults 18 years of age or older. The COVID-19 pandemic made respondents more likely to say they supported sharing of their EHRs, but had no impact on their views of matching or methods.

Health IT Barriers

So Americans are in sync with the reason the ONC was created: more widespread access to EHRs by themselves and their providers. Yet a January 2020 Health Affairs article noted issues with the lack of widespread patient access to their health records. The authors say the issue is not patient demand, but problems with the former meaningful use program (designed to speed adoption of EHRs) and misaligned incentives in healthcare. They suggest four actions that could speed patient access to their health records:

  1. Accelerate the technical requirements for patient access to data through open access application programming interfaces (APIs).
  2. Create a bridge to open APIs through the technology consumers already have and use most — email.
  3. Strengthen the privacy policy framework.
  4. Accelerate the move toward value-based care.

How do these suggestions fit with the 2020-2025 federal HIT strategic plan? The plan recognizes that APIs enable different technologies (mobile devices, computers, etc.) to connect and share information in real time. It also notes that many industries (banking, retail, education) use APIs to allow individuals to manage finances, track packages, and complete education, yet this same easy access does not exist in healthcare. A 2018 survey conducted by the ONC showed only 51% of individuals were offered access to their online medical records by their healthcare providers or payers. The ONC has finalized the Cures Act final rule to drive interoperability of EHI supporting Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) standard for APIs to help address the issue. One of the plan’s strategies is to promote greater portability of EHI through standards-based APIs and other interoperable HIT that permits individuals to readily send and receive their EHI. Another is to advance the use of validated, evidence-based digital therapeutics while increasing access to smartphones and other mobile technologies by at-risk, minority, rural, disabled, and Indigenous populations.
On the privacy issue, the ONC notes that several parts of the new strategic plan are based on “robust mechanisms” being implemented to secure health information from ransomware and cybersecurity risks. Their goal is to “build a secure, data-driven ecosystem” to advance individual and population-level
health data transfer to improve health management. The strategies outlined to promote secure health information practices that protect patient privacy include:

  • Mitigating patient data security risk by developing guidance for API and app developers on securely sharing patient data via standards-based APIs.
  • Implementing mechanisms to protect an individual’s data, such as multifactor authentication and encryption in APIs.
  • Increasing patients’ understanding of and control of their data, including how to make informed decisions concerning consent and data exchange.

With regard to value-based care, the plan’s entire underpinnings are based on supporting the move toward this care model, by putting individuals first and by focusing on value by promoting and pursuing activities that improve health and care quality, efficiency, safety, affordability, equity, effectiveness, and access. Other federal health principles outlined in the plan include building a culture of secure access to health information, putting research into action, encouraging innovation and competition, and being a responsible steward of resources using open, transparent, and accountable processes.

The 2020-2025 ONC federal HIT strategic plan continues efforts to progress toward the goals outlined when the ONC and federal HIT initiative were created in 2004. The plan addresses healthcare technology evolution, including mobile and web apps and devices. I encourage ComputerTalk readers to take a few minutes to scan the entire plan and see if there are insights that may inform their own strategies to meet their goals in the HIT space. CT

Marsha K. Millonig, B.Pharm., M.B.A., is president and CEO of Catalyst Enterprises, LLC, and an associate fellow at the University of Minnesota College of Pharmacy Center
for Leading Healthcare Change. The author can be reached at mmillonig@catalystenterprises.net.

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