What’s next from the ONC on interoperability and info blocking

Only a few months after the release of the Health Data, Technology, and Interoperability Final Rule (HTI-1), the Office of the National Coordinator is already planning its next steps to improve interoperability and prevent intentional information blocking.  

In a blog post published on HealthITBuzz, National Coordinator Micky Tripathi acknowledged the recent major milestones of TEFCA and HTI-1 while laying out the path to the next landmark rule, HTI-2, which will come with “a strong focus on interoperability and a specific focus on how strategic standards adoption can further interoperability.” 

“We are not slowing down,” Tripathi stated. “Our work to support patients, to help providers as they seek to provide care, and to create clear expectations for the entire care continuum when it comes to health IT is ongoing.”   

Building on a foundation of interoperability guidelines 

 After launching the long-awaited Trusted Exchange Framework and Common Agreement (TEFCA) in 2022 to create a “universal floor of interoperability,” the ONC released HTI-1 in December to continue defining the guardrails for data exchange across the industry.  

HTI-1 establishes new and updated certification requirements for EHRs to promote meaningful data exchange and clarifies information blocking regulations while prepping the industry for adopting AI in a transparent and equitable manner. 

The rule includes an extended timeline with multiple compliance checkpoints to give the industry time to adapt to new regulations and requirements. By the end of 2024, health IT developers provide updated certified health IT to their customers, but they have until July of 2029 to submit their final report on all applicable measures under the rule. 

Making information blocking a priority in a maturing landscape 

In the meantime, ONC will be working with stakeholders across the industry to further refine the definitions and penalties for purposeful information blocking, or the withholding of allowable data exchange due to competitive business maneuvering or misinterpretation of interoperability rules. 

“We expect to propose new provisions to support information sharing by deterring the occurrence of information blocking. Any proposals would be responsive to what we are seeing across the care landscape and responsive to the evolution of information sharing since the  Cures Act Final Rule was released, which finalized ONC’s information blocking framework to implement Section 4004 of the 21st Century Cures Act,” Tripathi said. 

In addition, HTI-2 will address a variety of foundational interoperability areas, including deeper integration of the clinical and public health environments that aligns with the CDC’s extensive Data Modernization Initiative. 

“We also expect to propose new provisions related to the certification for application programming interfaces (APIs) focused on use cases such as electronic prior authorization (ePA), patient engagement, care management, and care coordination,” Tripathi wrote. “APIs are well established as a secure mechanism to move information nimbly to where it needs to go, and ONC recognizes the continued potential of standards-based APIs in areas like ePA—where electronically completing prior authorization can impact the speed at which care is received. As another example, APIs are critical to patient engagement with providers. Identifying ways to support such interactions is an overall priority for ONC.” 

Leveraging industry engagement for a more interoperable future 

Over its 20-year history, the ONC has been a champion for technical interoperability while working closely with stakeholders across the care continuum on changing the culture of data exchange.     

As the team looks forward to the next major rule to continue this process, Tripathi urged industry leaders to stay involved with the conversation around interoperability, information blocking, health equity, and other topics of importance for improving outcomes and reducing costs. 

“We thank you for joining us in this work and for your continued feedback and engagement,” he said. “Once the HTI-2 proposed rule is published in the Federal Register, we look forward to receiving your comments. We encourage you to tell us where we got it right and where more work needs to be done to get it right.” 

“Quite simply, your feedback helps us to advance ONC’s vision of Better Health Enabled by Data. Thank you!” 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.