ONC Sets Sights on Interoperability, Information-Blocking Rule Enforcement

The Office of the National Coordinator for Health IT is focusing on making health care system interoperability more robust and preventing information-blocking across health IT networks and information exchanges, National Coordinator for Health IT Micky Tripathi said.

ONC has spent the past 10 years building a foundation for functional electronic health record systems, Tripathi said during Tuesday’s Health Innovation Summit, adding that now with about 90% of health provider organizations having a solid base of EHRs, there’s an opportunity to consider what opportunities there are beyond core EHR capabilities.

“We have the opportunity to think about what it is we want to do with that foundation now that all that hard work has been laid … the core functions of those systems, which is basic medical record documentation, which is payment — those are the core functions that those systems have to provide,” Tripathi said. “Now we’re also able to ask the question, what else do we want? What else do we want those systems to be able to do, and how do we get to that next level of use that all of us have been working for?”

Within ONC’s focus of medical and public health data-sharing and interoperability has been the work to connect systems to address COVID-19. ONC has collaborated with the Centers for Disease Control and Prevention to drive a data-driven response to the COVID-19 pandemic, Tripathi said, building off an experience of connecting public health data systems and infrastructure by identifying gaps throughout the process.

Tripathi added that ONC is looking to continue identifying gaps in the public health ecosystem, which has been rather siloed and largely separate from EHR, clinical and administration systems. ONC is striving to make the interconnectivity and communication flow of information across various systems from the federal to local and across public and private sectors more robust.

“One of the things that we’ve certainly seen with the public health emergency is that there was a one-way flow of information, but very limited ability, if any real ability, to be able to push information back down to the lower levels of public health infrastructure, as well as to the clinical settings where those organizations were at the frontline,” Tripathi said. “They really weren’t able to get through those systems any information that would help them make decisions on the group that would help us support the public health goals and the public health mission and public health emergency that we were in.”

Part of the future of getting to more robust data-sharing capabilities is in ONC’s goal to deliver on more 21st Century Cures Act requirements, such as the build-out of the Trusted Exchange Framework and Cooperative Agreement (TEFCA), a nationwide governance framework for network-based interoperability.

“There’s been a tremendous amount of progress,” Tripathi said. “We’ve got networks that are up and running — Carequality, Commonwell, the health exchange, state and local [health information exchanges]. And we’ve got a lot of fantastic work that’s being done in connecting those networks, open the aperture of exchange. That includes other types of exchange, so not just clinical exchange among providers for treatment purposes, but how do we bring in administrators exchange for payers, for example? How do we bring in public health, for example, to be part of those nationwide networks?”

Another Cures Act element that Tripathi focused on is the information-blocking rule that ONC finalized April 5. Since the provisions have gone into effect, ONC has been working on outreach to health information exchanges, providers and IT developers to educate them in information-blocking, and the agency is working with the Office of Inspector General to shape respective enforcement.

The information-blocking rule currently applies to electronic health information (EHI), but Tripathi noted that his agency is gearing up in the coming year toward Oct. 6, 2022, when all information on records must be made available, as well as Dec. 31, 2022, when all certified EHRs are required to have FHIR R4 base capabilities in their systems.