The long-awaited interoperability final rules from the Office of the National Coordinator for Health IT will finally be entered into the Federal Register on Friday, May 1 – more than 14 months since the proposed rules, drafted as required by the 21st Century Cures Act, were released.

Of course, amid the COVID-19 pandemic, we find ourselves in a very different world than existed when those proposed rules – or even the final rules – were first published.

'The patients have a right to that data'

In a wide-ranging discussion on Thursday, National Coordinator for Health IT Dr. Donald Rucker, spoke with HIMSS CEO Hal Wolf about what the new info-blocking and patient access regs will mean for healthcare organizations, and especially healthcare consumers, and how they fit in with the "new normal" of post-coronavirus care delivery.

Presented as part of the ongoing HIMSS20 Digital initiative, the conversation was necessarily more informal than the on-stage version that would have taken place in Orlando in March. But, as Rucker noted, it's remarkable to think that, thanks to ever-improving consumer technology, it could take place at all.

"I don't think we could have done this 10 years ago," said Rucker.

Thanks to broadband, more powerful laptops and higher-resolution cameras, a world that's sheltering in place has been able to still convene with ease in virtual form – whether on webinars like this one, or with the remote telehealth consults that have quickly become the norm amid COVID-19.

That degree of virtualization, especially when it comes to telehealth, is "here to stay," said Rucker.

Likewise this new era of connected health is one that's ripe for the new data access and exchange requirements outlined in ONC's voluminous 21st Century Cures regs, he said.

"This pandemic really points out the need to have interoperability," said Rucker. "If we'd had this rule a few years ago, we'd be in a far better spot."

With a novel coronavirus, about which so much critical information is still a mystery, having wider and more free-flowing data, "richer clinical information streams," could help unlock those secrets faster, he explained.

And in a time when telehealth has become the norm, having easier portability and access to data when "sites of services have to change" would be hugely useful, said Rucker.

Looking beyond the current historical moment, however, the main goal of the ONC rules are simple, he said: to "give the patient agency."

By mandating easy, API-enabled provision of data under patients' HIPAA-guaranteed right of access (with some allowable exceptions), the agency aims to empower them to direct their own healthcare more easily, with smartphones and secure apps as key tools, said Rucker.

"Rather than the patient being purely subject to the combination of what the payers and the large providers have negotiated, this is a way to give patients the consumer power that they have in the rest of their lives," he said.

"This is the only area where adults basically aren't really allowed to make decisions on an ongoing basis," Rucker explained.

"We wouldn't want somebody telling us what car to buy, what airline to fly, where to buy a house or an apartment. But in healthcare we've been made subject to the desires of others. This is a major step to get the public in – and it's done in a truly 21st Century way, because it's shaped not by the built environment, but by information."

The interoperability specs are in place and the technology is fast-evolving – even if some long-ingrained attitudes from payers and providers aren't quite. Rucker acknowledged that there are still some "components of that are works in progress."

But going forward, he said, healthcare consumers and providers can expect that an "entire ecosystem will build out" from the rules that will be codified in the Federal Register this week.

That will be a boon when it comes to addressing larger interoperability challenges, as Hal Wolf pointed out – such as instances where two HIEs on opposite sides of a state can't talk to each other, even during a pandemic, or the fact that the White House coronavirus task force still has to make daily phone calls to labs nationwide for the latest testing data, rather than having it automated and made available in a central database.

But more immediately (once the compliance dates kick in), the benefits of the 21st Century Cures rules will be experienced by individual healthcare consumers, said Rucker.

"The main driver here is our consumer expectation that what we're getting in healthcare isn't matching up to what we're getting in other aspects of our lives," he said. "The patients have a right to that data, for the patients to control and move as they desire, rather than under the control of the providers and payers."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com
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