LAS VEGAS - At a recent HIMSS21 session, National Coordinator for Health IT Micky Tripathi laid out some of ONC’s priorities under the Biden-Harris administration, as well as discussing some specifics of the recently imposed information blocking regulations.

“What are the things we want to accomplish?” he asked. “Well, we want a health IT system that directly serves patients, providers, payers, public health and developers. We want a platform-based business and technical model that allows for a rich and thriving app ecosystem and complements the EHR systems in place today." 

"We want health information networks that operate in the background to make basic clinical data available universally across the continuum in a commoditized, i.e. low-cost, high-consistency, way. And we want systems that help us identify health inequities and facilitate interventions that prevent such inequities from further turning into healthcare disparities," he continued.

ONC intends to use a number of levers to accomplish this goal, including regulation like the Cures Act, but also convening the industry to collaborate and, if necessary, nudge it along from the bully pulpit.

“So what is it you should expect out of ONC under the Biden-Harris Administration? First, a focus on what's practical and feasible, and at times pushing the envelope on what's practical and feasible, without losing sight of the vision,” he said. "Letting the market lead when it can, and providing enough leverage to put it in a position to lead when it can't. And doing that with as much transparency as federal processes will allow."

Tripathi laid out five priority areas for ONC:

• Continued COVID-19 response and support of the public health system.
• A renewed focus on “the spirit and the letter” of 21st Century Cures.
• Promotion and adoption of EHR interoperability standards.
• An enhanced focus on health equity.
• Alignment and collaboration with other federal agencies.

'Information sharing'

Tripathi believes that what have come to be called the "information blocking" rules need a reframe: He’d prefer the positive framework of “information sharing.”

"We don't believe that every provider, vendor and the health information network is presumptively guilty until proven innocent being an information blocker," he said. "That's why I want the law to talk about information sharing. The industry has actually made tremendous progress in information sharing in a relatively short period of time.

"That said, in a highly fragmented system, progress is really patchy and is not uniform, and it suffers from different priorities among industry actors. And that creates, on unequal footing, with at least the benefits of interoperability, barriers to [the] scale of the nation for developers.

"The information sharing requirements of the Cures Act bring consistency across the industry by directing providers, vendors to health information networks to begin to make information sharing their default posture, which is a paradigm shift from HIPAA, which permits but doesn't obligate such sharing of information," he continued.

While the law gives the ONC the power to set info sharing guidelines, Tripathi reminded the crowd that the Office of the Inspector General is responsible for enforcement.

“When we took office, there were a number of gaps in the enforcement side that we're now filling to getting clarity and transparency to the market and ensure efficient use of taxpayer dollars. Perhaps the biggest gap being filled on the enforcement side is the definition of 'appropriate,' disincentives for providers found in violation of the law.

"The law specifies civil monetary penalties for members of certified technology and information networks of up to one million dollars per incident. But it delegates to the Secretary of Health and Human Services the responsibility for defining appropriate disincentives for providers. Unfortunately, not only have such disincentives not yet been identified, there was no process in place for determining how they might even be defined and managed.”

HHS is addressing these gaps via a cross-agency work group that’s already begun its efforts. 

"In addition, we're finalizing processes for managing and tracking complaints, mechanisms to give individual complainants some visibility into the status of their complaints and processes for reporting aggregated information on the number and types of complaints received and adjudicated," Tripathi said.

Keep the feedback coming

He asked people to keep asking questions and offering feedback, but to accept that certain questions - like those concerning case-by-case enforcement - are beyond HHS’ purview to answer.

"We'd also be doing you, you know, a great disservice by even stepping into that, because we'd be giving you a false sense of security, because we're not responsible for investigation and enforcement," he said.

In general, though, Tripathi vowed to continue to communicate clearly and transparently, even as he asked the industry to keep talking to HHS.

"There remains confusion in the marketplace, both from what we've published [and] questions we haven't yet answered," he admitted. "We do take this feedback very, very seriously. We assure you communication, after all, isn't about what I say. It's about what you hear. 

"And so, redouble our efforts to get industry feedback through even more proactive reach-out to stakeholders through increased frequency, timeliness, the relevance of our reviews and other communication channels, such as targeted blogs and information briefs to give more plain English, nontechnical, non-legalistic explanations of the key issues at hand. You'll be seeing those very, very soon."