5 keys to a better information exchange

Improving the nation’s health information exchange (HIE) capabilities is the primary directive for the Office of the National Coordinator (ONC), which has been working steadily for almost 20 years to discharge its mission. 

The last two decades have seen incredible progress: almost complete EHR adoption among hospitals and physician offices, enormous advances in standards-based interoperability, and seismic shifts in policy and reimbursement to support the business case for continued transformation. 

But there is still much work to be done, says National Coordinator Micky Tripathi in the ONC’s 2022 Report to Congress.  

“Progress is not universal across the country and is affected by different priorities, resources, and business models among industry actors,” he said. “Certain providers across the care continuum, such as long-term and post-acute care, hospice, some types of behavioral health providers, and home and community-based providers…lag in EHR adoption and, thus, their ability to engage in interoperable exchange of EHI to support data sharing across the full spectrum of care.” 

“In addition, the COVID-19 pandemic exposed many challenges in the nation’s healthcare system, particularly the need for more reliable data, especially to support vulnerable individuals and those persistently marginalized. As a result, public health agencies were unable to make full use of certified health IT. Instead, public health agencies saw one-way data flows, overwhelmed public health data systems, and manual data review that led to limited actionable data for decision making and no ability to provide real-time feedback to communities.” 

Overcoming these challenges and expanding interoperability even further across the national healthcare infrastructure will require concerted effort from across the public and private sectors. 

Here are the ONC’s recommended action items for continuing to make progress in key areas of health information exchange over the next several years. 

Support “health equity by design” in health IT and HIE 

Health IT is intended to foster more equitable health outcomes, particularly in traditionally marginalized and underserved communities, by illuminating disparities and connecting individuals with evidence-based resources for clinical and non-clinical challenges. The idea of “health equity by design” includes building health equity into policy and technology from the very beginning of the process to ensure that digital tools enable engagement without perpetuating historical biases.   

The ONC is playing a significant part in bringing the HHS Equity Action Plan to life by working with industry stakeholders to improve timely, accurate, and comprehensive data capture via certified health IT tools and other interoperability methods.  

Coordinate with other federal agencies to modernize health IT and public health infrastructure 

Successful interoperability begins with a strong and unified approach at the federal level, the ONC says. ONC is a member of the Federal Health IT Coordinating Council, which also includes other HHS agencies such as the CMS, CDC, NIH, SAMHSA, FDA, and OCR, as well as additional federal bodies like NIST, NASA, DOD, VA, and the Social Security Administration. 

These participants are collaborating on a number of activities to align investments, ensure adoption of ONC-based data standards, and revamp infrastructure to create a solid foundation of information exchange infrastructure. 

This is especially important in the wake of the COVID-19 pandemic, which exposed many gaps in the nation’s public health infrastructure. Key federal agencies, including the CDC, must work together to connect and modernize public health data systems that enable the collection, exchange, and use of public health data.   

For example, the ONC is working closely with the CDC on its ongoing Data Modernization Initiative, including a $189 million modernization program to adopt cloud-based public health infrastructure. The agencies will need collaboration from public and private stakeholders to upgrade interoperability across the clinical and public health environments to get prepared for future health emergencies. 

Educate patients and the care community about information blocking  

Information blocking is a serious concern at multiple levels. Health systems and EHR vendors have been accused of blocking information between rival entities for broader business reasons, but they have also been chided for preventing patients from accessing their personal health information on an individual basis. 

The ONC has been tasked with laying down new ground rules for interoperability in light of the 21st Century Cures Act but faces challenges with changing the culture of data sharing. Neither ONC nor HHS currently have the authority to issue binding advisory opinions on information blocking, hampering their ability to clearly define incidents and set precedents for future events. 

Instead, the agencies must focus their efforts on providing education and guidance to providers, payers, patients, and technology vendors about the rights and responsibilities of all players. Continuing the discussion around the appropriate flow of information will be vital for making progress in this area.  

Implement TEFCA to create nationwide infrastructure for interoperability 

The Trusted Exchange Framework and Common Agreement (TEFCA) has the potential to radically accelerate interoperability – if enough of the industry implements its provisions to create a “universal floor” for data exchange. 

Stakeholders will need to align around the use of shared data standards to create a “network of networks” that allow for the appropriate movement of data between disparate systems.  Implementing TEFCA will be the ONC’s major focus over the next few years as the roadmap is rolled out across the industry. 

Advance data standards to support HIE across all care settings 

Data standards are fundamental for achieving shared interoperability goals. While the industry has made significant progress over the past several years with adopting application programming interfaces (APIs), the US Core Data Set for Interoperability (USCDI), and standards such as FHIR®, some care settings are less familiar with these tools than others. 

Education, guidance, and technical assistance will be required to ensure even adoption of data standards across organizations that have struggled to implement the most modern health IT strategies so they can exchange standardized, complete, usable data with their peers. This is the ONC’s core mission, and it has many resources at its disposal to keep making good progress.  

Leaders from across the care continuum will need to actively contribute to the vision for a more interoperable health system and support their peers with achieving the multifaceted goals of the ONC over the next few years, Tripathi said. 

“As we collectively look toward the future, we should ask the question: What do we want to accomplish with the foundation built over the past decade?” he asked. “As National Coordinator, I will continue to work with partners in the public and private sectors to have health IT systems that serve all users’ needs.”