Tripathi: Let’s Do Great Things With EHR Systems, Interoperability

The Office of the National Coordinator for Health IT (ONC) is maintaining its focus on information blocking, interoperability, and coordination between federal agencies, according to Micky Tripathi, national coordinator for health IT.  

“We built this foundation of EHR systems and we are now able to pause and ask the question ‘what is it that we want to do with these systems now?” Tripathi posited at the Workgroup for Electronic Data Interchange (WEDI) 2021 Conference.

“There is still hard work to do and there are still adoption issues in parts of the healthcare delivery system that haven’t benefited directly from the federal government incentives,” Tripathi said. “But in terms of hospitals and the ambulatory side, they were able to benefit from those incentive programs and do the hard work of implementation.”

Now that ONC and healthcare stakeholders laid the foundation, Tripathi urged the industry to think deeply and “jump ahead” to do great things with EHR systems.

“We’ve spent a lot of time getting EHR systems to do the basic things, such as core clinical documentation, core clinical documentation to support payment, and medical records,” Tripathi pointed out. “Those are important functions, but they are baseline functions.”

The ONC leader highlighted four that ONC is working on information blocking, COVID-19, TEFCA, and coordination between federal agencies for the present and the future..

Since April 5, 2021, when the information blocking provisions went into effect, providers, health information exchanges, and health IT developers have been held accountable to abide by the regulations.

“We need to do all of the hard work now and change the fundamental attitude toward sharing information with patients, as well as other authorized parties that are involved in the care of patients,” Tripathi said.

Tripathi said ONC is working on educating the sector through media channels, FAQs, and speaking directly with healthcare stakeholders. Additionally, ONC is working with the Office of Inspector General (OIG) to help define and put in place information blocking enforcement.

“It’s a multi-party collaborative approach,” Tripathi said. “ONC constructs the policy and OIG takes care of the enforcement.”

The ONC leader also said some of the most significant issues during COVID-19 related to the lack of interoperability. 

“In the recent weeks, we’ve seen some turns to the positive, but we also recognize we are not out of the woods yet,” Tripathi admitted. “The 21st Century Cures Act and the information blocking rule were specifically designed to address the things that did not allow us to have as effective of a response as we wanted to have during the height of the COVID crisis.”

Next, Tripathi said ONC continues to work on TEFCA and gain traction toward interoperability and nationwide networks, along with local and statewide HIEs.

“With TEFCA, we do not want to inhibit that, but we are working to figure out how TEFCA leverages what’s been done today and how it can take us to the next level,” Tripathi said. “Also, we need to give the industry a good timeline for TEFCA, which we haven’t done yet, but we are working hard toward that.”

Furthermore, Tripathi said ONC needs to figure out how to open up interoperability to include other use cases. Now, most of the nationwide interoperability networks focus on a provider-to-provider exchange for treatment purposes.

“That’s a lot of activity,” Tripathi noted. “CareQuality does upward of five million transactions per day, but unfortunately, that’s not extending out toward payers to participate or public health to participate or patients to directly participate in that. That’s what we want TEFCA to be an enabler of going forward so we have a much better roadmap for what nationwide interoperability looks like regardless of which network you’re on.”

Looking forward, Tripathi and other leaders are working hard to improve coordination between the federal agencies. There are growing interests in health IT across the federal agencies and its opportunities from public health, real-world evidence, and value-based decisions.

“There’s growing interest from a number of industries, which is a blessing and a curse,” Tripathi joked. “The good news is they are very interested, and the bad news is that they are very interested. We are spending a lot of time working with other agencies to identify the use cases, business needs, and goals. We also have to leverage the standards-based approaches that we’ve put into the market to help those federal agencies achieve what they want to achieve.”