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

I recently received an email update from the Office of the National Coordinator for Health Information Technology (ONC) that grabbed my attention with its headline story, “Sunsetting the Interoperability Roadmap.” ComputerTalk readers may recall several of my columns over the years that have featured updates from the ONC since its formation in 2004. ONC exists to support the adoption of health information technology and the promotion of nationwide, standards-based health information exchange to improve healthcare. It has released a number of roadmaps and health IT strategic plans for the nation. Six years ago, this column featured the then-just-released strategic plan that outlined ONC efforts through 2021, which coincided with the roadmap’s release. While much of our attention has been focused the past year on the COVID-19 pandemic, ONC efforts have continued toward its mission.

In a recent blog by the deputy national coordinator for health information technology, Steven Posnack, he notes that the roadmap “helped lay the groundwork and set the direction for policy development on information blocking, reducing provider burden, and nationwide, electronic health information exchange,” among other areas. In particular, he noted that the roadmap set the stage for investment toward interoperability through the HL7 Fast Healthcare Interoperability Resources (FHIR) standard and application programming interfaces (APIs). The roadmap set goals within three periods of time: 2015–2017, 2018–2020 and 2021–2024. Posnack goes on to say that when it was released, the roadmap spurred action and dialogue across policy and technology arenas. Since then, he says, “the entire health IT ecosystem has made substantial leaps forward in many areas highlighted by the roadmap.”

As a result, he reflects, “there comes a time when the future becomes the present. Collectively, we have all made solid progress on many of the early milestones identified by the roadmap. It’s important to recognize those successes while at the same time acknowledging that the roadmap itself no longer drives our work.” The document will continue to be accessible for referential purposes.

Further advancement in health IT will now be the result of the ONC final rule implementing the 21st Century Cures Act’s IT provisions and the 2020–2025 Federal Health IT Strategic Plan that was released last October with little fanfare, as the pandemic continued to be in the forefront. The Health Information Technology Advisory Committee (HITAC) will continue to guide ONC’s work, according to Posnack’s blog. Additionally, ONC will continue to coordinate across government and industry as it aligns investments in standards development, pilots, and programs. It will also focus on promoting implementation and use of “what’s been built over these many years; and drive to outcomes not yet fully realized,” Posnack says.

The 21st Century Cures Act rule focuses on a number of key health IT areas:

  • Requirements for health information technology (health IT) developers under the ONC Health IT Certification Program.
  • Voluntary certification of health IT for use by pediatric healthcare providers.
  • Reasonable and necessary activities that do not constitute information blocking.

The last provision is critical toward expanded patient access and data sharing with providers. The rule prohibits gag clauses in EHR (electronic health record) vendor contracts. ONC National Director Micky Tripathi (appointed in January 2021) says the rule requires APIs to be standardized by December 2022. From a practical standpoint — say a patient is treated at one organization that uses the Epic EHR and is able to download the medical record to a phone app, then wants to share this with a provider at a different organization that uses the Cerner EHR — the new rule forces the standardization that will make this possible. The information-blocking components also apply to information exchange between providers, not just patients and providers.

Links To More Information > 21st Century Cures Act final rule and the new Federal Health IT Strategic Plan


Prior to the December 2022 deadline requiring information to be made available via a FHIR API, beginning April 5, 2021 the rule requires providers to make information available to patients through means the providers already have, such as through their EHR system’s continuity of care document (CCD). In essence, the rule says patients should have access to their electronic health information when they want it and in the format in which they want to view it.

Tripathi also refers to the importance of the Trusted Exchange Framework and Common Agreement (TEFCA), which was released by ONC in April 2019. TEFCA outlines a common set of principles, terms, and conditions for a common agreement designed to help enable nationwide exchange of electronic health information across disparate health information networks (HINs). ONC notes, “The TEFCA is designed to scale EHI exchange nationwide and help ensure that HINs, health care providers, health plans, individuals, and many more stakeholders have secure access to their electronic health information when and where it is needed.” The analogy Tripathi gives is, say person A is on Verizon and person B is on AT&T, and they can’t call one another. The common agreement will allow the call to happen.

Both the 21st Century Cures Act final rule and the new Federal Health IT Strategic Plan will advance interoperability, enhance health IT certification, and reduce the burden and costs in the healthcare system. I’ll focus on the 2020–2025 Federal Health IT Strategic Plan in my next column. In the meantime, I encourage all system providers to access and read the ONC Final Rule on the Cures Act to see what provisions might impact your company and its offerings. 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