The Office of the National Coordinator (ONC) for Health Information Technology, part of the U.S. Department of Health and Human Services, seeks to advance a health information technology infrastructure to revolutionize the U.S. health care system. One of the keywords of its strategy is “interoperability,” which means the ability to exchange and interpret shared data across systems and devices. The ONC pushes for maximum interoperability on a number of levels so that health data can be accessible when and where it matters most, thereby increasing — through the use of health information technology — the overall health of patients.
Recently the ONC released a budget proposal for the fiscal year 2017, which includes four new legislative proposals that will impact the health care system. These legislative proposals are explained and expounded on below.
Establish Health IT Governance Certification
The health care industry is full of data that can be aggregated and analyzed to improve patient care, patient outcomes and financial cost. However, it is a challenge to actually integrate all of this data into a system so it can be best read and understood. Detailed technical specifications and standards are not enough to inspire the health system into adopting a large model of data interoperability, but standards must be established and implemented.
This first proposal, according to the ONC report, will allow the ONC to “establish standards, implementation specifications and certification criteria related to the business policies, practices and behavior of health IT entities.” So far, any certifications, policies and standards regarding health IT and health data integration have been voluntary. This legislation will hopefully allow the government to set better standards that will improve the health care system’s integration and efficient use of health data.
Prohibit Information Blocking and Associated Business Practices
According to the ONC, information blocking occurs “when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information.” This can include many alleged practices: contractual terms and restrictions that prohibit or interfere with information sharing or access to electronic health records, blocking information as a practice to control referrals or consolidate markets, or implementing health information in ways considered nonstandard. Also, some entities in the health care system and industries have incentives to exercise control over electronic health information and its exchange in ways that prohibit interoperability.
This second legislative proposal from the ONC’s budget proposal also seeks to derail the practice of information blocking by providing “a coordinated approach to explicitly prohibit information blocking and investigate and impose appropriate sanctions for offenders.” Although the ONC is not a law enforcement organization, this legislation makes it clear that they intend to cooperate with other government agencies to stop this practice.
Require Health IT Transparency
Purchasers have lacked reliable information about the costs and limitations of competing health IT products and services; they therefore have found it difficult to understand the kinds of issues and costs associated with implementing health information technology. This lack of transparency also disincentivizes innovation by developers and incentivizes practices such as information blocking, discussed above.
The proposed legislation would “authorize the Secretary to require that certified health IT vendors submit ongoing and detailed information to the National Coordinator concerning the costs, capabilities, limitations and other performance characteristics of certified health IT.” This enables the ONC to address this lack of transparency, which impairs the “efficient functioning of health IT markets.”
Provide ONC Authority to Use Contracts, Grants or Cooperative Agreements to Establish a Health IT Safety Collaborative and Provide Adequate Confidentiality Protections
In health IT, safety is of utmost importance. Electronic health records and other forms of health information technology are networked, and therefore vulnerable to security threats. Many high-profile hacks have breached the confidential and private information of thousands of individuals and patients.
This fourth piece of proposed legislation seeks to establish a public-private collaboration in order to develop better confidentiality protections. According to the budget report, “ONC will establish a Health IT Safety Collaborative that identifies and strengthens ways to encourage better reporting of health IT-related safety events.” It provides a “confidential space for developers and providers to address concerns and cultivate new educational resources and training materials to build health IT safety competencies.” In other words, the legislation promotes greater information sharing between public and private institutions to help communicate and develop the most effective ways to ensure maximum confidentiality of patient information.
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