Future directions in federal health IT policy are taking shape. We are starting to see clear, reinforcing themes from Congress, the Administration, policy experts, and key stakeholders.
First, policymakers’ number one (and two, three, four, etc.) priority is interoperability, with experts identifying scenarios (i.e., “use cases”) where interoperability is needed, the feasibility and priority of addressing each use case, and applicable current or needed standards. The ongoing work by recently departed National Coordinator for Health IT Dr. Karen DeSalvo and the Office of the National Coordinator for Health IT (ONC) on a multiyear interoperability roadmap reflects this emphasis as does recent congressional activity highlighting the need for and perceived barriers to interoperability.
Second, health IT must be usable, safe, and developed and implemented in an environment of innovation. ONC is developing a roadmap for a Health IT Safety Center as part of its implementation of recent HIT and patient safety proposals jointly developed by ONC, FDA, and FCC. Providers are also increasingly focusing on usability and have identified the potential negative implications of federal certification requirements on EHR usability. Finally, key congressional leaders have emphasized the need for health HIT to enable innovation in healthcare while the electronic health record (EHR) developer community has emphasized the need to facilitate innovation as policymakers develop proposed rules and timelines for Stage 3 of Meaningful Use, expected later this year.
Third, although EHRs are (and are likely to remain) central to the health IT landscape, this broad area of technology, like all others, continues to evolve rapidly. Development is “agile,” solutions are increasingly modular, the “cloud” is increasingly important, and interoperability is essential beyond EHRs to cover the broad range of IT serving providers, patients, and consumers generally, including devices and “wearables.”
Fourth, there is no “free lunch.” In technology development, the three critical constraints are scope, timing, and resources. As emphasized in a recent report of the JASON Task Force of the Health IT Policy Committee whose recommendations were largely adopted by the Health IT Policy and Standards Committees in October 2014, Stage 3 of the Meaningful Use program should emphasize interoperability, and it will therefore be important to focus the program going forward to free up health IT developers and providers to achieve aggressive interoperability goals and timeframes.
Fifth, it is essential to achieve a balance between primary reliance on well-established and mature standards and associated technologies and adoption and timely and prudent use of newer standards and technologies. The recent report of the Jason Task Force reviewed the need for and approaches to achieving such balance very well. In a recent blog post, my colleague Keith Boone and I discussed the use of Application Programming Interfaces (APIs) as an emerging approach to interoperability; APIs are central to the Jason Task Force recommendations.
Sixth, federal health IT policies, notably those for the Meaningful Use program, are being challenged to provide more flexibility for providers and vendors as a result of actual on the ground experiences with current regulations and timelines. Recent rules and notices from ONC and CMS have expanded Meaningful Use penalty hardship exceptions and the timeline to apply for some of these exceptions as well as providing greater flexibility in which versions of certified EHR technology and Meaningful Use criteria must be used in 2014. In addition, provider groups are advocating for shorter reporting periods in 2015.
Finally, EHRs and other health IT are being viewed, appropriately, as important tools to advance a variety of national health policy aims. Clearly, health IT is central to major payment and delivery system reforms, such as accountable care, value-based payment, and as an overarching theme, integrated care. The challenge here is for policymakers to avoid being overly prescriptive as providers and HIT developers identify the best health IT solutions for these models. And recently, there has been a high priority focus on the ways in which EHRs and other health IT can assist the federal government and providers in implementing CDC screening and management criteria for the emerging Ebola crisis. In general, it appears that EHR capabilities can be readily adapted to Ebola screening and management.
In assessing these trends, two overarching themes are clear, themes in a state of tension dating back to the earliest days of the United States – on the one hand, it is clear that federal policy must increasingly reflect and accommodate the market-driven dynamics of health IT development and U.S. healthcare – on the other hand, so long as the federal and state governments play a central role in healthcare financing and delivery, and in regulation of public health and patient safety, there will be a continuing drive for federal and state engagement in health IT policy. Such engagement will continue, in one form or another, regardless of which party controls the House, Senate, or White House. The challenge for all of us is to provide timely and detailed input, grounded in real world experience.