With adoption of electronic health records around 90%, the Office of the National Coordinator of Health Information Technology is now focusing on increasing usability and interoperability.
The next frontier in electronic health records (EHRs) is making the shift from adoption to usability. As of 2015, 87% of physicians were using an EHR system, which meant the Office of the National Coordinator (ONC) for Health Information Technology, could pivot away from promoting adoption of EHRs to a new conversation on progress made in using EHRs.
According to Genevieve Morris, principal deputy national coordinator for health information technology at ONC, the government has been identifying areas of under- and overregulation, as well as hearing from stakeholders through hundreds of meetings and the Health Information Technology Advisory Committee, which was established through the 21st Century Cures Act.
Usability needs will also vary with groups, Morris acknowledged, but there are “key underlying core functionalities” that are needed as a base before users can build variation on top in innovative ways.
“Maybe you have an underlying EHR system that’s the same, but you have different apps with different options for you to use based on the specialty that you are,” she explained. “So, I think there is some core infrastructure that is sort of the same … but when you get down to the capabilities and functions and workflow needs, that is highly variable depending on where you sit in the care continuum.”
These discussions with stakeholders also give the government a better idea of where it needs to step in with more regulation and where it can hang back and let the industry continue its work.
“I think as the government, one of the key responsibilities we have is to step in when people are being disenfranchised,” she explained. “So, if you think about interoperability, there are certain pockets of interoperability that are doing very well, and folks are exchanging data, and then there are certain groups that really just haven’t been at the table or had an opportunity to participate in interoperability to make their lives easier.”
Recently, ONC released a draft framework for advancing interoperability by setting up a Trusted Exchange Framework. The draft is open for public comment until February 18, 2018.
As the country moves away from fee-for-service, interoperability going to be required for success in value-based payment models, whether they be an accountable care organization (ACO), a patient-centered medical home, or the Comprehensive Primary Care Initiative, Morris explained.
Providers cannot operate effectively without exchanging patient data, but even in an ACO, the hospitals and provider practices within that ACO might be on different systems, which causes problems if a patient visits these different sites of care. The ACO needs participants to be able to share information if it hopes to reduce hospital admissions and readmissions, improve care for patients, and reduce costs.
“[Interoperability] is, honestly, just important to reduce the overall cost that we’re spending within healthcare and improving the lives of our patients,” Morris said.
However, greater interoperability and greater technology use also opens healthcare up to more data breaches, which have been a growing issue. Morris noted that healthcare providers and health systems should ensure their data are secured and that they are doing simple things like using appropriate credentials to log in and enabling audit logs.
She also recommends that people and organizations follow cybersecurity recommendations from the National Institute of Standards and Technology (NIST), which is applicable to all industries. Morris said NIST’s recommendations raise the bar for identity proofing and it is making its standards more stringent.
In a way, health information is more sensitive than banking information, Morris contends. While banking information is represented as a string of zeroes and ones, health information has personal information.
“There are always people out there looking to outsmart us and so I think folks just have to be really vigilant and make sure they’re doing really easy things like putting in security patches, not leaving unencrypted data lying around, or laptops that might not be encrypted,” Morris said. “Things like that that seem really easy but at the end of the day just sort of get missed with everything else going on.”