The Next Five Years in Health IT: ONC's Plan for the Future

by Helen R. Pfister and Susan R. Ingargiola, Manatt Health Solutions

TOPIC ALERT:

On Sept. 12, the Office of the National Coordinator for Health IT released an updated strategic plan for implementing a nationwide health information network. The Federal Health IT Strategic Plan 2011-2015 sets forth activities to improve health care through use of health IT tools.

Below is an overview of the Strategic Plan and some of the federal government's newest initiatives, including the Query Health initiative, the electronic health record data segmentation initiative and various initiatives to drive consumer engagement in health care, such as the recent proposed regulation affording individuals direct access to laboratory results.

Strategic Plan Background

ONC published its first Strategic Plan in June 2008. The Health IT for Economic and Clinical Health, or HITECH, Act required ONC, in consultation with other federal agencies, to update and republish it to include specific objectives, milestones and metrics relating to issues such as "the electronic exchange and use of health information," "the incorporation of privacy and security protections for the electronic exchange of an individual's individually identifiable information" and "methods to foster the public understanding of health information technology." ONC has indicated that it intends to update the Strategic Plan on an ongoing basis.

To update the 2008 Strategic Plan, ONC leveraged the work of the Health IT Policy Committee and conducted interviews with representatives from other federal agencies and the private sector. ONC also solicited public comments on a draft version of the Strategic Plan that it released in March.

The 2011 Strategic Plan is consistent with the 2008 version, employing the same general strategy to implement a nationwide health information network by advancing health IT adoption, interoperability, consumer engagement, privacy and security, and other issues. The main difference between the two plans is that the 2011 Strategic Plan takes into account the resources and policy goals included in the HITECH Act, which allocated significant federal funding for health care providers to adopt and meaningfully use EHRs, and the Patient Protection and Affordable Care Act, which builds on the HITECH Act and recognizes health IT as a critical enabler of broader health care reform.

Strategic Plan Overview

The Strategic Plan is 80 pages long, but the key takeaway is that over the next five years the country will be focusing on five health IT-related goals.

  • Goal 1: Achieve Adoption and Information Exchange Through Meaningful Use of Health IT. This is the centerpiece of the country's health IT strategy over the next five years. Activities are already underway and will continue to focus on defining the "meaningful use" of EHRs and encouraging health care providers to meaningfully use EHRs through the Medicare and Medicaid EHR incentive programs.
  • Goal 2: Improve Care, Improve Population Health and Reduce Health Care Costs Through the Use of Health IT. This goal highlights the specific ways health IT can contribute to the goals of the health reform law, which include improved care, improved population health and reduced per capita costs of health care. It reflects that widespread adoption of EHRs, information exchange and quality improvement initiatives are all integral to health care reform.
  • Goal 3: Inspire Confidence and Trust in Health IT. Under this goal, the federal government will put into place laws, policies and processes to keep health information private and secure despite the heightened risks posed by digitization. ONC has long maintained that privacy and security are essential to realizing the value of health IT.
  • Goal 4: Empower Individuals With Health IT To Improve Their Health and the Health Care System. Here the federal government is committed to providing individuals with access to their health information, helping to facilitate a strong consumer health IT market and better integrating individuals' and clinicians' communications through health IT. According to ONC, a public that has a voice in designing national health IT policies and is empowered with access to its health information can help lead to patient-centered health care.
  • Goal 5: Achieve Rapid Learning and Technological Advancement. This last goal is part of the federal government's vision of a "learning health care system," in which a vast array of health care data can be aggregated, analyzed and leveraged to improve knowledge about health care across populations.

The Future Is Now: New Initiatives That Advance the Strategic Plan's Goals

Over the past three years, the country has made significant progress toward meeting the goals in ONC's 2008 Strategic Plan, which focused on enabling patient-focused health care and improving population health activities. The 2011 Strategic Plan carries these goals forward and updates them to reflect the policy priorities included in the HITECH Act and the health reform law.

ONC recently announced a host of new initiatives designed to further advance the country's health IT goals, as articulated in the 2011 Strategic Plan. Several are highlighted below.

Query Health Initiative

The Query Health Initiative, announced by ONC on Sept. 5, aims to establish standards for requesting or "querying" population health data from widely distributed sources (e.g., EHRs in physician offices and hospitals throughout the country). The initiative is part of ONC's larger Standards and Interoperability Framework, through which ONC, in collaboration with the private sector, is developing harmonized health IT interoperability specifications. 

Data generated through distributed queries can aid in health care quality measurement, monitoring of disease outbreaks and prescription drug efficacy analyses, among other things. To engage in these activities today, researchers generally have to extract data from existing sources and integrate them into a centralized database to which queries can be directed. The Query Health Initiative will enable researchers to access data from sources like EHRs without first having to extract the information and move it to a separate database. In this way, Query Health is an example of an initiative that will contribute to several Strategic Plan goals, including Goal 2 -- Improve Care, Improve Population Health and Reduce Health Care Costs Through the Use of Health IT -- and Goal 4 -- Achieve Rapid Learning and Technological Advancement. 

Initiative on Segmenting EHR Data

On Sept. 19, ONC announced the soft launch of a new initiative, also part of the Standards and Interoperability Framework, that will use metadata tags to give individuals more choices over what pieces of health information they want shared electronically. The initiative is designed to enable health care providers to share certain types of information in an EHR but not others, such as information relating to substance abuse, sexually transmitted infections and mental health. Currently, segmenting data for exchange is difficult to achieve.

Within ONC, the Office of the Chief Privacy Officer and the Office of Standards and Interoperability will oversee the initiative, which ONC announced shortly after releasing an advance notice of proposed rulemaking on metadata standards. Because the initiative is evaluating strategies that will enable individuals to exert greater control over the privacy of their electronic health information, it will help to advance Strategic Plan Goal 3 -- Inspire Confidence and Trust in Health IT. 

Consumer Engagement Campaign

ONC is conducting an outreach campaign to explain the benefits of EHRs, personal health records and mobile health applications to consumers and health care providers alike. As part of this campaign, ONC on Sept. 8 launched HealthIT.gov, a website to encourage consumers to become more involved in their health care through the use of health IT tools. Meanwhile, ONC on Sept. 12 hosted a Consumer Health IT Summit, where consumers, health care providers and others discussed best practices for empowering consumers to become active partners in their health care by accessing and using their health information.

At the Summit, ONC announced the availability of a voluntary PHR model privacy notice designed to:

  • Increase consumers' awareness of PHR companies' data practices; and
  • Enable consumers to easily compare the data practices of two or more PHR companies. 

ONC developed the model notice in response to the growing number of consumers who are using PHRs to manage their health information. ONC is encouraging PHR companies to use the template to communicate with existing and potential PHR users. 

Also at the Summit, the federal government announced the release of a proposed regulation that would expand the rights of individuals to access their health information through health IT. The proposed regulation would amend the Clinical Laboratory Improvement Amendments of 1988 regulations and the HIPAA Privacy Rule to enable individuals to access laboratory test results directly from laboratories.

The new PHR model privacy notice, ONC's larger consumer engagement initiative and the federal government's efforts to provide individuals with direct access to their lab results are examples of activities that will advance both Strategic Plan Goal 3 -- Inspire Confidence and Trust in Health IT -- and Goal 4 -- Empower Individuals With Health IT To Improve Their Health and the Health Care System. 

Tracking Progress Toward the Strategic Plan's Goals

The 2011 Strategic Plan, like its 2008 predecessor, lays out an ambitious agenda. ONC will evaluate ongoing progress toward achieving the goals through a series of performance measures, including:

  • Increasing the percentage of U.S. residents who have been given electronic access to any part of their health care record;
  • Increasing the percentage of eligible hospitals and professionals receiving meaningful use incentive payments; and
  • Decreasing the percentage of U.S. residents who are very concerned about the security of EHRs.

The most important thing to remember, however, is ONC has indicated that the Strategic Plan should be considered a living document that will be updated based on experience, and we can expect it to continue to evolve as the nation proceeds further down the path to the development of a nationwide health information network.


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